Timing matters: Dental development and outcomes on secondary alveolar bone grafting in cleft lip and palate patients

Objective To evaluate the impact of secondary alveolar bone grafting (SABG) timing, based on canine root mineralization stages, on bone graft preservation, canine eruption, and space closure in patients with cleft lip and palate (CLP). Materials and Methods This retrospective single-center cohort study included 104 patients with unilateral or bilateral CLP (127 cleft sites). Orthopantomograms and clinical records were evaluated at three stages: pre-SABG, six months post-SABG, and post-orthodontic treatment. Canine root mineralization stage was classified as R = 0,25 − 1,0, corresponding to 25–100% root development respectively. Assessed parameters included the canine mineralization stage, axis-anglulation and vitality, limbus height, probing depths, and space closure strategy. Statistical analysis used the Student’s t-test. Results SABG performed at early stages of canine root development (R ≤ 0,5) was associated with higher success rates of orthodontic space closure (71,4% at R = 0,5 vs. 25% at R = 1,0; p  < 0,05) and bone graft preservation. In patients with lateral incisor agenesis, early SABG facilitated mesial canine eruption but increased the incidence of canine impaction (18,6%). The mean axis-angle of cleft-side canines differed significantly between orthodontic and prosthodontic space closure (81,3° vs. 91,0°, t = 5,702). Limbus alveolaris height was reduced when SABG occurred after root completion (R = 1,0, t = 4,234). Periodontal probing depths remained < 3 mm, and canine vitality was preserved in all groups. Conclusions Early SABG, timed according to canine mineralization, supports alveolar bone preservation and space closure without compromising periodontal health. Clinical Relevance Tailoring SABG timing based on dental development can optimize orthodontic and prosthodontic outcomes in patients with CLP.