Bone augmentation and autogenous transplantation of premolar to the site of the fissure in a cleft palate patient CASE REPORT Eloa ´ R. Luvizuto 1 , Eduardo F. S. Faco 1 , Renato S. Faco 2 , Thallita P. Queiroz 3 , Rogerio Margonar 3 , Walter Betoni-Ju ´ nior 4 , Kle ´ryo A. S. Camara 5 , Wirley G. Assunc ¸a ˜o 6 1 Department of Surgery and Integrated Clinic, Arac ¸atuba Dental School, Univ Estadual Paulista - UNESP, Sa ˜ o Paulo, Brazil; 2 Cranial Facial Anomalies Rehabilitation Hospital of Bauru, Sa ˜ o Paulo, Brazil; 3 Department of Health Sciences, Implantology Post Graduation Course, Dental School, University Center of Araraquara – UNIARA, Sa ˜o Paulo, Brazil; 4 Department of Oral Surgery, Dental School, University of Cuiaba ´ – UNIC, Mato Grosso, Brazil; 5 MSc student Implantology Post Graduation Course, University Center of Araraquara - UNIARA, Sa ˜o Paulo, Brazil; 6 Univ Estadual Paulista - UNESP, Arac ¸atuba Dental School, Department of Dental Materials and Prosthodontics, Sa ˜ o Paulo, Brazil Key words: permanent tooth; treatment; exarticulation; decidous Correspondence to: Eloa ´ R. Luvizuto, Department of Surgery and Integrated Clinic, Arac ¸atuba Dental School, Univ Estadual Paulista - UNESP, Rua Jose ´ Bonifa ´ cio 1193, CEP: 16015-050, Arac ¸atuba, SP – Brazil Tel.: +55 18 8111 9256 Fax: +55 18 3623 2301 e-mail: eloa@foa.unesp.br Accepted 22 May, 2012 Abstract – This article presents a case report of autogenous tooth transplantation to the site of the fissure, in addition to bone augmentation with graft of autogenous bone harvested from the iliac crest, performed in a cleft palate patient, who had insufficient bone volume. A non-syndromic 10-year-old girl, with a unilateral cleft lip and palate, incisal transforamen fissures, agenesis of the maxillary left central incisor and both maxillary lateral incisors, was treated with autogenous bone graft in the cleft area. The orthodontic treatment plan was to replace the missing lateral incisors with the maxillary canines and to extract the mandibular first premolars. One of the mandibular premolars was extracted from its site with 2/3 of its root formation completed and transplanted to the maxillary left central incisor area. After orthodontic treatment, the anatomic crowns were characterized with composite resin. Autogenous tooth transplantation can be performed in the area of the fissure in young cleft palate patients, by performing bone graft augmentation before transplantation of the tooth, to gain sufficient recipient alveolar bone volume. A multidisciplinary approach is mandatory for the success of this clinical procedure, especially in cleft palate patients. Non-syndromic cleft lip and palate (NSCL/P) patients have a high rate of dental anomalies. Among these, tooth agenesis, supernumerary teeth, microdontia, fused teeth, ectopic eruption, giroversion, taurodon- tism, and enamel hypoplasia are the most common (1, 2). An epidemiologic study showed that Dental anomalies were identified in 39.9% of the NSCL/P patients, and tooth agenesis (47.5%), impacted teeth (13.1%), and microdontia (12.7%) were the most common anomalies (3). Furthermore, the severity of dental anomalies is directly related to the severity of the cleft (1, 2). Several dental treatment plans may be prepared to restore the function of missing tooth structures and esthetic appearance of the cleft lip and palate patient. One of the treatment plans is to perform an autogenous tooth transplantation at the site of tooth agenesis. Literature has shown 90% success rate in cases of premolar transplantation after follow up of 269 transplants (4). As regards young patients, pros- thetic options are very limited and transplantation may be the best treatment plan (5–8). A successful treatment plan in autogenous tooth transplantation depends on periodontal ligament (PDL) and pulp healing (9). To maintain their viability, extraction should be performed with minimal mechanical force, and extraoral time of the tooth should be as short as possible to reduce damage to the © 2012 John Wiley & Sons A/S 1 Dental Traumatology 2012; doi: 10.1111/j.1600-9657.2012.01163.x