Assessment of secondary alveolar bone grafting using two-dimensional radiographic scales: A literature review

Abstract

Secondary alveolar bone grafting (SABG) is a key component of the multidisciplinary management of cleft lip and alveolus and cleft lip and palate. Alveolar cleft repair aims to create a bony bridge that restores maxillary continuity. The radiographic quality of this bridge is clinically important because it influences orthodontic tooth movement, prosthodontic planning, and decisions regarding possible re-grafting. Conventional X-ray images remain widely used for this assessment, and several two-dimensional scoring systems have been proposed to improve interpretive consistency. This narrative literature review critically examines the principal radiographic scales used to evaluate alveolar cleft repair and compares their core clinical properties. The Bergland scale remains the most widely recognized reference method, whereas the Enemark, Long, Kindelan, Chelsea, and SWAG scales seek to improve assessment of bone fill, morphologic detail, or applicability in mixed dentition. All of these systems rely on periapical or occlusal x-rays to estimate bony bridge height or the degree and distribution of bone fill in the cleft area.