Tooth loss of anterior region is the result of congenital anomaly or of a traumatic event. Maxillary lateral incisor is very important in masticatory function because permit lateral protrusion movement of mandible and is a key point in aesthetic of smile. Tooth agenesis is one of the most common developmental anomalies in man and it often is a feature of syndromes. Tooth developmental results by interactions of genetic and environmental factors, in particular mutations in MSX1, PAX9 contribute tooth agenesis, but also radiotherapy, chemotherapy, maternal systemic diseases aid genetic aberrations. Upper lateral incisor is in a unfavorable anatomical position because it's in fusion area of facial processes for this it's the most common tooth loss in oral cleft. The management of these patients is complex and it includes an orthodontic, prosthetic and surgical analysis This report addresses the fundamental considerations related to replacement of congenitally missing lateral incisors by a team approach.