Secondary bone grafting of alveolar clefts has become an integral part of management of the cleft lip and palate. Although it is accepted practice, the actual timing, donor site and evaluation of treatment results is variable in centers across North America. To evaluate the various approaches, a survey was mailed to 240 centers in the USA and Canada. Information was requested on indications, timing, donor sites, evaluation of results and treatment of the missing tooth. One hundred and ten responses were received for a 46% response rate. The results showed that about all centers do alveolar bone grafting (107/110) with 90% performing secondary bone grafting. The most common indicator for the timing of the graft was canine root development (38%) followed by canine eruption (17%) or lateral incisor eruption (13%). Four centers did not use any dental evaluation. Eighty-three percent used iliac bone grafts while 8% used cranial bone exclusively for donor sites. The greatest variability was seen in the evaluation of the alveolar bone graft take. Only 14% of the centers checked post-op periapical x-rays routinely, 62% used x-rays occasionally and 16% never used post-op x-rays. Seven percent of the time, care was turned over to the orthodontist after surgery and there was no long-term follow up. Seven centers in the country use a graded scale to evaluate post-operative alveolar bone graft take. Options for the missing tooth included moving the cuspid (25%), fixed bridge (11%), implants (19%) or a combination. With so much variability in management, the use of a standardized scale to measure post-op results would allow for better outcome studies in alveolar bone grafting.
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