Timing Extraction of Erupted Cleft-Adjacent Teeth for Secondary Alveolar Bone Grafting: A Scoping Review and Recommendations.

ObjectiveA scoping review of the literature to map the evidence for timing the extraction of erupted cleft-adjacent teeth, either in advance or during secondary alveolar bone grafting, and associated outcomes.DesignScoping review with a systematic search of Medline and Cochrane databases from inception to January 2026.Patients/ParticipantsHumans born with an alveolar cleft undergoing secondary alveolar bone graft during mixed dentition.Main Outcome MeasureThe determination of graft success or the presence of post-operative complications following the alveolar bone graft procedure.ResultsTwo studies met the inclusion criteria and were included in the primary review. Both studies reported that timing the extraction of cleft-adjacent teeth in advance of the bone graft was associated with advantageous outcomes in univariate analyses, yet this advantage was not maintained when a multivariate analysis was performed by 1 study. A further 6 studies were included in a secondary review, whereby the presence of intra-operative cleft-adjacent dental extractions was compared to an absence of dental extraction, with inconsistent associations reported between the occurrence of dental extraction and bone graft failure.ConclusionsThe evidence base is currently extremely limited. Available data would not support the timing of extracting cleft-adjacent teeth as being a major determinant of secondary alveolar bone graft success. Clinical decisions regarding timing of extraction of erupted cleft-adjacent teeth should consider dental, patient, safety and resource influences.