Bone grafting for the alveolar cleft defect.

Seventy-five percent of all cleft lip and palate patients have osseous defects of the alveolus. Bone grafting of this defect normalizes facial and dental function. Failure to reconstruct the osseous deformity may result in oronasal fistula, fluid reflux, speech pathology, anteroposterior deficiency of the maxilla, transverse deficiency of the maxilla, lack of bone support for the incisors and cuspids, dental crowding, and facial asymmetry. Bone grafting unifies the maxilla and is best done after the majority of facial growth is complete and the secondary dentition is erupting. This is known as secondary bone grafting and yields the best results. The dentofacial deformity of cleft lip and palate is best managed by coordination of dental development, surgery and orthodontics.