The secondary bone graft for patients with a primary alveolar cleft seems to be the procedure of de facto standard. The technique is to be applied before the patient reaches the age of 11, and the suffered canine is not erupted using the autogenous particulate cancellous bone marrow of the iliac crest. However, we have read many articles related to bone grafts, and many controversies still exist. There are four categories of bone grafts: primary bone grafts for infants under two and a half years old, early secondary bone grafts for children two to five years old, secondary bone grafts conducted before the eruption of canines, and late bone grafts conducted after the eruption of canines. The primary bone graft and/or gingivoperiosteoplasty with presurgical orthopedic correction is preferable to a secondary bone graft. Although it is not known whether a primary bone graft reduces the need for a secondary bone graft, there are other benefits with regard to the surgical technique and social adaptation. Moreover, the symmetric alar base configuration is not achieved with a secondary bone graft; we rely on presurgical orthopedics to move the frontal prominence of the maxilla forward. We can now use computed tomography to evaluate the results of bone grafts, although frequent use should be avoided for ethical reasons. In view of the limitations of 2-D film, ordinary dental x-rays still have value.
The clinical success rate for secondary bone grafts is more than 80%. It is higher on unilateral clefts than on bilateral clefts, and before the eruption of canines than after their eruption. Secondary bone grafting materials are also taken into consideration. Artificial bone and/or the human recombinant Bone Morphologic Protein -2 are discussed as well as the tibia or the chin bone, etc. because they can prevent morbidity in the harvested area after the bone harvesting. We have to improve the use of artificial materials in order to reduce the burden on patients. Periodontal conditions are most interesting among aged patients with primary alveolar clefts. In almost all references, no susceptibility to periodontal disease among cleft-lip and palate patients was found, even if there was a tooth involved without bone support. Further research is needed, especially on elderly patients who have had bone grafts.