In this video, Charles Verheyden, MD performs a bone grafting procedure to close the alveolar cleft in a 15-year-old male. He has previously had a lip repair and the secondary palate was not cleft. This video illustrates gingival and mucoperiosteal flaps, and the harvesting of bone from the iliac crest. Cancellous bone is inserted into the pocket created by closure of the flaps on both the anterior and posterior surfaces of the alveolus. The final result is a closed cleft that stabilizes the maxilla which now has a smooth anterior alveolar surface. This procedure creates a foundation that facilitates orthodontic manipulation as a subsequent step.