Study Examines Factors Influencing Timely Preparation for Alveolar Bone Grafting in CL/P Patients


  • Many factors may affect a care team’s ability to effectively prep patients for bone grafting
  • A dedicated specialty nurse coordinator or case manager could improve care delivery and timely patient prep

CHAPEL HILL, N.C. / Sept. 28, 2020 – A variety of factors can affect a care team’s ability to effectively prepare cleft lip/palate (CL/P) patients for alveolar bone grafting (ABG), according to a recent research study. The results were published in the September 2020 issue of The Cleft Palate-Craniofacial Journal (CPCJ).

“Providers who serve patient with cleft palate and craniofacial disorders would agree that one of the greatest challenges is the heterogeneity of the patients we serve. Advances in science continue to suggest patient-specific treatment programs. Having said that, uniform protocols that can address the hurdles and obstacles that our patients might face in optimizing care is equally as important as patient-specific care. This paper serves to do just that by examining the factors that impact a team’s ability to ensure patients are orthodontically and dentally prepared for ABG. Data from this study demonstrate the variability across sites, patients served, and challenges related to care. As the authors acknowledge ‘teams should follow a protocol that is appropriate and comfortable given the team’s working dynamic.’ The collective responses from teams across the country through this study provide valuable shared insights into ways that we can improve the process of preparing patients prior to ABG,” said Jamie L. Perry, PhD, CCC-SLP, editor of The Cleft Palate-Craniofacial Journal.

Continuous multidisciplinary care, from birth to young adulthood, is key to the successful treatment of CL/P. A vital step in the rehabilitation of the alveolar cleft is ABG. This procedure is generally performed prior to the eruption of the maxillary permanent canine teeth—usually between the ages of 9 and 11 years.

“It can be challenging to prepare patients, both orthodontically and dentally, for alveolar reconstruction, given the narrow window of time that experts agree will result in an optimal outcome,” according to Diana S. Jodeh, MD, lead researcher. “In this study—the first of its kind—we investigated the factors that may affect a care team’s ability to prepare a CL/P patient, within that time frame, to undergo a successful ABG.”

An email was sent to cleft and craniofacial multidisciplinary coordinators from 167 teams identified by the American Cleft Palate-Craniofacial Association (ACPA). Fifty-three cleft team coordinators responded and completed a 17-question survey that queried participants about factors associated with team care, treatment protocol preferences, resources available to team coordinators, and access to care barriers.

The survey responses reflected a great variability in patient volumes, clinic frequency, and dental/orthodontic coverage models between teams. The frequency of team clinics and the percentage of patients who sought dental and orthodontic care from a provider within a team were highly variable as well. In addition, most cleft teams’ preferred age range for bone grafts was 8 to 13 years (49.06%), followed by 6 to 8 years (47.17%).

“Much of the variability in the survey’s responses is related to the unique factors that affect how care teams function and deliver care. However, the survey data did not identify a single factor associated with improved success in preparing patients prior to ABG,” Jodeh noted. “There was a perception that a specialty nurse coordinator and/or case manager might improve the rate of timely preparation, but the survey data does not support this. Going forward, additional research on this topic is needed, since the majority of study participants (82%) believed this specialty nurse coordinator/case manager role would be a valuable addition to the care team.”

To learn more about the American Cleft Palate-Craniofacial Association and cleft and craniofacial conditions, please visit

About the American Cleft Palate-Craniofacial Association
The American Cleft Palate-Craniofacial Association (ACPA) is a nonprofit 501(c)(3) association of interested individuals and health care professionals who treat and/or perform research on oral cleft and craniofacial conditions. Since 1943, ACPA has worked to optimize outcomes for individuals with oral cleft and craniofacial conditions through education, support, research, advocacy and interdisciplinary team care. ACPA also provides information to affected individuals and families and seeks to educate the public about facial differences through its ACPA Family Services program. For more information, please visit