Transformation from cleft lip/palate to confident smile.

Cleft Lip and Palate Repair: Understanding Secondary Bone Grafting

Beau Callahan in Health & Wellness December 2025 • 4 min read.

"A Portuguese hospital's experience sheds light on optimizing outcomes in orofacial cleft treatment."

Orofacial clefts, including cleft lip and palate (CLP), are among the most common congenital craniofacial birth defects. These conditions often involve a bone defect in the upper jaw (alveolar cleft), which can impact facial aesthetics, speech, and dental development.

Secondary alveolar bone grafting (SABG) has become a widely accepted surgical technique to correct these bone defects. SABG involves transplanting bone, often from the iliac crest (hip), to the alveolar cleft to provide support for the teeth, close any abnormal openings between the mouth and nose (oronasal fistulas), and improve overall facial structure.

This article explores the experience of a Portuguese tertiary hospital with SABG, analyzing the factors that contribute to successful outcomes and highlighting the importance of a multidisciplinary approach to CLP care.

What Factors Influence Success in Secondary Bone Grafting?

Transformation from cleft lip/palate to confident smile.

Researchers retrospectively reviewed 29 SABG procedures performed at their institution between 2007 and 2014. The study evaluated the effectiveness of the bone grafts using the Bergland scale, a system that classifies the degree of bone fill achieved after surgery. They also looked for correlations between the success of the graft and various factors related to the patient and the surgical procedure.

The study revealed that:

A majority of the grafts (72%) were considered successful, achieving either complete or near-complete bone fill (Bergland types I and II).
The type of cleft (unilateral, bilateral, pre-foramen, or transforamen) did not significantly impact the outcome of the SABG procedure.
The presence of a lateral incisor (a tooth next to the cleft) and the stage of canine tooth eruption at the time of surgery also did not show a strong correlation with graft success.
A notable proportion of patients (17%) required a second bone grafting procedure to achieve adequate correction.

The findings suggest that while SABG is generally effective, several factors can influence the final outcome. Further research is needed to fully understand these variables and optimize surgical techniques.

Why a Multidisciplinary Approach is Key

The study emphasizes the importance of a multidisciplinary team in the management of CLP. This team typically includes surgeons, orthodontists, speech therapists, and other specialists who work together to provide comprehensive care for patients.

The optimal timing for SABG is a critical decision, requiring careful consideration of the patient's dental development, facial growth, and overall health. A multidisciplinary team can best assess these factors and determine the most appropriate time for intervention.

Long-term follow-up is also essential to monitor the success of the bone graft and address any potential complications. The Portuguese hospital's experience underscores the need for continued research and collaboration to improve outcomes for individuals with cleft lip and palate.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.20344/amp.6418, Alternate LINK

Title: Enxerto Ósseo Na Fenda Lábio-Palatina: Experiência De Um Hospital De Referência Português

Subject: General Medicine

Journal: Acta Médica Portuguesa

Publisher: Ordem dos Medicos

Authors: Ana Isabel Costa, Hélder Morgado, Carlos Mariz, José Manuel Estevão-Costa

Published: 2016-03-31

Everything You Need To Know

What exactly is secondary alveolar bone grafting (SABG) and why is it performed?

Secondary alveolar bone grafting (SABG) is a surgical procedure used to correct bone defects in the upper jaw, specifically the alveolar cleft, which is common in individuals with cleft lip and palate (CLP). The procedure involves transplanting bone, often from the iliac crest, to the alveolar cleft. This aims to provide support for teeth, close oronasal fistulas, and improve facial structure. While the study mentioned a 72% success rate, the effectiveness can vary.

According to the research, which factors did NOT significantly influence the success of secondary alveolar bone grafting (SABG)?

The study indicates that the type of cleft (unilateral, bilateral, pre-foramen, or transforamen), the presence of a lateral incisor, and the stage of canine tooth eruption did not significantly correlate with the success of secondary alveolar bone grafting (SABG). However, the need for a second bone grafting procedure in 17% of patients highlights that other factors are at play. Further research is needed to understand variables and optimize surgical techniques.

Why is a multidisciplinary team so important in the treatment of cleft lip and palate (CLP)?

A multidisciplinary approach is essential in managing cleft lip and palate (CLP) because it addresses the various complexities associated with the condition. Surgeons, orthodontists, speech therapists, and other specialists collaborate to provide comprehensive care. This coordinated effort ensures that all aspects of the patient's needs are met, leading to better outcomes in facial aesthetics, speech, and dental development.

What is the Bergland scale, and how was it used in this study on secondary alveolar bone grafting (SABG)?

The Bergland scale is a classification system used to assess the degree of bone fill achieved after secondary alveolar bone grafting (SABG). It helps in evaluating the effectiveness of the bone grafts by categorizing the outcomes based on the amount of bone regeneration. Types I and II on the Bergland scale indicate complete or near-complete bone fill, which are considered successful outcomes. The study used the Bergland scale to determine the success rate of SABG procedures.

Besides secondary alveolar bone grafting (SABG), what other treatments or considerations are important in managing cleft lip and palate (CLP)?

While secondary alveolar bone grafting (SABG) focuses on correcting bone defects, it's important to remember that cleft lip and palate (CLP) often involve soft tissue deformities as well. Procedures like cheiloplasty (cleft lip repair) and palatoplasty (cleft palate repair) are crucial for addressing these issues. Furthermore, the long-term management of CLP may involve additional orthodontic treatment, speech therapy, and psychological support to ensure optimal functional and aesthetic outcomes. These aspects extend beyond bone grafting but are integral to comprehensive CLP care.