Clinical Orthodontic Outcomes Following Secondary Alveolar Bone Grafting in Patients With Cleft Lip and Palate: A Systematic Review

Objectives: To examine and synthesize orthodontic outcomes, including treatment feasibility, spontaneous or orthodontically assisted eruption of maxillary canines, and periodontal or alveolar bone-related outcomes, following secondary alveolar bone grafting (SABG) in patients with cleft lip and palate (CLP). Materials and Methods: A comprehensive PubMed, Scopus, EBSCOhost (MEDLINE), and Cochrane Library search was conducted until February 9, 2025. Randomized controlled trials and observational clinical studies of non-syndromic unilateral or bilateral cleft lip and palate patients who had SABG were eligible. The GRADE framework rated evidence certainty, whereas the Cochrane RoB 2 tool assessed bias in randomized trials and the ROBINS-I instrument in non-randomized research. Narrative synthesis was used due to study design and orthodontic protocol heterogeneity. Results: From 528 records, 6 studies (1 randomized controlled trial and 5 observational cohorts) with 167 patients met the inclusion criteria. The synthesized results showed that thorough orthodontic mechanics and spontaneous and directed canine eruption into the grafted region were possible after graft integration. Cone-beam computed CT showed excellent short- to mid-term periodontal architecture, including alveolar crest height and no prominent bone dehiscences. Conclusion: SABG provides a clinically effective foundation for CLP patients orthodontic rehabilitation. Directed orthodontic tooth movement and maxillary canine eruption are feasible; however, the low certainty of the evidence means that current data should inform clinical judgment and therapy planning rather than treatment efficacy. © 2026, American Cleft Palate Craniofacial Association