Mandibular premolar autotransplantation in cleft affected patients: the replacement of congenital missing teeth as part of the cleft patient's treatment protocol.

Background: Tooth autotransplantation has developed into a safe and predictable procedure, which preserves the continuity of the dental arch and the alveolar process and provides an acceptable aesthetic and physiological outcome.

Aim: To describe our experience with autotransplantation of the developing mandibular premolar to the iliac crest grafted alveolar cleft as part of the cleft patient's treatment protocol.

Material And Methods: Four cleft affected patients were referred to the Orthodontic and Craniofacial Department, Rambam Health Care Campus, Haifa, Israel due to loss of teeth in the cleft area. In all cases, orthodontic closure of the missing teeth space in the maxillary dental arch was considered inappropriate and therefore autotransplantation of the extracted mandibular premolar to the bone-grafted alveolar cleft site was conducted.

Results: None of the transplanted teeth in the reported cleft affected patients had signs or symptoms of progressive root pathology, gingival disease or advanced tooth mobility. Long-term clinical follow-up examination revealed improved facial aesthetics and occlusal relationships along with increased self-esteem and welfare of the patients' with no need for future dental restorative treatment.

Conclusion: Autotransplantation of mandibular premolars should be considered an alternative to prosthodontics in cleft affected patients as an integral part of the cleft patient's treatment protocol.