The study assessed the need for revision surgery and the relating factors in alveolar cleft autogenous bone grafting in patients with complete cleft. It was a retrospective study carried out in 2009. The medical records of the 54 patients with alveolar cleft who underwent autogenous bone grafting in the maxillofacial department in Shariati Hospital from 2005 to 2008 were studied. The patients’ age, sex, cleft type, age at palatal and alveolar clefts repair, tooth missing, surgery turn, and presence of orthodontic treatment were assessed. The patients’ alveolar bone height was evaluated from their postoperative and follow-up panoramic radiographs. In general, 41% (n = 22) of patients needed revision surgery. Among all patients, 20 (37%) had secondary bone grafting and 34 (63%) had tertiary bone grafting. For 77% of the secondary unilateral clefts and 71% of bilateral ones, the remaining bone was at least three-fourths of the normal. Logistic regression model controlling for grafting time, surgery turn, orthodontic supervision, and age at palatal cleft closure showed that orthodontic treatment is associated with a lower need for revision surgery (odds ratio = 0.3; 95% confidence interval, 0.1–1.0). In conclusion, although alveolar cleft bone grafting is necessary for the reconstruction of the complete clefts, all these patients must be under the supervision of orthodontists to benefit from the surgical treatment.