The repair of alveolar cleft defects remains a formidable challenge in craniofacial surgery, with implications for dental arch continuity, tooth eruption, speech, and facial aesthetics. Traditional bone grafting methods (especially iliac crest autografts) have remained the gold standard, yet donor-site morbidity, graft resorption, and limitations in large defects drive the search for more advanced strategies. In recent years, developments in biomaterials, stem cell-based tissue engineering, and computer-aided surgery have opened new conceptual and practical pathways for alveolar cleft repair. This chapter reviews the embryology and pathophysiology of alveolar clefts, the structural and functional sequelae, and conventional surgical approaches. It then delves into advances in scaffold design, growth factor delivery, mesenchymal stem cell therapies, and 3D bioprinting strategies, highlighting preclinical and early clinical findings. Additionally, the role of CBCT, CAD/CAM, and custom surgical guides is examined in improving graft placement, reducing surgical error, and optimizing outcomes. Clinical successes and persistent challenges are analyzed, including graft integration, long-term stability, tooth eruption, and ethical/regulatory issues. We conclude by identifying key research gaps and proposing future directions—such as scaffold-free regeneration, AI-driven planning, and patient-specific regenerative protocols—that may transform alveolar cleft management in the coming decade.