Introduction: Graft loss is a common complication following alveolar bone graft surgery. Periodontists have shown that epithelialization from oral mucosal wound edges may be responsible for bone graft loss. Use of a barrier membrane hinders epithelial intrusion, preventing sinus formation, graft exposure, and graft loss. We report on the long-term outcome of 20 patients who underwent alveolar bone graft surgery, with acellular dermal homograft used as the barrier membrane. Methods: There were 12 males and 8 females. Six cases were bilateral. Median age was 10 years (range 9-18). Our alveolaplasty utilizes the gingivobuccal sliding flap technique. The dermal homograft is placed between all mucoperiosteal wound edges and the cancellous bone graft. A palatal wafer splint is placed prior to extubation and worn for 4 weeks. Perioperative antibiotics are given and continued for 2 weeks. Liquid diet is started immediately. Chlorhexidine gluconate 0.12% oral rinse is used for 2 weeks. Results: Mean follow-up was 19 months. One patient with bilateral cleft developed 70% graft loss on one side at 7 months, although exam at one month had revealed intact graft. No other patient experienced graft loss. Conclusions: Acellular dermal allograft is a promising adjunct in successful bone grafting of alveolar clefts.