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

Autologous Tooth Transplantation in Craniofacial Malformations

OBJECTIVE

To evaluate the applicability of transplanted teeth in young patients with craniofacial anomalies.

DESIGN

Observational study.

SETTING

Comprehensive Centre for Cleft Palate and Craniofacial Malformations.

PATIENTS/PARTICIPANTS

Patients with craniofacial anomalies who underwent tooth transplantation. Only children with complete clinical and radiological documentation and a follow-up period of at least 1.5 years were included.

INTERVENTIONS

Tooth transplantation.

MAIN OUTCOME MEASURE(S)

Retrospective evaluation of clinical records, pre- and postoperative radiographs, and operative charts. Clinical characteristics of patients, preoperative parameters and postoperative outcome parameters were collected.

RESULTS

A total of 17 patients with 23 tooth transplantations were included. The median follow-up period was 6.7 years. The pooled survival and success rates were 91%. Notably, one out of two teeth that were transplanted into the bone grafted alveolar cleft site had to be extracted, which might indicating a higher risk for this procedure. In total, two transplanted teeth had to be extracted during the follow-up period, one due to external resorption and the other one due to perio-endo lesion. One patient needed endodontic treatment due to pulp necrosis.

CONCLUSION

We consider tooth transplantation to be a reliable and suitable procedure in the dental rehabilitation of young patients with craniofacial anomalies and fitting concomitant circumstances. We encourage craniofacial teams to reconsider this option more frequently in appropriate cases.

Unusual Indications of Teeth Transplantation: A Literature Review

Dental implants are one of the best valid tooth replacement options, though these are not always appropriate in growing young patients. Tooth autotransplantation can be indicated then. However, this is not the only scenario where dental transplantation can be indicated. This comprehensive literature review discusses a wide range of unusual indications of dental transplantation as reported throughout the medical literature. Surprisingly, these indications include management of some developmental dental anomalies, hypodontia, oroantral communications, alveolar clefts, deficient alveolar ridges, ectopic teeth, and maxillofacial injuries. Limited high-quality evidence in this field regarding most of these unusual indications warrants further research of high-quality design.

Technology at the service of surgery in a new technique of autotransplantation by guided surgery: a case report

Background

The aim of this case report was to use a surgical technique for autotransplantation of tooth using virtually planned 3D printed surgical templates for guided osteotomy preparation of the recipient of donor tooth.

Case presentation

An 18-year-old male patient received autotransplantation of the right mandibular third molar to replace an included right second molar. This procedure was based on guided implant surgery methods by superimposition of DICOM files and 3D data sets of the jaws. In order to design a 3D-printed template with the aid of a fully digital workflow; the third molar was conserved in PRGF during the surgical procedure and the tooth socket was prepared with a template and the help of a 3D-printed donor tooth copy in order to prevent iatrogenic damage to the donor tooth. This template and replica were manufactured using 3D-printing techniques. The transplanted tooth was placed in infra-occlusion and fixed with a suture splint and root canal therapy was performed 15 days later. The intervention was be accomplished by performing preplanned virtual transplantations with guided osteotomies to ensure accurate donor tooth placement in the new recipient site. The 24 months follow-up showed physiological clinical and radiologic results compatible with healing periradicular tissues.

Conclusions

This approach enables the planning and production of a 3D printed surgical template using the latest diagnostic methods and techniques of guided implant surgery. These accurate virtually predesigned surgical templates and printed analogues of the donor tooth could facilitate autotransplantation, ensuring an atraumatic surgical protocol.

Orthodontics for Unilateral and Bilateral Cleft Deformities

Orthodontic treatment of patients with unilateral and bilateral cleft palate requires an extensive interdisciplinary approach to achieve optimal functional and esthetic rehabilitation. Intervention is divided into 3 main stages: early mixed, late mixed, and permanent dentition. Treatment modalities can vary according to developmental stage, severity of cleft, and presence of other dentofacial abnormalities. This article describes the use and efficacy of different orthodontic, orthopedic, and surgical approaches at each developmental stage of unilateral and bilateral clefts, whereby the orthodontist plays a pivotal role in the different phases of growth and development of the cleft lip and the patient.

Autotransplantation in combination with orthodontic treatment

INTRODUCTION

Autotransplantation is a surgical method in which a tooth is repositioned within the same patient. It can be described as a controlled reimplantation of an extracted tooth into a new, surgically prepared socket. The key to success of this treatment is the preservation and regeneration of the periodontal ligament. It is an underutilized technique which, if conducted with a multidisciplinary team, can be an ideal treatment option for patients with failing or missing teeth.

OBJECTIVES

The detailed clinical procedures, indications for this technique, and the factors affecting its success are discussed.

Survival rate of autotransplanted teeth after 5 years - A retrospective cohort study

BACKGROUND

Autotransplantation of teeth (TX) is a predictable treatment option, although this type of therapy is often overlooked compared to other types of restorations.

PURPOSE

As current literature contains few long-term studies concerning the outcome of autotransplanted immature molars, the aim was to evaluate results after a follow-up period of 5 years.

MATERIAL AND METHODS

This retrospective study enrolled all patients treated with immature autotransplanted molars after a follow-up period of 5 years. In order to ensure comparable results, survival rate was investigated as well as clinical and radiological parameters. Contralateral teeth (TC) were used as controls for further assessments and for ensuring comparable future results.

RESULTS

52 patients with 66 TX were examined. Mean age at the time of surgery was 19.64 years. Tooth survival rate after 5 years was 89.39%. The results for parameters such as PPD, BOP, mobility, dental caries, periapical pathologies and endodontic treatments showed no differences. In contrast, dental restorations (p < 0.001), occlusal contacts (p = 0.003) and sensitivity (p < 0.001) differed significantly between TX and TC.

CONCLUSIONS

The current findings clearly confirm that TX is an effective alternative treatment option to fixed prosthodontic restorations and dental implants, and provides for results equivalent to those with the patients' natural teeth.

Autotransplantation donor tooth site harvesting using piezosurgery

BACKGROUND

The harvesting of a tooth as a candidate for tooth autotransplantation requires that the delicate dental tissues around the tooth be minimally traumatized. This is especially so for the periradicular tissues of the tooth root and the follicular tissues surrounding the crown. The aim of this report is to describe the use of piezosurgery as an attempt at morbidity reduction in the harvesting of teeth for autotransplantation.

METHODS

A piezosurgical handpiece and its selection of tips were easily adapted to allow the harvesting and delivery of teeth for autotransplantation purposes.

RESULTS

Twenty premolar teeth were harvested using a piezosurgical device. The harvested teeth were subsequently successfully autotransplanted. All twenty teeth healed in a satisfactory manner without excessive mobility or ankyloses.

CONCLUSIONS

Piezosurgery avoids some of the traumatic aspects of harvesting teeth and removing bone which are associated with thermal damage from the use of conventional rotary instruments or saws. Piezosurgery can be adapted to facilitate the predictable harvesting of teeth for autotransplantation purposes.

Autotransplantation of Teeth Associated with Dentigerous Cyst: A Case Report

This paper discusses the treatment of impacted permanent incisors and unerupted ectopic canine associated with a dentigerous cyst in mixed dentition that was successfully managed by the combined approach of decompression followed by enucleation, primary closure, autotransplantation and endodontic therapy which enabled the utilization of teeth which were hitherto nonfunctional, transferred to an optimal functional and esthetic position. Decompression is a less invasive technique which reduces the cystic pressure, avoids a more stressful surgical procedure and necessity for general anesthesia. It gives more pleasing results as the body's own mechanism heals the defect gradually. Autotransplantation of teeth induces bone formation around the root with the help of viable periodontal ligament on their root surface. In this case, bone lost by cyst was regenerated and lamina dura was appreciable in the follow up radiographs and transplanted teeth are functioning well.

Secondary bone grafting with simultaneous auto-tooth transplantation to the alveolar cleft

One of the most important purposes of secondary bone grafting of the alveolar cleft is to stabilize the maxillary alveolar arch with completion of the dental arch. We report a case of secondary bone grafting with simultaneous auto-tooth transplantation to the alveolar cleft, using particulate cancellous bone and marrow (PCBM) combined with platelet-rich plasma (PRP), which contains many growth factors. The patient was born with a bilateral cleft lip and left buccal-localized cleft alveolus. We performed bone grafting to the cleft using PCBM with PRP and transplantation of the supernumerary tooth under general anesthesia when the patient was aged 11 years, 10 months. The postoperative course was uneventful and without any complications. The orthodontic treatment was nearly complete 10 months after the operation. The transplanted tooth was stable, and a normal gingival contour was attained during the 2-year follow-up period. The case was successful in achieving a stable occlusal condition within a short period. We suggest secondary bone grafting with simultaneous auto-tooth transplantation as an option for alveolar cleft treatment.