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

Abstract

Background: Secondary alveolar bone grafting (SABG) places bone in the alveolar cleft, crucial for managing cleft lip and palate. SABG restores ridge continuity, aids tooth eruption, and stabilizes the maxilla. Autogenous iliac crest grafting is the standard treatment option. However, varied evidence on donor-site morbidity, graft resorption, and outcomes prompts exploring alternative grafts and adjuncts. Objective: To systematically map and critically synthesize randomized controlled trial (RCT) evidence on graft materials, adjunctive biologics, and outcome assessment strategies in SABG, and to identify methodological gaps that limit translational decision-making. Methods: A comprehensive search was performed across PubMed, Scopus, Web of Science, and Embase for RCTs published in the last decade that evaluated graft materials and biologic adjuncts in SABG. Data on graft materials, adjunctive biologics, surgical strategies, outcome assessment methods, and clinical outcomes were extracted and synthesized narratively. Results: Of 408 records identified, 27 RCTs met the eligibility criteria. Most studies used autogenous iliac crest grafting. Adjunctive strategies included platelet concentrates, cell-based therapies, barrier membranes, graft substitutes, and tissue-engineered constructs. Some studies reported improvements in early healing, intraoperative handling, or bone density. Radiographic assessments were primarily CT and CBCT-based. Outcome measures and reporting approaches varied across studies. Most studies reported short-term outcomes, with limited long-term follow-up data available. Conclusions: Across the 27 RCTs, autogenous iliac crest bone remained the main graft and comparator, with no adjunct or alternative showing consistent superiority in bone volume, density, or resorption. Adjunct benefits were context-dependent, while heterogeneity in outcomes, imaging, and follow-up limited cross-study comparability.

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