Successful dental rehabilitation of the cleft lip and palate patient can be difficult to achieve without careful planning and sustained effort. A case is reported where tertiary osteoplasty using cancellous autogenous iliac bone graft was performed as dental implant site development prior to restoration. This was followed by the insertion of a root analogue dental implant and later the provision of suprastructure. Good long term results were obtained in this case. The success of this case supports the use of iliac bone to enhance alveolar ridge width prior to dental implant placement in a skeletally mature patient. A dental implant placed in the bone grafted area of a cleft patient is an effective long-term solution to replace missing upper lateral incisor tooth in an adult patient with alveolar cleft.