Alveolar Bone Grafting Research Articles

A meta-analysis of alveolar bone grafting using bone substitutes in cleft lip and palate patients.

In individuals with cleft lip and palate (CLP), an alveolar bone graft (ABG) is carried out for alveolar cleft closure. Several sources for ABG include autologous bone, xenologous bone, and alloplastic substitutes. Autologous bone has been the preferred source for ABG. Alloplastic substitutes might serve as an alternative. This study aimed to compare the outcomes between autologous and alloplastic as sources for ABG. This study made use of eight web databases. Randomized control trials (RCTs) and non-RCTs were included. CLP patients with alveolar cleft with imaging studies, computed tomography (CT scan) and/or cone beam CT scan, and bone graft volume within 6-12 months postintervention were selected. Bone graft volume within 6-12 months postintervention was assessed. Three studies met the inclusion criteria. After 6-12 months of follow-up, there were no statistically significant differences in bone graft volume between autologous and alloplastic bone grafts (fixed-effect model estimate value = 0.21; confidence interval - 0.301-0.730; P = 0.414). The limitations include small research sample sizes, a high likelihood of bias among included studies, and different alloplastic materials from each included study. Autologous and alloplastic bone grafts showed similar effectiveness in alveolar bone grafting. Further clinical trial studies with bigger sample sizes and similar interventions are needed as evidence for future reviews.

Current Protocols for Bone Grafting in the Comprehensive Treatment of Patients with Cleft Lip and Palate

This study aims to evaluate current bone graft protocols in the comprehensive treatment of patients with cleft lip and palate, identifying trends, challenges, and improvement strategies. A mixed methodology is employed, including a retrospective cohort study of 75 patients treated between 2021 and 2023, an 18-month prospective observational study, and a survey of 46 experts in the field. Results reveal a preference for secondary alveolar bone grafting, with an optimal intervention age between 7-9 years, with iliac crest autograft being the most utilized. High success rates were observed in graft integration and aesthetic improvements, although challenges such as graft resorption and postoperative complications persisted. Experts emphasized the importance of a multidisciplinary approach and treatment personalization, identifying a growing trend towards the use of advanced technologies such as 3D surgical planning and cell therapies. It is concluded that current protocols are evolving towards more personalized and technologically advanced treatments, with success depending on a multidisciplinary approach, appropriate intervention timing, and long-term follow-up. The persistence of challenges underscores the need for continuous research, while the integration of new techniques and materials promises to improve functional and aesthetic outcomes, highlighting the dynamic nature of the field and the importance of continuous optimization of treatment protocols

Radiographic Assessment of Cleft Alveolar Bone Defects: A Preliminary Comparison of Periapical and Cone Beam Computed Tomography Images

Background & Purpose Accurate radiographic assessment of secondary alveolar bone grafting (SABG) is critical in evaluating SABG outcomes in patients with cleft lip and palate. This study compared Periapical (PA) and Cone beam computed tomography (CBCT) grading of SABG outcomes and conducted an analysis of agreement rate between the two imaging modalities. Methods A retrospective chart review was performed of patients who underwent secondary alveolar bone grafting at a single institution. Bone quality of the alveolar cleft site was assessed at three root levels of the adjacent teeth on PA and CBCT images. Results 48 patients had pre- or post-operative images with both CBCT and PA that were appropriate for comparison. A total of 174 alveolar bone sections (three root levels of adjacent teeth in 58 pairs) were graded on CBCT and PA images. Agreement of CBCT grading with PA grading was 41.3% (72/174) overall. CBCT assessments rated bone quality lower than PA grading in 51.2% (89/174) of sections. CBCT had higher grading than PA image grading in 7.5% (13/174) of sections. The weighted Cohen Kappa value for comparison of CBCT and PA readings was 0.17, indicating a low rate of agreement. Wilcoxon signed rank test demonstrated that the difference between grading on CBCT and PA assessments was statistically significant ( P < .001). Conclusions CBCT and PA readings demonstrated an overall low rate of agreement in the assessment of cleft alveolar bone. This investigation suggests that PA radiographs have lower sensitivity in detecting poor bone grafting outcomes.

Correlation Between Presurgical Alveolar Cleft Volume Measured by Simulation Software Using CBCT and Actual Bone Volume Used for Grafting

Objective To assess correlation between presurgical alveolar cleft volume measured by simulation software using CBCT and actual bone volume used for grafting. Design Prospective. Setting University hospital. Patients Patients with UCCLP who underwent alveolar bone grafting. Interventions 23 CBCT images of patients with UCCLP, aged 8.6–22.9 years, were taken. Alveolar cleft volume was measured using Mimics® software. Paired t-test was used to compare volume calculated from two measuring methods. Independent t-test was used to compare the volume between two age groups. Pearson's correlation coefficient was used to assess correlation between two measuring methods. Main Outcome Measures Paired t-test showed statistically significant difference between two measuring methods. Independent t-test showed statistically significant difference between both measuring methods in both age groups. Differences between two variables in both age groups were not significantly different. Pearson's correlation coefficient indicated significantly positive correlation between presurgical alveolar cleft volume measured by simulation software using CBCT and actual bone volume used for grafting. Results Mean alveolar cleft volume measured by computer simulation was 1.30 ± 0.40 ml, whereas actual bone volume used for grafting was 1.10 ± 0.39 ml. Mean difference between both measuring methods was 0.20 ± 0.14 ml. Mean alveolar cleft volume measured by simulation software, as well as actual bone volume used for grafting, differ significantly between 2 age groups. Conclusions There was significantly positive correlation between two measuring methods. CBCT method overestimated actual bone graft volume. Surgeons may harvest alveolar bone grafts ranging from 82% to 100% of CBCT volume.

Alveolar Bone Grafting in Unilateral Cleft Lip and Palate: Impact of Timing on Palatal Shape.

Alveolar bone grafting (ABG) is a critical surgical intervention in patients with a cleft of the alveolus, aimed at reconstructing the alveolar ridge to facilitate proper eruption, periodontal support, and alignment of adjacent permanent teeth. The optimal timing for ABG remains debated, with late secondary ABG between the ages of 9 and 11 being widely adopted. This study compared the palatal shapes of 28 children at a mean age of 9.5 years (SD = 0.7) who underwent early secondary ABG at a mean age of 2.1 years (SD = 0.6) or 33 children at a mean age of 10.8 years (SD = 1.5) who underwent late secondary ABG at a mean age of 8.6 years (SD = 1.3) to 60 non-cleft controls at a mean age of 8.6 years (SD = 1.2). The palatal shapes were captured with 239 landmarks digitized on the palate on a digital model. Utilizing geometric morphometric methods, i.e., generalized Procrustes superimpositions, principal component analysis, and permutation tests, we assessed the impact of ABG timing on palatal morphology. The first five principal components (PCs) explained 64.1% of the total shape variability: PC1 = 26.1%; PC2 = 12%; PC3 = 11.9%; PC4 = 7.8%; and PC5 = 6.4%. The Procrustes distance between both cleft groups and the control group was more than twice as large as the Procrustes distance between the early ABG and late ABG groups. Nonetheless, all intergroup differences were statistically significant. Our findings suggest that early ABG has a limited negative effect on palatal shape, providing comparable outcomes to late ABG. The study highlights the potential suitability of early ABG, challenging conventional practices and encouraging further exploration into its long-term effects on maxillary growth.

Bioglass 45S5, a relevant alternative to autogenous harvesting for secondary alveolar bone grafts in clefts? Retrospective study of one hundred surgeries

The secondary alveolar bone grafting (SABG) step restores the continuity of the alveolar bone necessary for dentition. Faced with the complications of autografts, synthetic biomaterials such as Bioglass (BG) 45S5 have been proposed. The objective was to evaluate the success rate of SABG with the addition of BG 45S5 and to highlight the prognostic factors.Patients who underwent operation between 2015 and 2021 and had follow-up cone-beam computed tomography (CBCT) were analyzed. Multivariate analysis was performed to determine factors influencing radiographic success. A total of 102 SABG were analyzed. They were unilateral total cleft lip and palate (49, 48.0%). The mean age at surgery was 9.32 ± 3.09 years. Surgeries were performed mainly outside a syndromic context and without a family history after orthodontic preparation.The radiographic success rate at 1 year was 80.4%. Mixed dentition stage (odds ratio [OR] = 7.3, p = 0.024), absence of syndromic context (OR = 20.7, p = 0.024) and female sex (OR = 4.88, p = 0.021) were factors predictive of surgical success.The use of BG 45S5 instead of autograft is relevant for SABG, with a 1-year success rate of over 80%. The stage of mixed dentition, the absence of syndromic context, and female sex were factors for good prognosis.

A Comparative Analysis of the Minimally Invasive Approach against the Traditional Open Harvesting Technique for Obtaining Iliac Bone Grafts in Secondary Alveolar Bone Grafting Procedures for Patients with Cleft Palate

Abstract: Secondary alveolar bone grafting (SABG) is an important surgery that people with cleft palate must have in order to have good dental rehabilitation. The goal of SABG is to create a stable alveolar ridge. The choice of graft picking method has a big effect on how well the surgery invasive harvesting methods used in iliac bone graft (SABG) procedures. The main points of the study are how happy the patients are, how these works and how well the patients do in the long run. This review study looks at the pros and cons of both traditional open harvesting and minimally methods have improved, and the results and problems that have happened.

Cone Beam-CT-Based Bone Volume Assessments of Alveolar Synthetic Bone Graft GlassBONE™ in Cleft Lip and Palate Patients: A Retrospective Study.

Clefts of the lip and palate(CLP) are facial deformities that require multiple surgical procedures during childhood. One of these steps consists of filling the alveolar space with bone graft, traditionally removed from the iliac crest. However, this procedure could be invasive in children. Here, we aimed to evaluate the outcomes of GlassBONE™ graft, a bioactive glass used as a bone substitute, as an alternative to the deleterious autologous bone graft in children. Retrospective monocentric study with 17children aged 7.5 ± 2.2yo[3.8-13.3yo] carrying CLP. This technique has been established at La Timone Children hospital (Assistance Publique - Hôpitaux de Marseille)since 2011. Clinical(scar, graft rejection and periodontal status) and radiological(both panoramic radiographs and cone beam-CT) follow-up was conducted oneyear after the graft. The primary outcome was the reduction of the cleft volume, and secondary was the eruption of the adjacent tooth through the graft. GlassBONE™ permitted a significant reduction in the cleft volume by 42.4 ± 27.7%[0.6-81.1%](p < 0.0001), corresponding to a filling of 57.6 ± 27.7% of the alveolar cleft. GlassBONE™ is well tolerated, ensuring satifactory clinical results(improvement in both scar and periodontal coverage), as well as the physiological evolution of the germs through the biomaterial. GlassBONE™ appears particularly suitable for small volumes, and we were able to determine a minimum volume of approximtely 0.259 + / - 0.155cc required for a successful bone fusion. The bioactive glass GlassBONE™ could be safely used in children with small CLP cases, providing satisfactory clinical and radiological results.

Current State of Clinical Trials Regarding Alveolar Bone Grafting.

Alveolar ridge defects develop because of surgery, trauma, infection, or congenital malformations. Alveolar ridge defects can be resolved using an osseous replacement. The primary outcomes of osseous replacement are the maintenance of contour; the elimination of dead space, the reduction of postoperative infection; and the increase in bony and soft tissue healing. Recent research shows promising developments in dental bone grafts. This review presents the results of several clinical trials and provides updates on current alveolar bone grafting. In May 2023, we searched Clinicaltrials.gov for interventional clinical trials related to alveolar bone grafting. A total of 66 clinical trials were included using Boolean Operators AND, OR, NOT we used the “advanced search” option with the search terms [Alveolar Bone Grafting] OR [Ridge Preservation] OR [Dental Bone Grafting] OR [Ridge Augmentation]. Reviewed publications are summarized. 28 out of the 66 trials were successfully completed. None of the trials had offered an invitation to enroll, and only one was terminated. Autograft was the most prevalent kind of grafting, at 28 out of 66, more than twice as prevalent as allograft, which ranked second at 12 out of 66. this study shows a lack of variety in location, low results provided, and low clinical trials regarding bone rejection. The focus of published trials was mainly on cleft palate rehabilitation using secondary alveolar bone grafting, and the usage of L-prf, rh-FGF-2, rhBMP2, and hyaluronic acid in association with alveolar bone grafting showed remarkable results concerning bone's osteoconduction, osteoinduction, and osteogenesis.

What is the Success Rate of Repeat Alveolar Bone Graft?

Success rates for alveolar bone grafting range from 30 to 96%. There is limited information regarding the success of repeat grafts. The purpose of this study was to determine the radiographic success rate of repeat alveolar bone grafts. The study designs was a retrospective cohort study of patients who underwent repeat grafting by 1 surgeon over 15years. To be included, subjects had to have: cleft lip and alveolus and a cone-beam computed tomography (CBCT) scan obtained >6months after repeat graft. Patients were excluded if CBCT was inadequate. Predictor variables were sex, age at repeat graft, cleft type, presence of an erupted canine, premaxillary osteotomy at time of repeat graft, presence of a visible oronasal fistula, size of bony defect, presence of a bony palatal bridge, and whether the surgeon who performed the repeat graft also performed the initial graft. The outcome variable was graft success determined using CBCT assessment and defined as a score of >3 out of 4 in each domain: vertical bone level, labiopalatal thickness, and piriform symmetry. The covariates were time from bone graft to CBCT (months) and age at time of CBCT (years). Frequency distributions, relative risk with 95% confidence intervals, medians, and interquartile ranges were calculated. Pearson c2 and Fisher exact tests were performed to determine predictors of outcome. A P<.05 was considered statistically significant. Fifty subjects (54% male) who had repeat bone grafting to 59 cleft sites were included. Median follow-up time from repeat graft to CBCT was 7.0months (interquartile range: 5.9months). The radiographic success rate was 81.4%:91.7% if the same surgeon performed both initial and repeat grafts, but 78.7% if initial graft was completed by another surgeon (P=.43). Despite being a multifactorial issue, extensive and bilateral clefts, the presence of an erupted tooth in the cleft area, a visible oronasal fistula, and concomitant osteotomy of the premaxilla are warning signs of the possibility of failure. Performing repeat alveolar bone grafting by an experienced surgeon appears to increase the chance of success.

The Life Cycle of Orofacial Cleft Operations.

Patients with cleft lip and palate must undergo various surgical interventions at appropriate times to achieve optimal outcomes. While guidelines for the timing of these operations are well known, it has not yet been described if national surgical practice reflects these recommendations. This study evaluates whether orofacial operations are performed in time frames that align with advised timing. Time-to-event analyses were performed using the 2012-2020 Pediatric National Surgical Quality Improvement Program database on the ages at time of orofacial operations. Outliers with an absolute Z-score of 3.29 or greater were excluded. Cleft lip (N=9374) and palate (N=13,735) repairs occurred earliest at mean ages of 200.99±251.12 and 655.08±694.43 days, respectively. Both operations clustered along the later end of recommended timing. 69.0% of lip versus 65.1% of palate repairs were completed within the advised age periods. Cleft lip (N=2850) and palate (N=1641) revisions occurred at a mean age of 7.73±5.02 and 7.00±4.63 years, respectively. Velopharyngeal insufficiency operations (N=3026), not including palate revision, were performed at a delayed mean age of 7.58±3.98 years, with only 27.7% of operations occurring within the recommended time frame. Finally, 75.8% of alveolar bone grafting cases (N=5481) were found to happen within the advised time period, with a mean age of 10.23±2.63 years. This study suggests that, with the exception of VPI procedures, orofacial operations reliably cluster near their recommended age periods. Nevertheless, primary lip repair, palatoplasty, and velopharyngeal insufficiency procedures had a mean age that was delayed based on advised timing.

Long-term radiographic and periodontal evaluations of the bone-grafted alveolar cleft region in young adults born with a UCLP.

Studies addressing the periodontal health of the teeth surrounding the bone-grafted cleft in patients born with unilateral cleft lip and palate disagree on whether periodontal health is compromised. To determine periodontal health differences between the cleft and the non-cleft sides nearly a decade after secondary alveolar bone grafting. This prospective, controlled (split-mouth design) study comprised an intraoral apical radiographic and a periodontal examination of 40 consecutive patients from one centre (n = 26 males) who had undergone bone grafting at mean age of 10.2 years (±1.6). Probing pocket depth, gingival index, gingival recession, and radiographic bone support were assessed. No significant difference occurred in probing pocket depth between teeth at cleft and non-cleft sites (OR 1.8, P = .488). Gingival recession was present at 6.6% of all examined sites on the cleft side and at 1.7% on the non-cleft side (OR 17.3, P < .001). Gingival recession occurred most often on the buccal and disto-buccal surfaces of the central incisor on the cleft side. The gingival index was significantly higher on the cleft side (OR 8.0, P < .001). The Bergland index was I or II in most patients (87%). Recruitment of eligible patients was lengthy. The teeth on the cleft side had high levels of gingival inflammation. Few pathological gingival pockets, however, were found. Shallow gingival recessions frequently occurred around the central incisor on the cleft side. Teeth in the bone-grafted cleft region generally had good bone support.

Dental Rehabilitation of the Unilateral Cleft Dental Gap: A Single Institution Experience With Long-Term Follow-Up.

The purpose of this study was to identify factors associated with the management of the cleft dental gap after alveolar bone grafting. This was a retrospective cohort study of patients with unilateral cleft lip and alveolus or palate who had successful alveolar bone grafting. Our primary study outcome was alveolar cleft management (orthodontic closure or space maintenance). Our secondary study outcome was the rate of fixed dental rehabilitation. Univariate comparisons were made with SAS 9.4. The final study sample consisted of 54 patients. Most patients were treated with orthodontic closure (55.6%). Patients missing multiple teeth ( P < 0.01) were less likely to receive orthodontic closure. Orthodontic closure was not associated with differences in intermaxillary midline coincidence ( P = 0.22) or the need for LeFort advancement ( P = 0.15). Only 41.7% of patients who were managed with space maintenance obtained a fixed prosthesis. Hispanic ethnicity ( P < 0.01) and Medicaid insurance ( P < 0.01) were associated with lower rates of fixed dental rehabilitation. Orthodontic closure was the most common approach, and it did not result in significant maxillary midline distortion. Less than half of patients treated with space maintenance obtained fixed restorations. Socioeconomic barriers are likely preventing access to definitive dental rehabilitation in patients with unilateral cleft lip and alveolus or palate.

Updates in Cleft Care

AbstractCleft lip and/or palate is a congenital malformation with a wide range of presentations, and its effective treatment necessitates sustained, comprehensive care across an affected child's life. Early diagnosis, ideally through prenatal imaging or immediately postbirth, is paramount. Access to longitudinal care and long-term follow-up with a multidisciplinary approach, led by the recommendations of the American Cleft Palate Association, is the best way to ensure optimal outcomes. Multiple specialties including plastic surgery, otolaryngology, speech therapy, orthodontists, psychologists, and audiologists all may be indicated in the care of the child. Primary repair of the lip, nose, and palate are generally conducted during infancy. Postoperative care demands meticulous oversight to detect potential complications. If necessary, revisional surgeries should be performed before the child begin primary school. As the child matures, secondary procedures like alveolar bone grafting and orthognathic surgery may be requisite. The landscape of cleft care has undergone significant transformation since early surgical correction, with treatment plans now tailored to the specific type and severity of the cleft. The purpose of this text is to outline the current standards of care in children born with cleft lip and/or palate and to highlight ongoing advancements in the field.

Postoperative Facial Edema Following Alveolar Bone Grafting: A Prospective Cohort Study

Objectives: The secondary alveolar bone graft (ABG) is one of the key components in the treatment of cleft lip and palate. However, an ABG is commonly accompanied by postoperative facial edema. Although appropriate assessment of facial edema can facilitate the early detection of major postoperative complications, the usual course of swelling post-ABG is not yet fully understood. The present, prospective cohort study was conducted to clarify the typical course of facial swelling post-ABG.

Efficacy of rhBMP-2 and Cellular Bone Matrix in the Revision of Alveolar Bone Grafting

Objective: This study presents a novel approach that utilizes recombinant human bone morphogenic protein 2 (rhBMP-2) and cellular bone matrix (CBM) for revision alveolar bone graft (ABG) in unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP) patients following failed autologous ABG. Methods: A case series of 14 UCLP and 4 BCLP patients who had failed autologous ABG with revision ABG with rhBMP-2 and CBM. Review of demographics, operative data, Bergland score, and alveolar cleft gap volume was performed. Results: Revision ABG had short operative times and low blood loss in both UCLP and BCLP. No postoperative complications were found in either revision group. Repeat ABG surgery was required in one patient. Bergland score improved from 3.86 ± 0.53to 1.21 ± 0.80 in the UCLP group and from 3.75 ± 0.50to 1.00 ± 0.00 in the BCLP group. The cleft volume decreased by 83.62 ± 9.78% in UCLP and by 86.73 ± 13.65% in the BCLP group. Conclusions: Revision ABG with rhBMP-2 and CBM is a successful and reliable approach. This method has decreased operative time and no postoperative complications. Most patients achieved clinically successful grafting with canine eruption. Both UCLP and BCLP groups saw a significant decrease in alveolar cleft gap volume.

The Effect of Insurance Status and Medicaid Expansion on Timing of Alveolar Bone Grafts in Patients with Orofacial Clefts: A Cohort Study Utilizing the Pediatric Health Information System (PHIS) Database

The Effect of Insurance Status and Medicaid Expansion on Timing of Alveolar Bone Grafts in Patients with Orofacial Clefts: A Cohort Study Utilizing the Pediatric Health Information System (PHIS) Database

A Comparison of Three-Dimensional Cone Beam Computed Tomography Outcomes between Early versus Late Secondary Alveolar Bone Grafting in Patients with Unilateral Cleft Lip and Palate

A Comparison of Three-Dimensional Cone Beam Computed Tomography Outcomes between Early versus Late Secondary Alveolar Bone Grafting in Patients with Unilateral Cleft Lip and Palate

Extracorporeal Shockwave Therapy Improves Outcomes Following Secondary Alveolar Bone Grafting

Background: Recent studies have reported that extracorporeal shock wave therapy (ESWT) enhances bone formation during mandibular distraction osteogenesis. This study seeks to investigate the clinical outcomes in children undergoing ESWT alongside secondary alveolar bone grafting procedures at our institution. Methods: Retrospective review of all children that underwent secondary alveolar cleft bone grafting with adjunctive ESWT between 2019 and 2021. Variables including age, gender, cleft type, cleft width, pre-operative cleft dentition, volume of bone graft placed intraoperatively, ESWT settings, pain medication utilization, length of stay (LOS), follow-up, cone beam computed tomography (CBCT) data, and complications were recorded. Results: Twenty patients met inclusion criteria. Median age at surgery was 9 years (range 8-16). Four (20%) patients were female; 16 (80%) were male. Eight (40%) patients had bilateral alveolar clefts; 12 (60%) had unilateral clefts. All (100%) patients were discharged on the day of surgery. Twelve (60%) patients required a median of 1.3 oxycodone doses post-operatively (range 0-6.5). All patients received ESWT treatments intra and post-operatively. All patients demonstrated an increase in bone graft volume visualized on CBCT: median increase of 6.8% (range 1.3%-35.7%) between 106.5 days (17.5% of ideal visualized, range 5%-42%) and 245.5 days (27.9% of ideal, range 8%-55.7%). Three (15%) patients experienced minor complications. Conclusions: Initial outcomes suggest that ESWT may expedite visualization of bone consolidation and facilitate recovery without increasing complications. ESWT could further represent an opportunity to improve care in craniofacial surgery. Pertinent considerations, the role of standardized assessment protocols, and future directions will be reviewed.

β-Tricalcium Phosphate as Alveolar Bone Grafting in Cleft Lip/Palate: A Systematic Review.

The aim of this systematic review is to describe and identify the prospects of β-Tricalcium Phosphate (β-TCP) as an alveolar bone grafting (ABG) material in cleft lip/palate (CL/P) or alveolar bone cleft defects. A systematic review protocol based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 (PRISMA 2020) was drafted. The literature search was conducted using MEDLINE/PubMed, Web of Science/ISI Web of Knowledge, Scopus, and the Cochrane Library, with English as the inclusion criterion and no publication year limits. The keywords yielded a total of 5824 publications. After removing duplicates and non-English articles, there were 3196 suitable articles available for evaluation. Subsequently, 1315 studies remained after reviewing titles and abstracts. Furthermore, 85 full articles were assessed for eligibility. After reading the complete texts of those papers, 20 were eventually selected that matched the inclusion requirements. Thirteen out of the twenty studies included in this systematic review were deemed to have a low risk of bias; one had a high risk of bias; and six had a moderate risk of bias due to not reporting randomization. β-TCP, when used as an ABG material, is biocompatible, visible, practical, offers a less invasive procedure, and does not interfere with orthodontic treatment. Synthetic β-TCP for ABG can be an alternative to autologous bone grafts under certain terms and conditions. The efficacy of β-TCP for ABG in CL/P or alveolar bone cleft defects can be enhanced through a tissue engineering approach that combines β-TCP with growth factors, mesenchymal stem cells, or other graft materials, along with modifications to β-TCP's physical properties.