A long-term study of 370 autotransplanted premolars. Part III. Periodontal healing subsequent to transplantation

Treatment options for impacted maxillary canines and occurrence of ankylotic and resorptive processes: a 20-year retrospective study

BACKGROUND

This 20-year retrospective study aimed to evaluate the treatment methods used in patients with impacted maxillary permanent canines and to determine the occurrence of ankylotic and resorptive processes and their association with potential risk factors.

METHODS

The cohort consisted of 351 consecutive Caucasian patients (120 males and 231 females, mean age 18.4 and 19.9 years, respectively) with 420 impacted maxillary permanent canines. CT and CBCT findings were subsequently confirmed during surgery. Statistical analyses were performed by the generalized linear models, Pearson x2 and Fisher exact tests using the statistical programs R and Statistica v. 14.

RESULTS

A total of 273 (65.0%) impacted canines were aligned in the dental arch by orthodontic traction after surgical exposure, this treatment was predominant in patients under 20 years of age. Surgical extraction was performed in 115 (27.2%) impacted canines and was more common in older patients. Ankylotic changes were recorded in 61 (14.5%) impacted canines. The probability of ankylosis increased with age, particularly after the patient's 20th year of life (p < 0.001). Patients were 1.2% likely to develop ankylosis at age 15 years, 4.3% at age 20 years, 14.1% at age 25 years, and 96.8% at age 45 years. Invasive cervical root resorption (ICRR) was found in 8 (1.9%) canines. In 4 canines (1.0%), root ankylosis in addition to ICRR was observed. In contrast to ankylosis, whose frequency of occurrence increased with age, the occurrence of ICRR resulting from PDL damage during surgery was more typical in younger patients. Canines in a high position above the root apices of the adjacent teeth, with a horizontal inclination of the longitudinal axis, with the crown located deep in the center of the alveolar bone and with labiopalatal position, should be considered critically impacted canines with a high risk to failure of orthodontic traction.

CONCLUSION

In conclusion, the treatment of impacted canines depends mainly on the age of the patient, and the position and inclination of the longitudinal axis of the impacted tooth. To select an adequate treatment method, we recommend CBCT examination, which allows a precise analysis of the position of impacted canines.

Long-Term Evaluation of Tooth Transplantation: An Umbrella Review

Aim/Objective: This umbrella review of systematic reviews aims to summarize the available data regarding both success and survival rates of tooth autotransplantation, in addition to analyzing the risk factors that are connected to those rates. Methods: This umbrella review was performed according to the evaluation of various meta-analyses and systematic reviews following AMSTAR2 guidelines. A systematic search of literature on PubMed, Scopus, MEDLINE, EMBASE, and the Cochrane Database. Six systematic reviews were included. Explicit inclusion and exclusion criteria were applied. It is registered in PROSPERO under the registration number (CRD-42023415623). Results: The studies reviewed were written from 2014 to 2018, which extracted the information from various studies spanning from 1968 to 2014. According to the selected studies regarding autotransplanted teeth in humans, they showed the following: A survival rate overall of 87.39% and a success rate overall of 90.29%. These factors were the most common in relation to the success of the autotransplanted teeth: age, gender, and stage of root development. On the other hand, common unfavorable results linked to the transplanted teeth in these studies were failure, ankylosis, and internal root resorption, followed by extraction and hypermobility. Conclusions: The wide body of evidence gathered illustrates that autotransplantation is an operation that dispenses high rates of survival and success. Furthermore, risk factors like root development stage, recipient site, and donor tooth type established a remarkable association with the negative outcomes of the procedure. For successful tooth autotransplantation, patient selection is crucial. Younger patients and those with donor teeth at an optimal stage of root development typically experience better outcomes. Preoperative planning should include comprehensive evaluations and advanced imaging techniques to accurately assess both the donor tooth and the recipient site. Nonetheless, on account of heterogeneity and the quality of the studies included in this investigation, caution should be taken when interpreting the mentioned results.

Midterm outcomes of autogenous mature third molars transplantation into surgically created sockets: A retrospective cohort study

BACKGROUND/AIMS

The purpose of this study was to observe the outcome of mature third molars transplantation into surgically created sockets with the assistance of computer designed three dimensional (3-D) printed replicas and compare its outcome with the conventional fresh socket autotransplantation.

MATERIAL AND METHODS

This study included total of 96 mature third molars autotransplanted in 96 cases with the guidance of computer designed 3-D printed replicas. Forty-eight teeth autotransplanted into surgically created sockets were enrolled into the surgically created socket group and 48 teeth conventionally autotransplanted into fresh sockets were enrolled into the fresh socket group. In the surgically created socket group, mature third molars were autotransplanted into surgically prepared sockets at the site of previously missed or extracted molars in the alveolar bone and in the fresh socket group, autotransplantation of mature third molars were performed in fresh sockets of extracted diseased molars simultaneously. After transplantation, the visual analogue scale (VAS) score, Landry Wound Healing Index (LWHI), mobility and probing depth (PD) of the transplanted teeth were measured and the patient satisfaction questionnaire were held in both group. All patients underwent clinical and radiographic examinations during the follow-up.

RESULTS

During the mean follow-up period of 47.63 ± 16.78 months (range 18-78 months), 92 out of 96 teeth remained in situ without clinical or radiographic complications with overall success rate of 95.83%. No statistically significant differences were found in success and survival rates between the two group. The average extra-oral time of the donor teeth were 60.76 ± 22.41 s and mean positioning trials of the donor teeth were 2.43 ± 1.19. The VAS score at Day 1 in the surgically created socket group was higher than the fresh socket group (p < .05). LWHI scores in the surgically created group were lower than the fresh socket group during the first 2 weeks (p < .05). The degree of mobility of the transplanted teeth in both group showed no statistically significant difference during the first 3 months. PD in the surgically created group were higher than the fresh socket group in the first month but there were no statistically significant difference after 1 month. Twenty-six out of 48 cases in the surgically created group needed crown restoration while only 10 cases went through crown restoration in the fresh socket group. Most patients in both group were satisfied with the treatment.

CONCLUSIONS

Autogenous mature third molars transplantation into surgically created sockets is as effective as conventional fresh socket transplantation. This technique is worth recommending in carefully selected cases and optimistic results can be achieved.

Use of 3D printing models for donor tooth extraction in autotransplantation cases

OBJECTIVE

To clarify whether the 3D printing model has auxiliary functions in toto extraction of donor tooth in autotransplantation cases.

METHODS

Two hundred and sixty patients who would have operation of ATT were divided into two groups. In group 1, determination of the tooth extraction in toto was predicted only according to the clinical and imaging examination. In group 2, the prediction was performed according to the clinical and imaging examination as well as the 3D model of donor tooth pre-extraction. A prespctive clinical study was designed on intra-group comparison between the predicted and actual donor teeth situation when extraction in cases of ATT. The consistent rate for the predicted results and the actual results were compared with the two groups.

RESULTS

A remarkable difference was observed between the predicted results and the actual results of tooth positions and root numbers in group without model (p < 0,05). The consistency rate of the model group (94.62%) was significantly higher than that of non 3D model group (86.15%) (p = 0.034).

CONCLUSION

The 3D printing model for the donor tooth is helpful for dentists to predict the accuracy of toto extraction of donor teeth in autotransplantation cases.

An evaluation of 910 premolars transplanted in the anterior region-A retrospective analysis of survival, success, and complications

AIM

The aim this retrospective analysis was to evaluate the survival, success and possible complications of transplanted premolars to the anterior region subdivided in development stage and patient's age.

MATERIALS AND METHODS

The material comprised patients that underwent a tooth transplantation between April 2004 and December 2021. A total of 910 premolars were transplanted in 707 patients. Tooth mobility, oral hygiene, and periodontal parameters were clinically evaluated. Standardized radiographs were used to evaluate pulpal and periodontal healing and root formation. The cumulative survival rate was calculated using the Kaplan-Meier method.

RESULTS

The data were subdivided in three groups based on the stage of root development and patient's age. The average age at surgery was 16 years. The main indication for transplantation was trauma, followed by agenesis and other indications. Two premolars were lost during the whole observation period. The overall survival and success in the immature premolars group after an observation period of 10 years was 99.8%. The 10-year survival and success rate when fully developed premolars were transplanted in the anterior region in adolescents were 100% and 96.3%, respectively. In adults, the 10-year survival and success rate were 87.5%.

CONCLUSION

Transplantation of premolars with developing and fully developed roots to the anterior region in children, adolescents, and adults is a predictable treatment modality.

Evaluation of the 3D Technology in the Auto-transplantation: An Original Research

Introduction

Using three-dimensional printed duplicates of the donor teeth, three-dimensional auto-transplantation is a medical procedure that moves a tooth from one location inside a patient to another. The intraoperative practicability during 3D auto-transplantation of teeth was evaluated in the present study.

Material and Methods

A prospective multicenter clinical study was done among the subjects. "Preoperative cone-beam computed tomography imaging," "computer-assisted design (CAD)," and "computer-assisted manufacturing (CAM)" were used in all operations to make a 3D duplicate of the donor teeth. The clinical parameters that were evaluated were the time required for the fit, number of attempts to fit, and intra-operative experience.

Results

Canines, premolars, molars, and one extra tooth were all transplanted during the 200 auto-transplantation surgeries among 152 subjects. An initial satisfactory fit of the donor tooth and an extra-alveolar time of less than one minute were achieved in 80% of the surgeries. The extra-alveolar time exceeded 3 minutes in ten teeth. Difficulties that were faced were related to the imaging, patient cooperation, and the bone quality.

Conclusions

The application of the duplicate teeth by 3D printing of a donor tooth all through auto-transplantation techniques reduced the time the tooth stays extra-alveolar as well as the efforts at transplant fitting during implantation. This allowed for more challenging surgeries as well as a speedy and reliable therapy.

Validation of a Cox prognostic model for tooth autotransplantation

OBJECTIVES

This study aimed to validate our Cox proportional hazards prognostic model for autotransplantation of teeth with complete root formation using prognostic index (PI) and determine whether the prognosis can be predicted.

PATIENTS AND METHODS

The Protocol group, as a training data set for validation, consisted of 259 autotransplanted teeth to create a PI using the Cox model, as described previously. The Pre-protocol group, as the first validation data set, consisted of 95 autotransplanted teeth treated without a protocol. The Post-protocol group, as the second validation data set, consisted of 61 autotransplanted teeth obtained after the establishment of the prognostic model. Because four prognostic factors, including history of root canal treatment (yes), number of roots (multirooted), source of donor tooth (maxillary tooth), and duration of edentulism (≥2.5 months), were selected as a Cox prognostic model, 16 patterns of PI were constructed. First, the autotransplantated teeth in the Protocol group were divided into low- and high-risk groups respectively according to the median of PI as the cutoff value. The survival curves of low- and high-risk groups were calculated using the Kaplan-Meier method and tested using the log-rank test. Then, in the Pre- and Post-protocol groups, all transplanted teeth were divided into low-and high-risk teeth by the median of PI and the survival curves of low- and high- risk teeth were analyzed statistically in a similar manner.

RESULTS

The survival curves of the low- and high-risk groups diverged significantly in the Protocol and Post-protocol groups. In the Pre-protocol group, the curves of the low- and high-risk groups were separated, and the low-risk survival rate was improved.

CONCLUSIONS

Our Cox prognostic model for autotransplantation of teeth with complete root formation was useful in predicting the prognosis by external validation using PI.

Translational approach to tooth autotransplantation: A 27-year case study

BACKGROUND

The aim of this case report was to present a translational approach to tooth autotransplantation using jiggling forces to enlarge the periodontal ligament (PDL) space before autotransplantation, with the goal of improving treatment success and long-term survival.

METHODS

A 23-year-old patient, undergoing orthodontic therapy and with an unrestorable maxillary first molar, was proposed to have a healthy and fully-erupted maxillary third molar transplanted in the socket of the first molar. Jiggling forces were applied to the third molar to enlarge the PDL space and facilitate the preservation of PDL fibers on the root surfaces during the extraction.

RESULTS

Jiggling forces induced hypermobility and widened PDL space of the third molar. The autotransplantation was successful and the patient was followed regularly over a 27-year period. At the 27-year visit, the patient showed optimal chewing function, oral plaque control, and absence of gingivitis. The transplanted molar exhibited periodontal health and absence of mobility. Probing depth of 5 mm and radiographic external root resorption was noted on a localized area of the transplanted tooth which had experienced traumatic and unintentional removal of PDL fibers during the extraction.

CONCLUSIONS

A translational approach was proposed by integrating knowledge from the fields of orthodontics, trauma from occlusion, and replantation. It validated the crucial importance of maintaining healthy PDL fibers on the root surface and demonstrated clinically the successful autotransplantation of a fully formed third molar into the socket of a first molar with a retention of 27 years.

KEY POINTS

Why is this case new information? This case provided evidence of successful autotransplantation of a molar with complete root formation. It reported the longest-term follow-up (27 years) present in the literature. Most importantly, it used a translational medicine approach to apply concepts from the fields of orthodontics and traumatic occlusion to improve the success of the autotransplantation procedure. What are the keys to the successful management of this case? Jiggling forces induced tooth hypermobility and increased the PDL space of the tooth planned for autotransplantation. In turn, they facilitated the atraumatic extraction and preservation of the PDL fibers on the transplanted tooth, improving the success of the reattachment of periodontal fibers. What are the primary limitations to success in this case? Traumatic extraction resulting in the unintended removal of PDL fibers from the tooth planned for autotransplantation, or intentional removal of PDL fibers with root planing are expected to decrease the success rate of the autotransplantation procedure. This is due to the lack of viable PDL cells necessary for reattachment.

Pulp Revascularization in an Autotransplanted Mature Tooth: Visualization with Magnetic Resonance Imaging and Histopathologic Correlation

Autotransplantation of a mature tooth usually leads to pulpal necrosis. Root canal treatment is recommended to prevent related inflammatory complications a few weeks after surgery. Extraoral root-end resection may facilitate reperfusion and obviate root canal treatment, but cannot be pictured with conventional dental radiography at this point in time. In the case of a lower mature transplanted molar, contrast-enhanced magnetic resonance imaging proved to be a feasible method for visualizing pulp revascularization just 4 weeks after autotransplantation. Consequently, root canal treatment was obviated. Nevertheless, the tooth had to be extracted 18 months postoperatively due to external cervical root resorption, probably caused by the extraction trauma. This allowed the histological processing and examination of the newly generated intracanal tissue. Uninflamed fibrovascular connective tissue was found, while odontoblasts or cementoblast-like cells were absent. These findings indicated that it was most likely stem cells from the bone marrow and the periodontal ligament that drove the regeneration.

Tooth autotransplantation: An umbrella review

Tooth autotransplantation is a versatile procedure with several clinical applications among patients across different age groups. The success of this procedure depends on multiple factors. Despite the wealth of studies available, no single primary study or systematic review is able to report on every factor affecting the outcomes of autotransplantation. The aims of this umbrella review were to evaluate treatment-related and patient-related outcomes of autotransplantation and to assess the pre-, peri- or post-operative factors that could affect these. An umbrella review was conducted according to the PRISMA statement. A literature search of five databases was performed up to 25 September 2022. Systematic Reviews (SR) with and without meta-analysis evaluating autotransplantation were included. Calibration among reviewers was carried out prior to study selection, data extraction and Risk of Bias (RoB) assessment. Study overlap was calculated using corrected covered area. Meta-meta-analysis (MMA) was performed for suitable SRs. The AMSTAR 2 critical appraisal tool was used to evaluate the quality of evidence. Seventeen SRs met the inclusion criteria. Only two SRs were suitable for conduct of MMA on autotransplantation of open apex teeth. The 5-year and 10-year survival rates were >95%. A narrative summary on factors that could affect autotransplantation outcomes and comparisons of autotransplantation to other treatment options were reported. Five SRs were rated as 'low quality' and 12 SRs were rated as 'critically low quality' in the AMSTAR 2 RoB assessment. In order to facilitate a more homogenous pool of data for subsequent meta-analysis, an Autotransplantation Outcome Index was also proposed to standardise the definition of outcomes. Autotransplantation of teeth with open apices have a high survival rate. Future studies should standardise the reporting of clinical and radiographic findings, as well as the definition of outcomes.

Multimodal Imaging of Dental Pulp Healing Patterns following Tooth Autotransplantation And Regenerative Endodontic Treatment

INTRODUCTION

Understanding the healing process of dental pulp after tooth autotransplantation (TAT) and regenerative endodontic treatment (RET) of immature teeth is important both clinically and scientifically. This study aimed to characterize the pattern of dental pulp healing in human teeth that underwent TAT and RET using state-of-the-art imaging techniques.

MATERIALS AND METHODS

This study examined four human teeth, two premolars that underwent TAT and two central incisors that received RET. The premolars were extracted after one year (case 1) and two years (case 2) due to ankylosis, while the central incisors were extracted after three years (cases 3 and 4) for orthodontic reasons. Nanofocus x-ray computed tomography was used to image the samples before being processed for histological and immunohistochemical analysis. Laser scanning confocal second harmonic generation imaging (SHG) was used to examine the patterns of collagen deposition. A maturity-matched premolar was included as a negative control for the histological and SHG analysis.

RESULTS

Analysis of the four cases revealed different patterns of dental pulp healing. Similarities were observed in the progressive obliteration of the root canal space. However, a striking loss of typical pulpal architecture was observed in the TAT cases, while a pulp-like tissue was observed in one of the RET cases. Odontoblast-like cells were observed in cases 1 and 3.

CONCLUSION

This study provided insights into the patterns of dental pulp healing after TAT and RET. The SHG imaging sheds light on the patterns of collagen deposition during reparative dentin formation.

Successful Non-Surgical Root Canal Treatment on Auto-Transplanted Maxillary Premolar with Apical Periodontitis

Auto-transplantation is a procedure that replaces traumatized or congenitally missing teeth. While most auto-transplanted teeth are successfully integrated into recipient sites, the donor tooth may develop apical periodontitis, causing early failure. In the present case report, the periodontic resident performed the procedure on a 15-year-old male by selecting donor teeth #4 and #13 and transplanting them at recipient sites #29 and #20, respectively. After 6 weeks, the patient was referred to the endodontic resident for evaluation of tooth #20 due to symptom development. While one auto-transplanted tooth (donor tooth #4, recipient site #29) was successfully integrated, the other (donor tooth #13, recipient site #20) was unsuccessful: the patient was diagnosed with pulp necrosis and a chronic apical abscess. Because of the patient's age, collaboration among periodontic, endodontic, and orthodontic residents/specialists informed the clinical decision to pursue non-surgical root canal treatment (NSRCT) rather than extraction. The canal was cleaned and shaped to a size #80 using copious irrigation of 2.5% sodium hypochlorite (NaOCl), followed by 17% ethylenediaminetetraacetic acid (EDTA) via the EndoVac Negative Pressure Irrigation system. The tooth was dried with paper points, and then calcium hydroxide was mixed with 2.5% NaOCl and placed with an amalgam carrier 2 mm from the radiographic apex. The tooth was next temporized with Teflon tape and Fuji TRIAGE. Four weeks later, after confirming the patient was asymptomatic and tooth mobility had decreased, the canal was obturated using EndoSequence Bioceramic Root Repair Material Fast Set Putty in 2 mm incremental layers to achieve a three-dimensional fill and create an apical plug to prevent gutta-percha extrusion, then backfilled in incremental layers of gutta-percha to the cementoenamel junction (CEJ). At the 8-month follow-up, the patient was asymptomatic, and the periodontal ligament (PDL) had no signs of periapical pathology. When teeth undergoing auto-transplantation procedures develop apical periodontitis, NSRCT can be implemented.

Biofabrication of engineered dento-alveolar tissue

Oral health is essential for a good overall health. Dento-alveolar conditions have a high prevalence, ranging from tooth decay periodontitis to alveolar bone resorption. However, oral tissues exhibit a limited regenerative capacity, and full recovery is challenging. Therefore, regenerative therapies for dento-alveolar tissue (e.g., alveolar bone, periodontal membrane, dentin-pulp complex) have gained much attention, and novel approaches have been proposed in recent decades. This review focuses on the cells, biomaterials and the biofabrication methods used to develop therapies for tooth root bioengineering. Examples of the techniques covered are the multitude of additive manufacturing techniques and bioprinting approaches used to create scaffolds or tissue constructs. Furthermore, biomaterials and stem cells utilized during biofabrication will also be described for different target tissues. As these new therapies gradually become a reality in the lab, the translation to the clinic is still minute, with a further need to overcome multiple challenges and broaden the clinical application of these alternatives.

Guided Autotransplantation of Impacted Canines Using a CAD/CAM Surgical Template

Autotransplantation is a potential treatment alternative when orthodontic traction of an impacted tooth is difficult. In this article, we describe two cases of guided autotransplantation of an impacted canine using a computer-aided designed and manufactured surgical template. The impacted canine was segmented on preoperative cone-beam computed tomography images to ensure a sufficient periodontal ligament space and placement of the donor tooth with the least pressure on it. The canine was virtually transposed using a simulation program considering the adjacent teeth. The surgical template, which was connected to the occlusal stop on adjacent teeth, was designed and 3D-printed with polymer resin. The recipient site was prepared using the surgical template, followed by immediate transplantation of the surgically extracted canine into the socket. The transplanted donor tooth was positioned in planned infra-occlusion to prevent occlusal interference. It was then splinted with the adjacent teeth for initial stabilization. During follow-up, one transplanted tooth showed pulp canal obliteration and the other had suspected pulp necrosis; endodontic treatment was performed. One year after the procedure, the periradicular condition of both teeth was favorable.

Multidisciplinary Approach for Autotransplantation and Restoration of a Maxillary Premolar into an Area of an Avulsed Anterior Tooth: A Case Report with a 6-Year Follow-up

The loss of an anterior tooth because of avulsion has been reported in up to 3% of dental injuries. Management alternatives, such as implant-supported restorations and a fixed partial denture, are contraindicated in growing patients because of the continuous growth of the alveolar process. At the same time, orthodontic treatment for gap closure will result in asymmetry and will require adjustment of the adjacent healthy teeth. Therefore, restoring a missing tooth imposes a treatment challenge, especially in children and young adults. Tooth autotransplantation is a treatment modality with high reported survival and success rates that overcome these mentioned limitations. It might also help to preserve the alveolar bone and the soft tissues. This case report describes a multidisciplinary approach for managing a 13-year-old boy who lost his right maxillary central incisor because of a fall. Management included autotransplantation of the left maxillary second premolar to the site of the lost right maxillary central incisor, management of external inflammatory resorption with an endodontic treatment, orthodontic treatment, and aesthetic restoration of the area with composite resin crowns that can be adapted to the expected changes of the jaws during the craniofacial growing period. At the 6-year follow-up, the teeth demonstrated a positive outcome.

The outcomes of auto-transplanted premolars in the anterior maxilla following traumatic dental injuries

BACKGROUND/AIMS

Tooth auto-transplantation is a treatment option, which is often not considered to replace anterior maxillary incisors in children and adolescents. There are multiple prognostic factors that may influence the outcomes of premolar auto-transplantation, but there is limited evidence from human studies. The aim of this study was to report the outcomes of auto-transplanted premolars in the anterior maxilla following traumatic dental injuries (TDIs) and to identify their prognostic factors.

MATERIALS AND METHODS

The clinical records of patients who had premolars transplanted in the anterior maxilla following TDI, with appropriate radiographs and a minimal of 1-year follow-up, were reviewed retrospectively. A specific data extraction form was developed, tested and used to collect information for the prognostic factors and outcomes.

RESULTS

The cohort included 120 patients with 144 auto-transplanted premolars. The mean age was 12.2 years (±2.0), and the mean observation period was 3.7 years (±1.8). The success rate was 80%, and the survival rate was 93%. Unfavourable outcomes included external replacement resorption in 12.5%, uncontrolled external inflammatory resorption in 2.7%, and both resorption types in 4.9% of teeth. Periodontal healing was significantly associated with donor tooth root maturity, graft handling at the time of surgery including ease of donor tooth extraction and placement at the recipient sites, recipient site alveolar bone status, and post-operative transplant mobility. Seventy-four teeth (53.4%) were immature at the time of transplantation where pulp revascularisation was anticipated, and 52 (70%) of those had radiographic and clinical signs of pulp healing. Pulp healing was significantly related to donor tooth eruption stage, ease of extraction of donor tooth, and ease of placement in the recipient site.

CONCLUSIONS

Good outcomes were observed for premolar teeth auto-transplanted in the anterior maxilla. The main prognostic factors were ease of extraction of donor tooth and ease of placement in the recipient sites and donor tooth root maturity.

Tooth auto-transplantation: A bibliometric analysis of the top 100 most-cited articles

BACKGROUND/AIM

Tooth auto-transplantation has recently gained high clinical acceptance. The aim of this study was to identify the top 100 most-cited articles regarding tooth auto-transplantation, to analyse multiple citations and publication metrics and to outline the historical scientific advancements in this field.

MATERIALS AND METHODS

An advanced search of the Clarivate Analytics' Web of Science 'Core Collection' and Elsevier's Scopus databases utilising specific keywords related to tooth auto-transplantation between 1971 and 2021 was performed. The retrieved articles were ranked in descending order based on their Web of Science citation counts and further cross-matched with citation data from Scopus. The extracted data included citation counts, citation density, level of evidence, year of publication, contributing authors names and institutes, corresponding author's address, journal of publication, journal local citations index, cumulative growth index, keywords and keywords Plus. Data analysis was performed using descriptive statistics and graphical mapping.

RESULTS

A total of 1290 articles were retrieved. The top 100 most-cited articles received a total of 4899 (Web of Science) and 5250 (Scopus) citations. Among these, cohort studies (29%) and case series (18%) were the most common study designs. Scandinavian countries produced major contributions in defining the top 100 most-cited articles and ranked within the top 5 countries based on the number of publications and citations per year. The greatest contributing authors were Schwartz O (n = 12), Andreasen JO (n = 8) and Paulsen HU (n = 6), and they were affiliated with Copenhagen, Denmark. The top contributing journals were American Journal of Orthodontics and Dentofacial Orthopedics, International Journal of Oral and Maxillofacial Surgery, Oral Surgery Oral Medicine Oral Pathology Oral Radiology, European Journal of Orthodontics, Dental Traumatology and Journal of Oral and Maxillofacial Surgery.

CONCLUSION

This bibliometric analysis revealed a large geographical scientific interest and broad development in the field of tooth auto-transplantation spanning multiple dental disciplines.

Orthodontic management of a horizontally impacted maxillary incisor in an adolescent patient

Horizontal maxillary incisor impaction is not common, but it affects facial esthetics, phonetics, and the patient's self-esteem. Therefore, it is necessary to manage this problem as early as possible. This case report presents a patient with an unerupted maxillary left central incisor combined with anterior and left posterior crossbite, edge-to-edge overbite on the right and left anterior open bite, low smile line, and mild skeletal Class III discrepancy. The treatment consisted of 3 stages: (1) maxillary expansion and sufficient space creation for the impacted tooth; (2) surgical exposure by closed-eruption technique; and (3) induced eruption of impaction. The treatment outcome was highly favorable. Maxillary impaction erupted in the proper position with a normal clinical crown height and consonant gingival line with the adjacent teeth. Maxillary and mandibular teeth had normal and stable occlusion. The 3-year follow-up demonstrated an esthetically functional outcome after orthodontically induced tooth eruption. This treatment required a good treatment plan by the orthodontist to obtain satisfactory results.

Extraoral Root-End Resection May Promote Pulpal Revascularization in Autotransplanted Mature Teeth-A Retrospective Study

Tooth germ autotransplantation of open apices of the teeth exhibits high pulpal healing rates, whereas that of mature permanent teeth normally causes irreversible pulpal necrosis. Extraoral root-end resection (EORER) during transplantation may promote pulpal revascularization (PRV) in transplanted mature teeth and reduce endodontic treatment requirement. This study compared the primary outcomes of survival rates, PRV, and root resorption and determined relevant confounders in autotransplanted mature and immature teeth. The medical charts of consecutive patients who underwent tooth autotransplantation between January 2017 and March 2021 were evaluated. Teeth with a documented follow-up of at least 1 year were included. During the study period, 59 teeth were transplanted in 44 patients. Overall, 2 teeth were excluded owing to missing data; 57 teeth were analyzed, including 25 mature teeth additionally treated with EORER. After a mean follow-up of 21.2 ± 16.1 months, no significant differences in primary outcomes were detected. Fifty-five teeth remained in situ (96.5%), and radiological signs of root resorption were detected in 9/57 teeth (15.8%). PRV was positive in 54/57 teeth (94.7%). Surgical duration and PRV failure were significantly associated with high incidences of root resorption. Mature teeth autotransplantation with EORER yielded similar results to immature teeth autotransplantation and is a feasible treatment option. Long surgery and failed revascularization increased root resorption rates. More factors should be evaluated in larger trials with longer observation periods.

Immediate Tooth Autotransplantation with Root Canal Filling and Partially Demineralized Dentin/Cementum Matrix into Congenital Missing Tooth Region

This clinical report describes immediate tooth auto-transplantation with an autograft of partially demineralized dentin/cementum matrix (pDDM), based on an orthodontic treatment plan for a 16-year-old male patient with a congenital missing tooth (#45). First, vital teeth (#14, #24) were extracted, and root canal filling (#14) was immediately performed with the support of a fixation device. Simultaneously, the tooth (#24) was crushed in an electric mill for 1 min, and the crushed granules were partially demineralized in 2% HNO₃ solution for 20 min as the graft material. Next, the donor tooth was transplanted into the created socket (#45), and stabilized using an enamel bonding agent. The wet pDDM was loaded into the location of the congenital missing tooth, and the flap was repositioned. The bonding agent for stabilization was removed at 28 days, and also small contact points between the transplanted tooth and the upper premolar (#14) were added using photopolymerizable composite resin. X-ray photos were taken sequentially, and there were no postoperative complications. The radiographic images showed that the periodontal ligament space and alveolar ridge line could be observed at 18 months. The pDDM was harmonized with the mandible, and the remodeled bone-like shadow was observed in the graft region. We concluded that immediate tooth transplantation with root canal fillings and autogenous pDDM may be a valuable alternative to dental implanting or bridge formation for patients with a congenital missing tooth, followed by orthodontic treatment.

Does Root Development Status Affect the Outcome of Tooth Autotransplantation? A Systematic Review and Meta-Analysis

Background: Tooth autotransplantation is defined as the surgical repositioning of an autogenous tooth in another surgical site within the same individual. Aim: The aim of this research was to analyze the outcome of tooth transplantation using immature donor teeth compared with closed apex teeth and to compare differences between donor tooth positions on the arch. Methods: Electronic and manual literature searches were performed in different databases, including the National Library of Medicine (MEDLINE), EMBASE (OVID), Cochrane Central (CENTRAL), and the digital library of the Universitat Internacional de Catalunya (UIC University) from 1978 to March 2021. Studies were selected when they fulfilled the following criteria: only human prospective clinical studies, minimum sample size of 10 patients, minimum follow-up of 1 year, studies reporting or with at least deducible data on survival rates, immediate tooth autotransplantation with completed or incomplete root formation, and publications in the English language. A meta-analysis of random effects was developed to estimate the global effect measure of the survival rate, success rate, and root resorption involving the total sample, as well as open- and closed-apex groups. Results: Twenty-four articles were eligible for analysis. The Cohen’s kappa corresponding to this review was 0.87, and the risk assessment was considered low–moderate for the included studies. Overall survival and success rates were 95.9% and 89.4%, respectively, with a mean follow-up of 4 years and an overall mean age of 25.2 ± 12.3 years. Closed apex teeth showed a survival rate of 3.9% lower than that of open apex teeth. Higher complication rates were found for both inflammatory external root resorption and replacement root resorption in the closed-apex group, without reaching statistical significance. Conclusions: Tooth autotransplantation is a viable treatment alternative, regardless of the apical condition, with high survival and success rates after a mean follow-up of 4 years. Open-apex donor teeth could be considered the gold-standard option, showing lower complication rates when compared to closed-apex donor teeth. Future randomized controlled clinical studies are needed to examine the long-term prognosis of this technique.

Root Membrane Replantation as an Alternative Technique for the Socket Preservation

Background and Overview. Socket shield is a technique that allows the maintenance of tissue volumes. In the reported clinical case, the replantation of the buccal root fragment mistakenly extracted during a socket shield surgery is performed. We present a follow-up to 5 years with an unexpected healing.Case Description. An 88-year-old patient underwent an immediate loading implant placement associated with the replantation of the mistakenly extracted root fragment. The shaping of the fragment was performed extraorally, and the replantation was done so that the fragment protruded above the crest margin.Conclusions and Practical Implications. The 5-year follow-up shows an uneventful healing of the implant. At 48 months, postoperative CBCT exam reports images compatible with the regeneration of the bone over the portion of root that protruded over the margin. The outcome suggests clinical implications, as the opportunity to easily shape the fragment extraorally and replant sound portion of the root (not necessary the buccal) in buccal socket with bone defect.

Three-Dimensional (3D) Stereolithographic Tooth Replicas Accuracy Evaluation: In Vitro Pilot Study for Dental Auto-Transplant Surgical Procedures

After immediate tooth extraction or after alveolar socket healing, tooth transplants are increasingly used for functional restoration of edentulous maxillary areas. Recent studies have shown the periodontal ligament (PDL) viability and the tooth housing time in the adapted neo-alveolus as key factors for transplantation success. During surgical time, 3D stereolithographic replicas are used for fitting test procedures. In this paper, the accuracy of 3D dental replicas, compared with the corresponding natural teeth, is assessed in surgical transplantation. Lamb skulls were selected and submitted to Cone Beam Computer Tomography (CBCT). Scanning information, converted into Standard Digital Imaging and Communications in Medicine (DICOM) and Standard Triangulation Language (STL), was sent to the Volux X-ray Centre for 3D replica printing. After the tooth extractions, all lambs’ incisors were measured with a digital caliber and compared with the 3D replicas. Volume and dimensional error values were evaluated. All replicas showed macroscopically smaller volume (45.54%). Root replicas showed higher variations compared with the crown areas, with several unreplicated apical root areas. The cement–enamel junction tooth area was replicated quite faithfully, and the base area relative error showed 9.8% mean value. Even further studies with a larger number of replicas are needed. Data obtained confirmed high volumes of macroscopic discrepancies with several unreproduced apical root sites. The achieved accuracy (90.2%) confirmed that the 3D replicas cannot be used to reduce the surgical time during transplantation predictable procedures.

Periodontal and Periapical Outcomes of Surgical Extrusion: A Prospective Clinical Volumetric Study

INTRODUCTION

Outcome predictors for the restoration of endodontically treated teeth mainly include cavity wall integrity and the presence of a 1.5-2 mm ferrule. However, in some clinical situations, the aforementioned predictors cannot be achieved. Three different techniques have been proposed to obtain an adequate ferrule respecting the supracrestal tissue attachment: surgical crown lengthening, orthodontic forced eruption, and surgical extrusion. There are little published prospective data evaluating periodontal changes after surgical extrusion. Therefore, the aims of this study were to report the outcome of surgical extrusion in single-rooted teeth, to digitally evaluate soft tissue volumetric changes after surgical extrusion, and to observe patient satisfaction regarding the treatment after a minimum of 1 year.

METHODS

This prospective clinical study was performed between 2017 and 2020. Thirteen patients referred for surgical extrusion met the following inclusion criteria: nonsmokers; systemically healthy with at least 1 straight, single-rooted tooth with an insufficient ferrule; a favorable tooth crown-to-root ratio, and no periodontal pathology. Preoperative clinical variables included patient age, sex and phenotype, tooth number, tooth mobility, crown-to-root ratio, gingival index (GI), probing pocket depths at 6 sites, bleeding on probing (BOP), and mesial and distal interproximal papillae volume. Surgical extrusion was performed by a single operator who completed the root canal treatment/retreatment and restored the teeth with a crown. One year later, all patients were controlled, and the following variables were recorded: tooth mobility, crown-to-root ratio, GI, pocket depth, BOP, interproximal papillae aspect, soft tissue rebound, periapical healing, marginal bone loss, and patient-reported outcome measures of the treatment. All variables were analyzed using a descriptive method (mean, %). The Wilcoxon test was used to evaluate pre- and postoperative clinical parameters at a significance level of .05.

RESULTS

At a mean follow-up period of 18.8 months, no teeth were extracted. Compared with preoperative GI and BOP, a significant reduction was observed at 1 year after surgery. Likewise, no significant differences in probing depths were shown, and only 1 tooth presented a type 2 mobility. The mean soft tissue rebound was -0.46 ± 0.69 mm. Overall, no significant interproximal papillae height loss was observed.Apical lesions were completely healed after surgery. The tooth crown-to-root ratio was favorable in all cases before extrusion, whereas in 3 cases it was appropriate (1 = 1), and only 1 case presented >25% of marginal bone loss during the follow-up period. The reported success rate was 92.3%, and patients were generally satisfied with the outcome.

CONCLUSIONS

Surgical extrusion of single-rooted teeth was successful with minimal or no soft tissue loss, and patients were satisfied with the surgical procedure and the esthetic result.

Orthodontic Extrusion vs. Surgical Extrusion to Rehabilitate Severely Damaged Teeth: A Literature Review

The need to rehabilitate severely compromised teeth is frequent in daily clinical practice. Tooth extraction and replacement with dental implant represents a common treatment choice. However, the survival rate for implants is inferior to teeth, even if severely damaged but properly treated. In order to reestablish a physiological supracrestal tissue attachment of damaged teeth and to arrange an efficient ferrule effect, three options can be considered: crown lengthening, orthodontic extrusion and surgical extrusion. Crown lengthening is considered an invasive technique that causes the removal of part of the bony support, while both orthodontic and surgical extrusion can avoid this inconvenience and can be used successfully in the treatment of severely damaged teeth. The aim of the present narrative review is to compare advantages, disadvantages, time of therapy required, contraindications and complications of both techniques.

Autotransplantation of the Third Molar: A Therapeutic Alternative to the Rehabilitation of a Missing Tooth: A Scoping Review

INTRODUCTION

Tooth autotransplantation is the repositioning of an erupted, partially erupted, or non-erupted autologous tooth from one site to another within the same individual. Several factors influence the success rate of the autotransplant, such as the stage of root development, the morphology of the tooth, the surgical procedure selected, the extraoral time, the shape of the recipient socket, the vascularity of the recipient bed, and the vitality of the cells of the periodontal ligament. The aim of this scoping review was to provide the most up-to-date information and data on the clinical principles of the third-molar autograft and thus provide clinical considerations for its success.

MATERIALS AND METHODS

This review was conducted based on PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews). The research was conducted by searching for keywords in three databases-PubMed, Scopus and Google Scholar-by two independent reviewers following the PRISMA protocol, from which 599 records were identified.

CONCLUSIONS

Third-molar autotransplantation is a valid solution to replace missing teeth. The key to the success of this technique is the surgical procedure, which must be as atraumatic as possible to preserve the periodontal ligament of the tooth to be transplanted. The success rate is also linked to the stage of development of the root, with a worse prognosis in the case of a complete root.

Effect of donor-specific blood transfusions on allotransplanted teeth in a monkey model: Histoquantification of periodontal healing

BACKGROUND/AIMS

Pre-transplant blood transfusions have previously shown a positive effect on organ allograft survival in humans and various animal species. The aims of this study were, first, to evaluate the effect of pre-transplant donor-specific blood transfusions on periodontal healing of fully developed allotransplanted teeth in monkeys; and second, to investigate the immune response against donor antigens and to determine a possible correlation between alloimmune reactions and histopathological signs of rejection.

MATERIAL AND METHODS

Twenty monkeys (Cercopithecus aethiops) were divided into ten pairs with similar sizes of incisors. One monkey in each pair gave three transfusions to the other monkey with 1-week intervals. One week after the last transfusion, each pair exchanged simultaneously a central maxillary incisor and a lateral mandibular incisor. The corresponding central maxillary and mandibular lateral incisors were autotransplanted to the contralateral sockets. All teeth were treated endodontically per-operatively. Histocompatibility was evaluated by mixed lymphocyte culture before the first transfusion, while alloantibodies and cell-mediated alloresponses were measured before transfusions and at 2 and 8 weeks after transplantation. All animals were sacrificed 8 weeks after tooth transplantation. Serial sections of the transplanted teeth were quantified histologically.

RESULTS

Mixed lymphocyte cultures showed positive reactions in 19 of 20 cases, indicating incompatibility. The majority of the monkeys developed antibodies towards the tooth donor. Cell-mediated cytotoxicity was negative in all monkeys. Histoquantification revealed a mean score of 70% normal periodontal ligament (PDL) in autotransplanted teeth, with 5% ankylosis. The allografts had a mean score of 17% normal PDL and 63% ankylosis, with no significant influence of transfusion. However, in the mandibular grafts, a tendency towards a positive transfusion effect was seen.

CONCLUSIONS

Donor-specific blood transfusion did not reduce ankylosis in tooth allografts. The healing of mandibular incisor tooth allografts was improved, but not that of maxillary incisors. Donor-specific antibodies showed no effect on the survival of allograft PDL.

Status of the alveolar bone after autotransplantation of developing premolars to the anterior maxilla assessed by CBCT measurements

Background/Aims

Autotransplantation of developing premolars is an established treatment to replace missing teeth in the anterior maxilla in growing patients with a reported success rate of over 90%. The normal shape of the alveolus is observed after transplantation, but data on the presence and amount of alveolar bone after healing has not been previously reported. The aim of this study was to look for potential differences in alveolar bone dimensions between sites where autotransplanted premolars replaced missing incisors and control sites of contralateral incisors.

Material/Methods

There were 11 patients aged between 10 and 12 years five months (mean age: 10 years and 7 months) who underwent autotransplantation of a premolar to replace a central incisor. Cone Beam Computed Tomography (CBCT) performed at least 1 year after transplantation served to evaluate bone at sites of autotransplanted premolars and controls (contralateral maxillary central incisor). The thickness of the labial bone, plus the height and width of the alveolar process were measured on scans and compared at transplant and control sites.

Results

Mean thicknesses of the labial bone at the transplant and control sites were 0.78 mm and 0.82 mm respectively. Mean alveolar bone height was 15.15 mm at the transplant sites and 15.12 mm at the control sites. The mean marginal thickness of the alveolus was 7.75 mm at the transplant sites and 7.98 mm at the control sites. Mean thicknesses of the alveolus for half of its vertical dimension at the transplant and control sites were 7.54 mm and 8.03 mm, respectively.

Conclusion

The mean values of bone thickness, width and height of the alveolar process at sites of transplanted premolars were comparable to the mean values for the control incisors. Successful autotransplantation of developing premolars to replace missing central incisors allowed preservation of alveolar bone in the anterior maxilla.

Autotransplantation of a completely developed impacted maxillary canine: A 7-year follow-up case report

BACKGROUND

Impacted maxillary canines are likely to be extracted in adult patients once orthodontic treatment is ruled out. The missing teeth are generally replaced with dental implants.

CASE DESCRIPTION

The authors report the clinical case of a 45-year-old man who was missing the maxillary left canine for 30 years. Radiographic examination revealed that the maxillary permanent left canine was palatally impacted. The tooth was transplanted into the prepared socket on the missing tooth site and secured in the desired position with a flexible wire splint. During the 7-year follow-up, the tooth remained clinically sound with no radiographic manifestation of inflammatory or root resorption.

PRACTICAL IMPLICATIONS

The prognosis for the transplanted tooth was favorable after long-term follow-up observation. This result suggests that autotransplantation of impacted maxillary canines can be a viable treatment option for some adult patients who expect to retain their natural teeth.

Intentional replantation and Biodentine root reconstruction. A case report with 10-year follow-up

AIM

To describe the innovative use of intentional replantation for Biodentine root reconstruction of a previously treated immature maxillary central incisor with vertically extended crown root fracture and root detachment.

SUMMARY

In the present case, the intentional replantation of a failing, previously treated maxillary central incisor with a vertical crown/root fracture in a 12-year-old male patient is reported. The gross extrusion of gutta-percha points beyond the apex and the pre-existing extensive, trauma related, distal cervical dentinal detachment justified the intentional replantation treatment plan as an option for tooth retention. After controlling the infection by oral administration of antibiotics, the immature tooth was extracted atraumatically and kept in gauze embedded with tooth replantation medium. The apical third of the immature fractured tooth was treated with ultrasonics and an MTA plug (MTA Angelus White, Londrina, Brazil). The distal cervical dentinal root defect was reconstructed with Biodentine (Septodont, St. Maur-des-Fosses, France). The tooth was reinserted and stabilized to the adjacent teeth for 2 weeks. The total extraoral time before replantation was 25 min. In the 10 years since the initial trauma (9 years after the intervention) radiographic and clinical evaluation revealed uneventful healing of the periapical lesion, normal mobility and no detectable signs of external replacement resorption.

KEY LEARNING POINTS

Intentional replantation may provide a viable treatment alternative in cases of severe complicated crown/ root fractures Biodentine may be useful in the reconstruction of external root defects in crown root fractured traumatic dental injuries.

European Society of Endodontology position statement: Surgical extrusion, intentional replantation and tooth autotransplantation: European Society of Endodontology developed by

This European Society of Endodontology (ESE) position statement on surgical extrusion, intentional replantation and tooth autotransplantation represents the consensus of an expert committee, convened by the ESE. A narrative review in the International Endodontic Journal (Plotino et al. 2020, international Endodontic Journal, 53, 1636-52) formed the basis for the position statement. The review provided detailed information on the background, clinical procedures and the outcome of surgical extrusion, intentional replantation and tooth autotransplantation techniques. The aim of the current statement is to summarize the best available evidence on these clinical techniques to provide appropriate clinical guidance to undergraduate and postgraduate students, dental practitioners, clinical teachers and researchers. The current position statement will be updated by the ESE periodically to reflect new evidence as it becomes available to provide the most current treatment guidance for clinical practice.

Use of 3-dimensional-Printed Guide in Hemisection and Autotransplantation of a Fusion Tooth: A Case Report

Three-dimensional (3D)-printed guides have been used in endodontics to prepare a conservative access, locate calcified or missing canals, and perform precisive osteotomy in apicoectomy. Here, we present the treatment of a fusion tooth by combining 3D printing technology and endodontic intervention in a 10-year-old patient. The bifid crown of a maxillary right lateral incisor #7 had caused esthetic concerns and malocclusion. Clinical and radiographic examinations showed that #7 is fused with a supernumerary tooth with 2 independent root canals. The fusion involved the entire crown and the coronal and middle roots. Because of financial constraints, a multidisciplinary approach involving endodontic, orthodontic, and prosthodontic treatment was excluded. We hemisectioned the tooth intraorally with a 3D-printed guide, extracted the supernumerary tooth, and transplanted tooth #7 to a position with improved esthetics and occlusion. A 3D-printed tooth replica was used to prepare the recipient site for autotransplantation. At the 6-month follow-up, tooth #7 was diagnosed with pulp necrosis and asymptomatic apical periodontitis. Root canal treatment of tooth #7 was completed, and osseous healing was observed 8 months later. The patient had no clinical symptoms and was satisfied with the outcome 14 months after hemisection and transplantation. The open space between teeth #7 and #8 was closed without orthodontic treatment. We present an alternative option to treat a fusion tooth in young patients who do not opt for other treatment options because of their stage of development or for socio-economic reasons. Techniques in modern endodontics, such as cone-beam computed tomographic imaging and 3D printing, should be adapted when it is beneficial to patients.

Autotransplantation of Two Immature Third Molars with the Use of L-PRF

Tooth autotransplantation is a procedure which provides the extraction of an erupted or impacted tooth and its repositioning to another site in the oral cavity. This Case Report describes a successful case of two autotransplantations of open-apex mandibular third molars in place of the hopeless first mandibular molars with the use of L-PRF in a growing patient. A 15-year-old male patient was referred to the Dental Clinic for the extractions of the two hopeless mandibular first molars. Autotransplantation was considered the best treatment option for both sites 36 and 46, because the presence of two impacted mandibular third molars (38 and 48) with an incomplete root formation. Teeth 36 and 46 were extracted and replaced with teeth 38 and 48. The patient had an uneventful healing. At follow-up visits, the two autotransplanted teeth showed physiologic mobility, absence of inflammation and discomfort, and absence of infection; probing depth values were within normal range, and the vitality tests were positive. After 2 years, the teeth in position 36 and 46 showed absence of infection and mobility, and positive pulp vitality tests and the radiographic examinations exhibited closure of the root apices as well as absence of any periapical radiolucency or root resorption. Tooth autotransplantation is a good treatment option in case of tooth loss offering an alternative to traditional or implant-supported prosthesis especially for growing patients.

The orthodontic bonding properties of human enamel after cryopreservation

The aim was to investigate the effect of cryopreservation on the enamel bonding properties of orthodontic brackets. Sixty-six human premolars were randomly allocated to a control group or a cryopreserved group. Conventional stainless-steel orthodontic brackets were bonded with a light cure adhesive on the buccal side of the premolars. The shear bond strength (SBS) was determined at a crosshead speed of 1 mm/min. The SBS and adhesive remnant index (ARI) were evaluated respectively by an independent samples t test and Fisher's exact test (α≤0.05). The mean failure load was lower in the cryopreserved group. However, this difference in SBS was not significant (p=0.443). In both groups, the ARI mostly indicated a failure at the enamel-adhesive interface. The mean ARI scores for both groups were not significantly different (p=0.099). Within the limitations of this macro bond strength testing, it can be concluded that cryopreservation does not significantly affect the bonding properties of enamel.

A retrospective analysis of autotransplanted teeth including an evaluation of a novel surgical technique

OBJECTIVES

To assess survival rates and frequency of complications for immature and mature autotransplanted teeth after at least 1 year in function.

MATERIALS AND METHODS

All consecutive patients who had undergone tooth autotransplantation between 2000 and 2018 were invited to a clinical and radiographic follow-up examination. First, survival rates were calculated on the basis of a phone inquiry. A clinical follow-up examination allowed for the calculation of the success rate, i.e., absence of any potentially adverse clinical and radiographic findings of the autotransplanted teeth. Moreover, the effect of demographic, dental, and surgical variables on survival/success was analyzed statistically.

RESULTS

Thirty-eight teeth in 35 patients were transplanted during the study period. Three teeth in 3 patients were excluded due to missing records. All other patients were successfully contacted and interviewed by phone. Out of these 35 transplants, 32 were still in function, and 3 had been extracted, yielding a 91.4% survival probability after a median follow-up of 3.4 years. Of the 32 teeth qualifying for the success analysis, 20 (62.5%) showed absence of potentially adverse findings, while 3 (9.4%) required root canal treatment (RCT). Out of the 9 mature, root-end resected transplants, 4 exhibited ongoing pulp canal obliteration, all with a single root canal. Postoperative and potentially adverse findings or failures were found more frequently in the group of mature transplants (55.6%) than immature transplants (30.4%) and for molars (72.7%) than premolars (17.6%) or canines (25%). None of the potential predictors had a statistically significant effect on survival or success.

CONCLUSION

Autotransplanted teeth yielded a satisfying midterm survival rate regardless of their stage of development. An additional, extraoral root-end resection of mature transplants may lead to rates of revascularization and postoperative pulp canal obliteration higher than the data reported on unmodified mature transplants.

CLINICAL RELEVANCE

Extraoral root-end resection of mature teeth shows promising outcomes for transplants especially with a single root canal and uncomplicated root morphology.

Success, Survival Rate, and Soft Tissue Esthetic of Tooth Autotransplantation

INTRODUCTION

The aim of this retrospective study was to assess the success, survival rate, and soft tissue esthetic of autotransplanted teeth.

METHODS

This study included patients with at least 1 tooth autotransplanted to the maxilla during childhood or adolescence. The autotransplantation technique included the removal of an immature tooth from a donor site and its placement in the maxilla as a replacement for a missing or extremely compromised tooth. The cases were properly restored to ensure function and esthetic. To be considered successful, the tooth should be asymptomatic at the time of assessment, no pain to palpation and percussion, have no signs of apical periodontitis or a sinus tract, have a periodontal probe ≤3, and have an absence of root resorption and development of at least 70% of the normal root. The esthetic evaluation of the soft tissue was based on the pink esthetic score and graded as very unsatisfactory, unsatisfactory, poor, fair, good, or excellent. Data were statistically analyzed at a significance level of 5%.

RESULTS

Thirty-five patients (23 males and 12 females) had 43 anterior teeth replaced, including 42 central incisors and 1 lateral incisor. The follow-up period ranged from 1-25 years. In regard to success and the survival rate, 43 teeth were assessed; 34 cases (79.07%) were considered successful and 9 (20.93%) unsuccessful. Only 1 tooth was lost, and 42 teeth remained functional (survival rate = 97.67%). In regard to the esthetic, 40 teeth could be assessed and were considered as excellent (30%), good (35%), fair (27.5%), and poor (7.5%); there were no reports of unsatisfactory or very unsatisfactory cases.

CONCLUSIONS

Tooth autotransplantation can be considered a valid procedure to replace lost teeth in the maxilla, presenting high survival and success rates. The overall esthetic of the patients was considered as satisfactory.

Survival and success of autotransplanted impacted maxillary canines during short-term follow-up: A prospective case-control study

OBJECTIVES

This prospective clinical trial aimed to examine the predictability of maxillary canine transplantation as compared to biological canine eruption. Additional objectives were to examine hard and soft tissue outcomes, including aesthetic outcome compared to outcomes with the contralateral canines.

SETTINGS AND SAMPLE POPULATION

The sample comprised 17 consecutively transplanted maxillary canines in 17 patients (mean age at surgery, 18 years; range, 11-29 years). Minimal follow-up time was 12 months post-transplantation. Clinical and radiographic parameters were recorded for the transplanted and contralateral canines, showing a natural eruption pattern.

MATERIAL AND METHODS

The Maxillary Canine Aesthetic Index (MCAI) and the Autotransplanted Maxillary Canine Radiological Index (AMCRI) were scored for all upper canines. Successful transplantation was considered as the absence of pathology during intermittent clinical and radiographic controls and a good-to-excellent outcome compared to the contralateral biological erupted canine, as defined by the MCAI and AMCRI.

RESULTS

The mean follow-up period was 28 months (±9; range, 12-40 months). The overall survival rate was 100%, and the success rate reached 68% at 1 year post-operatively. Significant predictors of success were the extra-oral time during transplantation, amount of damage to the root surface, quality of surrounding tissues and immediate post-operative oral hygiene.

CONCLUSION

Standardized measurements demonstrated clinically satisfactory outcomes with maxillary canine autotransplantation compared to outcomes with the contralateral canine during 1-3 years of follow-up. The potential predictors of success identified here should be confirmed with long-term follow-up studies.

Autotransplanted premolars with incomplete root formation in a growing patient with multiple missing teeth

A boy aged 8 years 11-months with 4 missing teeth in his mandibular arch and with a skeletal Class II pattern was treated with autotransplantation of developing premolars from his maxillary arch with the aid of temporary skeletal anchorage devices. The active treatment duration was 25 months. After treatment, he had a normal occlusion, and his profile was improved. Posttreatment records at 12 months showed stable occlusion and successfully autotransplanted premolars.

The use of 3D additive manufacturing technology in autogenous dental transplantation

Background

In medicine and dentistry, 3D technology allows the virtual planning and printing of surgical replicas of anatomical structures that can facilitate certain transplant procedures. In dentistry, 3D technology is useful in autogenous tooth transplantation.

Case presentation

We present a clinical case of an ectopic mandibular second premolar, describing the preoperative planning with dental replicas and the autotransplantation surgery. 3D prints of the surgical replica of the tooth to be transplanted was made using an Objet30 Prime® Printer, PolyJet. Clinical controls performed at 3, 6 and 12 months indicated the satisfactory evolution of the transplanted tooth.

Conclusion

3D additive manufacturing technology allows the preparation of a new recipient socket with the aid of a surgical replica of the tooth to be transplanted, thus minimizing handling and extraoral time.

Effect of Orthodontic Treatment on Tooth Autotransplantation: Systematic Review of Controlled Clinical Trials

This systematic review was focused on evaluating tooth autotransplantation, considering its impacts on the teeth, bone, soft tissues, and aesthetics in orthodontic patients. A bibliographic search was conducted without limitations on year of publication or language in the databases of PubMed, Web of Science, Scopus, Medline Complete, Cochrane, Clinical Trials, and Trials Central. For triage of articles, indications, surgical planning, orthodontic movement, risk factors for treatment, and long-term follow-ups were considered. For outcomes, the results with reference to teeth, alveolar bone, periodontal tissues, and esthetic satisfaction were considered. Risk of bias was evaluated using the methodological index for nonrandomized studies-MINORS. The results showed 10 controlled clinical trials, and no randomized clinical trials were found. The selected studies included 715 patients and 934 autotransplanted teeth among which there were premolars, molars, and anterior teeth evaluated in the long term, indicating that orthodontics associated with autotransplantation indicated a result that was generally clinically acceptable. The quality of the set of evidence was considered medium due to the presence of different methodological problems, risk of bias, and significant heterogeneity in the evaluated studies. There was a sufficient body of evidence that justified autotransplantation in patients who needed orthodontic movement. In teeth, there was an increase in root resorption influenced by orthodontics, but without impacting on the general clinical result in the long term. Bone and periodontal tissue do not appear to be affected by orthodontics. The patient’s aesthetic satisfaction was not considered in the studies.

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.

Autotransplantation of third molars with completely formed roots to replace compromised molars with the computer-aided rapid prototyping

OBJECTIVE

To describe a method to fabricate donor tooth replica to assist surgeons in preparation of recipient socket during tooth autotransplantation.

MATERIALS AND METHODS

A total of 28 compromised molars in 27 patients were transplanted with third molars using computer-aided rapid prototyping (CARP) technique. Surgery time and extra-alveolar time were documented. Postoperatively, the distance between cervix of transplanted tooth and the alveolar wall was measured. The degree of postoperative pain experienced was assessed with visual analog scale at day 1, 3, and 7.

RESULTS

From 28 clinical cases, the average extra-alveolar time and surgery time were 2.5 minutes (±1.3) and 44 minutes (±6.8), respectively. Postoperatively, the average distance between cervix of transplanted tooth and the alveolar wall was 0.87 mm (±0.15) at the mesial-cervix, 0.95 mm (±0.17) at the distal-cervix, 0.88 mm (±0.18) at the buccal-cervix, and 0.95 mm (±0.13) at the lingual-cervix. The value of visual analog scale score significantly decreased from day 1 to day 3.

CONCLUSIONS

CARP is a reliable technique for fabrication of tooth like surgical replicas in conventional autotransplantation.

CLINICAL SIGNIFICANCE

CARP technique minimized extra-oral time, reduced iatrogenic damage, and consequently increased the survival rate of tooth autotransplantation.

Ectopic eruption of the second premolar: an analysis of four different treatment approaches

PURPOSE

Ectopic second premolars may lead to impaction and loss of space in the jaws, and in rare cases even to resorption of the first permanent molar. The aim of this study was to analyse different treatment strategies of ectopic second premolars and if possible give guidelines on when to favour different treatment approaches.

MATERIALS AND METHODS

The study was a retrospective, non-randomised, outcome analysis of treatment on 41 ectopic second premolars in 37 patients (24 females and 13 males). In all cases oral examination, radiographs (pre-, peri-, and post) and full medical history were obtained. The treatment options included: (a) spontaneous eruption, (b) spontaneous eruption + extraction of primary tooth, (c) surgical exposure, (d) surgical uprighting, and (e) surgical uprighting + orthodontic extrusion. For evaluation each tooth was scored according to: (1) stage of root development, (2) distance between edges of the premolar and first permanent molar, (3) depth of impaction, (4) inclination, (5) horizontal position of the tooth. The level of significance was set to 5%.

RESULTS

Only mild cases of ectopic second premolars are self-correcting. Based on the position of the tooth in the jaw different treatment options may be chosen, these may include: extraction of primary predecessor (impaction depth < 5 mm, inclination < 55°), surgical exposure of tooth germ (impaction depth < 5.5 mm, inclination < 95°) or surgical uprighting (impaction depth > 5.5 mm with no inclination limit).

CONCLUSION

If there is no sign of self-correction after a short observation period, it is important to consider active treatment to help guiding the tooth into the correct eruption pathway.