Treatment of cleft lip and palate requires multiple interdisciplinary treatment steps. Concerning rehabilitation of this deformity, there is a heightened and in part controversial debate regarding the correct treatment modalities, particularly for alveolar cleft reconstruction. The aim of this review article is to present the literature-based findings for the timing of surgery and the donor site for alveolar cleft repair and to provide a basis for discussion of primary alveoloplasty with calvarial bone. Regarding optimal timing for osseous reconstruction of the alveolus in cleft lip and palate management, primary alveolar cleft repair is indicated during eruption of the cleft-proximal lateral incisor to benefit from the osteogenic potency of this process, thus promoting optimal stabilization of the alveolar process. Additionally, the width of the alveolar cleft should be minimalized by the therapeutic pretreatment of cleft lip closure to a few millimetres. The calvarial bone graft is particularly suitable in these cases, with slight advantages in donor site morbidity compared to the iliac crest.