Tooth Auto-Transplantation in Patients with Cleft Lip and/or Palate: A Systematic Review and Preliminary Clinical Protocol Proposal.

Background: Tooth auto-transplantation (TAT) is a surgical procedure in which a person's own tooth is extracted and repositioned in the recipient site. The aim of the study is to evaluate the clinical outcomes, treatment strategies, and methodological characteristics, and to propose a preliminary management algorithm of TAT in patients with cleft lip and/or palate (CLP). Methods: A search of the literature was conducted in PubMed, Google Scholar, ClinicalKey, Web of Science, and Cochrane Library databases until 21 June 2026. The systematic review was written according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Risk-of -bias was assessed by the Joanna Briggs Institute (JBI) tool. Results: Five case series and three case reports were included, with four "low" and four "moderate" JBI reporting-quality ratings (reflecting reporting completeness, not low risk of bias). They presented data about 23 patients and 27 TAT cases. The majority of patients (n = 16) received secondary alveolar bone graft with iliac bone. The most common donor teeth were mandibular premolars (n = 20). The most frequent recipient sites were the maxillary 2nd premolar (n = 9) and maxillary incisors (n = 15). Twenty-six teeth (96.3%) survived, and one tooth (3.7%) was extracted. Conclusions: TAT appears to be a promising treatment option in carefully selected CLP patients; however, further high-quality studies are needed with the application of our proposed algorithm.