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Cleft lip and/or palate (CL/P) are among the most common birth defects that affect the face and oral cavity. Within the general population, CL/P are noted to occur with a prevalence of approximately 1:700 live births. Their etiology is complex and multifactorial, due to the interaction between environmental and genetic factors (1). CL/P, furthermore, are often related to the occurrence of various complications including feeding and speech difficulties, repetitive infections of the upper respiratory tract, impaired esthetics and dental anomalies. In these individuals, the anatomical deformities usually involve the lip, alveolar ridge and palate. Thus, several surgical procedures and other health interventions are required for the comprehensive treatment in the vast majority of cases (1-3). In the last years, some craniofacial treatment centers have performed the alveolar reconstruction of individuals with complete cleft lip and alveolus (with or without cleft palate), with use of recombinant human bone morphogenetic protein type-2 (rhBMP-2). This protein is a biomaterial, which is capable to induce bone formation in the cleft area (3). This surgery is called secondary alveolar graft (AG) with rhBMP-2. It is ideally performed between nine and 12 years of age, that is, before the eruption of the maxillary permanent canines. Although the available literature has suggested that use of rhBMP-2 presents similar bone formation results to the secondary AG (4), there are additional advantages for the use of this protein compared to the conventional technique that uses autogenous bone from iliac crest. The main advantages are the elimination of surgical morbidity of the donor area, need for a smaller team of professionals to the surgery, and the absence of physical limitation of the amount of bone tissue available in the donor area (3).

Evaluation of surgical outcomes of alveolar graft with rhBMP-2 assisted by content-based images retrieval: a commentary