Background Cleft lip and palate (CLP) is the most prevalent congenital malformation in the United States. Approximately 75% of CLP patients will have an alveolar cleft that can impair support of palatal and dental structures. Alveolar bone grafting (ABG) is standard management for alveolar defects, typically with iliac cancellous bone. Previous operative planning has been limited in terms of quantification of alveolar clefts and the amount of graft to obtain sufficient bony bridging across the defect. Here, we examine the potential use of Cone-Beam Computed Tomography (CBCT) and 3-Dimensional (3D) segmentation for volumetric quantification of alveolar clefts. Methods A retrospective chart review was performed for patients who underwent ABG since 2018 and CBCT imaging studies for operative planning and outcomes assessment were collected. Peri-operative data, cleft characteristics, demographics, and post-operative data were collected along with CBCT images. ITK-Snap neuroimaging software (University of Pennsylvania, 2023) was used in 3-Dimensional segmentation of CBCT imaging, obtaining measurements of volume and widths of alveolar clefts pre- and post-operatively. Anatomic landmarks were agreed upon by craniofacial orthodontists and surgeons. Results 68 post-operative studies were identified, with 66 studies demonstrating measurable bony bridging. 11 post-operative studies had enough residual cleft volume to undergo 3D segmentation, 9 of which had measurable bony bridging. 33 pre-operative CBCT studies for patients who underwent ABG were available for 3D segmentation. 21 pre-operative studies were conducted for clefts undergoing primary ABG and 12 were conducted for revisions. 40% of patients who underwent grafting had a bilateral cleft and alveolar defect. For post-operative segmentations of successful ABG, original cleft width averaged 5.35mm, cleft residual volume averaged 559.1mm3, and bony bridging height averaged 6.06mm. Cleft width in patients who required revision was significantly higher compared to those who did not (8.02mm vs. 5.35mm, p=0.011). A comparison between the residual volume of clefts which required revision and those that did not approached, but did not meet, statistical significance (980.2mm3 vs. 559.1 mm3, p=0.058). Conclusion 3D segmentation has potential in pre-operative planning of alveolar bone grafting. Preliminary results from 3D analysis of CBCT indicate width of cleft may be more influential in ABG success than cleft volume. Comparison of these characteristics of cleft defects may help determine if a threshold exists for increased risk of bone graft failure. Continued analysis will include regression analysis of cleft width and volume corresponding to ABG outcomes, as well as receiver operating characteristic curves to investigate thresholds of failure risk.