Design of Patient-Specific Customized 3D Bone Grafts for Unilateral Alveolar Cleft Repair

Alveolar cleft, affecting almost 75% of cleft lip and palate patients, disrupts dental arch continuity and maxillofacial symmetry. Although autogenous iliac crest grafting remains the gold standard, donor-site morbidity and limited graft source drive demand for alternatives, including 3-dimensional printed patient-specific solutions. This study implemented a methodology for designing of 3-dimensional patient-specific bone graft for alveolar cleft repair using computed tomography data. On the basis of the boundaries defined by previous studies, we fulfilled the clinical functional need for alveolar cleft repair. Mirroring technology combined with manual refinement generated model precisely matching defect geometry while replicating the non-cleft side's piriform aperture curvature. Two operators independently conducted 3-dimensional modeling of patient-specific alveolar bone graft twice with a 2-week interval. One of the operators segmented the original alveolar defect and measured its volume. High intraclass correlation coefficient indicated stable reproducibility of the design workflow. Paired t test with p＞0.05 demonstrated satisfactory symmetry in height and width of piriform aperture. Pearson correlation analysis indicated there was a strong positive correlation between the bone defect volume and 3D graft volume (r=0.991, p=0.000). This methodology addressed functional needs including restoration of dental arch continuity and bone volume for tooth eruption, as well as aesthetic outcomes including nasal base symmetry and piriform contouring. This work bridges gaps in craniofacial reconstruction by integrating digital design with clinical needs.