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The aim of this study was to determine whether molar incisor hypomineralization (MIH) is greater in patients with cleft lip and palate (CLP) who underwent primary alveolar grafting (PAG) as compared with CLP waiting for secondary alveolar grafting (SAG) and with controls.A retrospective analysis of intraoral photographs of 13 CLP patients who underwent a PAG, 28 CLP prior to SAG, and 60 controls without CLP was performed. Mantel-Haenszel χ2 tests were used to compare the 3 groups for differences in MIH scores, and Wilcoxon rank sum tests were used to compare the groups for differences in average MIH scores. A 5% significance level was used for all tests.Molar incisor hypomineralization scores were significantly higher for the PAG and SAG groups compared with the control group (P < 0.001). The PAG group had significantly higher incisor MIH (P = 0.016) compared with the SAG group. Molar incisor hypomineralization average scores were significantly higher for the 2 graft groups compared with the controls (P < 0.0001). The PAG group had significantly higher average MIH score and average MIH score for incisors compared with the SAG group (P = 0.03).Cleft lip and palate patients have significantly greater MIH compared with controls, and CLP patients with PAGs have significantly greater MIH in the incisor region compared with CLP patients with SAGs, indicating that subjects with PAGs have more severely affected dentition.