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PubMed This is a summary of 16 peer-reviewed journal articles Updated
Craniofacial surgery · Alveolar Cleft

What Happens During Alveolar Bone Grafting for Cleft Palate?

At a Glance

A secondary alveolar bone graft fills the bony gap in a child’s upper jaw caused by an alveolar cleft, usually before the permanent canine erupts. Bone most often comes from the hip, followed by soft-food restrictions, hip recovery, and X-ray monitoring.

In this answer

3 sections

01

Why is it done around age 8 or 9?

02

Where does the bone come from?

03

What to Expect: Preparation and Recovery

If your child was born with a cleft lip and palate, their early surgeries in infancy closed the lip and the roof of the mouth. However, if the cleft extends through the alveolar ridge—the bony part of the upper jaw (gum line) that holds the teeth—those infant surgeries do not fill this gap [1]. If imaging confirms a bony defect in this area, an alveolar bone graft is usually recommended [2].

This procedure aims to provide a solid bridge of bone for your child’s permanent teeth—especially the canine (eye tooth)—to grow into [3]. It also helps stabilize the upper jaw arch and may help close any remaining holes between the nose and mouth (fistulas) [2]. While successful for most children, it is a goal, not a guarantee. Sometimes the grafted bone does not provide enough support, a permanent tooth may still need orthodontic help to erupt, or a separate procedure might be needed to fully close a fistula [4][5].

Why is it done around age 8 or 9?

An alveolar bone graft is generally performed during the mixed dentition stage, when your child has a mix of baby teeth and permanent teeth [6]. The exact timing isn’t based on your child’s birthday, but rather on their dental x-rays and orthodontic plan [7]. The cleft team carefully monitors the development of the permanent canine tooth near the cleft [8].

A common target is to place the bone graft before that canine erupts (comes through the gum), usually when its root is about half to two-thirds formed [9]. This aims to give the tooth healthy bone to erupt into, which may improve the chances of the tooth coming in successfully [4][10].

Where does the bone come from?

The most established and commonly used option is autogenous bone—meaning bone taken from your child’s own body [3]. The standard place to get this bone is from the iliac crest (the hip) [11].

The surgeon takes the spongy inner bone (cancellous bone) from the hip because it contains living cells that help the graft integrate into the jaw [2]. While having a second surgical site on the hip can sound intimidating, serious complications are uncommon [12]. However, it is a real surgery: your child will likely have some pain, bruising, and a temporary limp [13]. Other risks include bleeding, infection, or numbness around the hip scar [12]. Your child’s ability to walk and bear weight will follow the surgeon’s specific instructions.

In some specific circumstances, the team might recommend taking bone from the lower jaw or using artificial alternatives, depending on the size of the cleft and the cleft team’s experience [10][14].

What to Expect: Preparation and Recovery

  • Before Surgery: Your child may need a palate expander or braces to prepare the space for the graft [15].
  • Hospital Stay: The surgery is done under general anesthesia. Many children stay in the hospital for 1 to 2 days for pain control and to ensure they are drinking enough fluids.
  • Diet and Hygiene: Your child will likely be on a strict liquid or soft-food diet to protect the delicate stitches in their mouth. You will receive specific instructions on how to keep the mouth clean without brushing the surgical area.
  • Hip Recovery: Expect some hip pain and a temporary limp. Follow your surgeon’s guidance on when your child can walk, return to school, and resume sports.
  • Follow-up: The cleft team will monitor the graft’s success with follow-up x-rays and continue guiding the permanent teeth as they come in [16].

When to Call the Doctor

Always follow your specific cleft team’s instructions. Seek medical attention if your child experiences:

  • Trouble breathing or uncontrolled bleeding from the mouth
  • An inability to drink fluids
  • Rapidly worsening swelling, pain, or fever
  • Redness, drainage, or severe pain at the hip wound

Common questions in this guide

When is the best time for a child to have an alveolar bone graft?
The operation is often planned when a child has both baby and permanent teeth, commonly around ages 8 or 9. The exact timing is based on dental X-rays and development of the permanent canine, not age alone. Teams often aim to graft before the canine erupts, when its root is about half to two-thirds formed.
Why is a bone graft needed for an alveolar cleft?
The graft fills the gap in the bony upper jaw and creates support for the permanent teeth, especially the canine, to erupt. It can also strengthen the upper jaw arch and may help close a persistent opening between the mouth and nose.
Is hip bone usually used for a child’s alveolar cleft graft?
Yes. The most established source is the child’s own cancellous bone from the iliac crest, the hip, because it contains living cells that help the graft join the jaw. In selected cases, surgeons may use bone from the lower jaw or an artificial material.
What should parents expect during recovery from an alveolar bone graft?
The surgery is performed under general anesthesia, and many children stay one to two days for pain control and fluids. A liquid or soft-food diet and special mouth-care instructions protect the stitches. Children may have hip pain, bruising, and a temporary limp, and activity restrictions depend on the surgeon’s instructions.
What warning signs should be reported after the graft?
Seek medical attention for trouble breathing, uncontrolled mouth bleeding, inability to drink, or rapidly worsening swelling, pain, or fever. Redness, drainage, or severe pain at the hip wound also needs prompt medical evaluation.
How will the cleft team know whether the bone graft worked?
Follow-up dental X-rays and examinations assess the new bone and track the permanent canine as it develops and erupts. If support is insufficient, the tooth may need orthodontic help, and a separate procedure may be needed if an opening between the nose and mouth remains.

Questions For You

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Related questions

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Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Is my child's permanent canine tooth in a good position, and when is the best time for this surgery?
  2. 2.Will my child need a palate expander or braces to prepare the space before we can do the bone graft?
  3. 3.What are the benefits and risks of using hip bone versus another graft source for my child's specific cleft?
  4. 4.What are the exact activity restrictions for my child after the hip bone is harvested, and when can they return to normal play or sports?
  5. 5.How will we monitor the area to know if the bone graft was successful, and what happens if the canine tooth does not erupt?

References

References (16)
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    Updates in Cleft Care.

    Parham MJ, Simpson AE, Moreno TA, Maricevich RS

    Seminars in plastic surgery 2023; (37(4)):240-252 doi:10.1055/s-0043-1776733.

    PMID: 38098682
  2. 2

    Secondary bone grafting for alveolar clefts: surgical timing, graft materials, and evaluation methods.

    Kim J, Jeong W

    Archives of craniofacial surgery 2022; (23(2)):53-58 doi:10.7181/acfs.2022.00115.

    PMID: 35526839
  3. 3

    Current Methods for the Treatment of Alveolar Cleft.

    Kang NH

    Archives of plastic surgery 2017; (44(3)):188-193 doi:10.5999/aps.2017.44.3.188.

    PMID: 28573092
  4. 4

    Evaluation of Cleft Adjacent Canine Eruption in Patients With Alveolar Cleft Treated With Early Secondary Alveolar Bone Grafting.

    Doucet JC, Patel MH, Russell KA

    The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association 2026; (63(7)):1929-1934 doi:10.1177/10556656251356211.

    PMID: 40605650
  5. 5

    Radiology of Cleft Lip and Palate: Imaging for the Prenatal Period and throughout Life.

    Abramson ZR, Peacock ZS, Cohen HL, Choudhri AF

    Radiographics : a review publication of the Radiological Society of North America, Inc 2015; (35(7)):2053-63 doi:10.1148/rg.2015150050.

    PMID: 26562237
  6. 6

    [Timing of alveolar bone graft and sequences of canine eruption in cases of cleft lip and palate: a systematic review].

    Elhaddaoui R, Bahije L, Zaoui F, Rerhrhaye W

    L' Orthodontie francaise 2017; (88(2)):193-198 doi:10.1051/orthodfr/2017011.

    PMID: 28597839
  7. 7

    Early secondary bone grafting in children with alveolar cleft does not modify the risk of maxillary permanent canine impaction at the age of 10 years.

    Kleinpoort F, Ferchichi H, Belkhou A, et al.

    Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery 2017; (45(4)):515-519 doi:10.1016/j.jcms.2017.01.021.

    PMID: 28237254
  8. 8

    Early secondary alveolar bone grafting in cleft lip and palate patients - personal experience.

    Budner M, Wilhelm G, Lasota A, et al.

    Annals of agricultural and environmental medicine : AAEM 2026; (33(1)):130-134 doi:10.26444/aaem/210223.

    PMID: 41906518
  9. 9

    Predictive factors for secondary alveolar bone graft failure in patients with cleft alveolus.

    Najar Chalien M, Mark H, Rizell S

    Orthodontics & craniofacial research 2022; (25(4)):585-591 doi:10.1111/ocr.12573.

    PMID: 35347856
  10. 10

    A Prospective Study of Chin Bone Graft Harvesting for Unilateral Maxillary Alveolar Cleft During Mixed Dentition.

    Shirzadeh A, Rahpeyma A, Khajehahmadi S

    Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons 2018; (76(1)):180-188 doi:10.1016/j.joms.2017.07.143.

    PMID: 28774851
  11. 11

    Graft materials and regenerative strategies in secondary alveolar bone grafting: A scoping review of randomized clinical trials.

    Erdiansyah AM, Mubarak H, Ariestiana YY, Tajrin A

    Journal of oral biology and craniofacial research 2026; (16(5)):101508 doi:10.1016/j.jobcr.2026.101508.

    PMID: 42597949
  12. 12

    Complication Rates of the Anterior Iliac Crest Bone Graft Donor Site for 426 Pediatric Patients Undergoing Alveolar Bone Grafting.

    Haws L, Ma B, Godfrey T, et al.

    Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons 2025; (83(9)):1101-1105 doi:10.1016/j.joms.2025.05.006.

    PMID: 40460894
  13. 13

    Iliac Crest Pain in Alveolar Cleft Bone Grafting.

    Saito T, Lo CC, Fukuyama S, et al.

    The Journal of craniofacial surgery 2026; doi:10.1097/SCS.0000000000013363.

    PMID: 42733946
  14. 14

    A Comparative Analysis of Recombinant Human Bone Morphogenetic Protein-2 with a Demineralized Bone Matrix versus Iliac Crest Bone Graft for Secondary Alveolar Bone Grafts in Patients with Cleft Lip and Palate: Review of 501 Cases.

    Hammoudeh JA, Fahradyan A, Gould DJ, et al.

    Plastic and reconstructive surgery 2017; (140(2)):318e-325e doi:10.1097/PRS.0000000000003519.

    PMID: 28746285
  15. 15

    Customized Maxillary Expansion in a Child with Unilateral Cleft Lip and Palate and Multiple Anchorage Teeth Loss.

    Park JH, Levine T

    The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association 2026; 10556656261473958 doi:10.1177/10556656261473958.

    PMID: 42560164
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    Permanent maxillary canine eruption in children with clefts - a retrospective study.

    Podleśny MH, Lithovius R, Ylikontiola L, et al.

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    PMID: 41670245

This page is for informational purposes only and does not constitute medical advice. Your child’s cleft surgeon and orthodontist can explain the best timing, graft source, activity limits, and follow-up for your child.