Dental Implants in a Cleft Palate

Mark, a dental implant patient in Pennsylvania, asks:

I was born with a bilateral cleft palate. My two front teeth have been diagnosed with extensive external root resorption. I’ve
gotten several opinions, and the consensus is extraction/graft with
dental implants.

One surgeon wants to do the extractions and allograft in
separate procedures, while another surgeon would do the graft at the same time of the
extractions. I’ve had 2 autographs (iliac bone) 10 and 12 years ago to
repair the cleft, both of which were successful.

Are there any special considerations for grafting/ dental implants given the previous work that was done around the cleft? Are there any factors to be considered when placing dental implants for a cleft palate? Would an allograft, as opposed to native bone, be advisable given the greater amount of bone that will be needed?

One surgeon also said that removing the teeth may create a passageway into my nose, necessitating an autograft 3-4 weeks after extraction. He said he wouldn’t be completely sure about the amount of bone surrounding the teeth until the extraction. Any advice is greatly appreciated.