Secondary alveolar bone grafting

What is cleft alveolus and what is its importance?

The alveolus is the part of the bone that holds our teeth. The alveolus is made of alveolar bone. Some people with a cleft lip and palate can also have a cleft defect of the alveolus, where there is a gap in the alveolar bone. Teeth develop inside the jaw and break through the gums (erupt) when they are nearly fully developed. Teeth need to be surrounded by bone to erupt. If a child has a cleft of the alveolus, where there is a gap in the bone, the teeth near it may erupt in the wrong place or may not erupt at all. Sometimes, the teeth near a cleft may be absent, have an unusual shape or there can be extra teeth.

What is an alveolar bone grafting?

A bone graft is when bone is taken from elsewhere and placed in an area where there is not enough bone. An alveolar bone graft is an operation done under general anaesthetic. The aim is to fill the gap in the cleft of the alveolus with bone from elsewhere. The alveolar bone graft can also help to close a fistula if there is one.

Are there any additional procedures needed along with alveolar bone grafting?

After alveolar bone grafting teeth may not always erupt into the right position. The child may need a brace at a later stage to move the teeth into a better position and to the straighten the teeth. If there are other abnormalities of the teeth, your child may also need other dental treatment like replacement of missing teeth,  reshaping of unusually shaped teeth. There can sometimes be impacted teeth, which need to uncovered from underneath the gum.  

At which age is the procedure performed?

The operation is normally done when the child is between 8 and 10 years old. However, it mainly depends on how quickly your child’s teeth are developing. Radiograph pictures (x-rays) are used to work this out so that the operation can be timed appropriately.

What does the operation involve?

The operation is in two parts. First, bone is taken, usually from your child’s hip, to put into the cleft lip. The surgeon will make a small cut in the skin and muscle over the hip bone. The surgeon will then remove a small piece of bone from the hip and the cut in the muscle and the skin is then sewn closed with dissolvable stitches. During the operation, a local anaesthetic is injected to the region, and a dressing is put on top of the skin. After a few weeks, the bone that was removed will have regrown. The second part of the operation is to repair the cleft of the alveolus. The surgeon will uncover the cleft by making a cut in the gum. They will then put the bone from the hip into the cleft. The fistula will be closed with sutures and the surgeon will finish by placing stitches over the gums to cover the bone graft, ensuring that the region is water-tight.