Tooth autotransplantation: An umbrella review

Interdisciplinary management of an adolescent patient with a severely impacted mandibular canine

Impacted mandibular canines often result in a variety of clinical dilemmas. Orthodontic disimpaction of severely displaced mandibular canines may be extremely challenging and associated with significant patient discomfort and a high risk of iatrogenic damage. This case report demonstrates the interdisciplinary management of a horizontally impacted permanent mandibular canine, utilising a combination of three-dimensional radiology, biomodel fabrication and subsequent endodontic treatment. © 2024 Australian Dental Association.

Tooth autotransplantation and resin composite reshaping as a multidisciplinary approach for treating dental agenesia: A 10-year follow-up

CASE REPORT

This case report describes the multidisciplinary approach performed in a 9-year-old male patient with dental agenesia affecting teeth 21 and 22. Autotransplantation of the right upper second premolar with incomplete rhizogenesis to the missing area was combined with coronary reshaping with resin composite and orthodontic therapy. The treatment began with the extraction of the deciduous upper left central incisor, bone preparation for the recipient site of the donor tooth, atraumatic extraction of the right upper second premolar and immediate autotransplantation in the surgically prepared recipient site. Subsequently, sutures to reposition the flap and a rigid splint were performed. After 12 months, coronary reshaping of the autotransplanted tooth with resin composite was carried out. Orthodontic treatment involving the use of a fixed appliance was used to correct the interdental spaces and achieve adequate occlusion. Clinical and radiographic follow-up 10 years after tooth autotransplantation and 9 years after reshaping revealed partial obliteration of the pulp chamber, root resorption, ankylosis and the presence of endodontic treatment.

CONCLUSIONS

The long-term outcomes highlighted that tooth autotransplantation represents a biologically and cost-effective procedure for replacing missing teeth in young patients, particularly in cases of incomplete rhizogenesis of the autotransplanted tooth.

CLINICAL SIGNIFICANCE

This case report discusses tooth autotransplantation and resin composite reshaping as viable and long-term clinical options for treating young patients with dental agenesis.

Methodological quality of umbrella reviews in endodontics: A cross-sectional study

INTRODUCTION

In endodontics, the number of umbrella reviews has increased significantly over the last few years, but there is no evidence that they were methodologically sound. The aim of the current study was to appraise the methodological quality of umbrella reviews in endodontics, and to identify possible predictive factors associated with methodological quality.

METHODS

Umbrella reviews published in the discipline of endodontics until December 2023 were included. The methodological quality of the reviews was evaluated using a checklist consisting of 11 items. Each item in the checklist was evaluated by two independent assessors who assigned a score of '1' if it was fully addressed, '0.5' if it was partially ddressed, and '0' if it was not addressed. Bootstrapped multiple linear regression analysis was used to examine the association between the total scores awarded and five predictor variables (a priori protocol registration, year of publication, number of authors, journal impact factor (IF) and continent of the corresponding author). The statistical significance level was set as 5%.

RESULTS

A total of 27 reviews were included. Ninety-six per cent of the reviews adequately reported: eligibility criteria for selecting the reviews, details of the reviews, techniques for assessing the risk of bias or methodological quality of the individual systematic reviews they included. Only 30% of the reviews adequately managed overlapping primary studies within individual systematic reviews. Among the five predictors analysed, a priori protocol registration and journals with IFs were associated with significantly greater total methodological quality scores.

DISCUSSION

Several methodological shortcomings in the umbrella reviews published within the field of endodontics were revealed. Umbrella reviews published in journals with IFs and those with protocols registered a priori had significantly superior methodological quality scores.

CONCLUSION

In endodontics, authors intending to publish umbrella reviews should consider the limitations revealed in this study and follow the appropriate rules to ensure their reviews comply with the highest standards and provide accurate and dependable information and conclusions.

Combined application of artificial bone powders and concentrated growth factor membranes on the autotransplantation of mature third molars: A 5-year retrospective case series

AIM

This study aimed to observe the efficacy and outcomes of the combined application of artificial bone powder and concentrated growth factor (CGF) membranes for tooth transplantation in cases with wide recipient sockets and small donor teeth.

MATERIAL AND METHODS

A total of 36 teeth from 36 patients with wide recipient sockets and small donor teeth were enrolled. Autogenous tooth transplantation was performed using bone powders and CGF membranes. After transplantation, the visual analog scale (VAS) score, Landry Wound Healing Index, probing depth (PD), mobility, and gray value of the alveolar bone around the transplanted teeth were measured, and a patient satisfaction questionnaire was administered. All patients underwent clinical and radiographic examinations during follow-up.

RESULTS

The VAS score of 16 (44.4%) cases after 1 week was 0, and 26 (72.2%) patients showed excellent gingival healing after 2-4 weeks. The PD of a few cases was deeper than 3 mm during the first month; however, returned to normal after 3 months. Although the majority of the transplanted teeth possessed mobility greater than grade I during the first month, the mobility gradually improved within 3 months. The gray value of the alveolar bone around the transplanted teeth, 1 year postoperatively showed no difference with pre-operation (p > .05). During the mean follow-up period of 42.7 months (range 20-72 months), 33 of the 36 transplanted teeth remained in situ without clinical or radiographic complications, with an overall success rate of 91.7%.

CONCLUSIONS

Although the PD and mobility of the transplanted teeth were not ideal during the early stages of healing, most of the transplanted teeth had good clinical outcomes. In cases with large recipient sites accompanied by small donor teeth, autotransplantation of teeth using artificial bone powder combined with CGF membranes is a viable option and can lead to optimistic results with favorable success rates.

Evaluation of Bone Growth around Autotransplanted Teeth Using Cone-Beam Computed Tomographic Images

INTRODUCTION

The aim of this observational study was to evaluate bone growth at the recipient site of autotransplanted teeth using cone-beam computed tomography (CBCT) images and to compare it to the control tooth.

METHODS

Bone growth was measured on CBCT images obtained from the anterior region of the maxilla, which received a single transplant of immature premolars due to early loss of the central incisor. The results were compared to the bone growth of contralateral central incisor that served as control. The sample consisted of 13 autotransplanted teeth and 13 control teeth. It was determined the thickness of the buccal bone of the marginal ridge, the thickness of the palatal bone of the marginal ridge, the height of the maxillary bone, and the thickness of the maxillary bone at its mid-height. The measurements were analyzed statistically, adopting a significance level of 5%.

RESULTS

The mean interval between the dental autotransplantation surgery and the CBCT scan was 16.2 years. The mean thickness of the buccal bone of the marginal ridge, thickness of the palatal bone of the marginal ridge, height of the maxillary bone, and thickness of the maxillary bone at its mid-height were, respectively, 0.85, 0.94, 19.6, and 8.85 mm for autotransplanted teeth and 0.79, 1.09, 18.88, and 8.5 mm for control teeth. There were no significant differences in the bone measurements between autotransplanted and control teeth (P > .05).

CONCLUSIONS

The growth of maxillary bone in the region that received the autotransplanted tooth was proportional to that of maxillary bone that supports the contralateral tooth. Thus, autogenous transplantation is efficient in maintaining the bone architecture at the recipient site.

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.

Effect of 3D printed replicas on the duration of third molar autotransplantation surgery: A controlled clinical trial

BACKGROUND/AIM

This study aimed to develop a protocol that combines cone-beam computed tomography (CBCT), software, and 3D printing to design 3D replicas for tooth autotransplantation. The goal was to evaluate the impact of this approach on the extraoral time of the donor teeth and the total surgical time, thereby enhancing surgical efficiency and outcomes.

MATERIALS AND METHODS

A non-randomized trial (protocol 10.1186/ISRCTN13563091) was conducted at Riga Stradins University, enrolling 46 patients (13-22 years old) who required molar extraction and possessed a non-erupted third molar. The patients were sequentially assigned to a 3D replica group (24 patients) or a control group (22 patients). The primary outcome measured was the extra-alveolar time of the donor tooth, and the secondary outcome was the total duration of surgery. Both were assessed using a sample size capable of detecting a 10-min difference. A generalized linear model adjusted for various factors was used to test for significant time differences (p < .05) between the groups.

RESULTS

Forty-six patients were included in this analysis. The effect of using 3D replicas was not statistically significant and was associated with a decrease in the extraoral time of the donor tooth in seconds (β = -9.35, 95% CI [-40.86, 22.16]). For the total surgical time in minutes, the use of 3D replicas had a statistically significant impact, reducing the operation duration in minutes (β = -13.42, 95% CI [-24.50, -2.34]). No early complications were observed in either group, with all teeth present at 3-4 weeks post-surgery.

CONCLUSIONS

The integration of 3D printing technology can enhance the efficiency of autotransplantation surgeries, primarily by reducing surgical time.

New Perspectives in Third Molar Auto-Transplantation: Literature Review and a Case Report of Clinical, Financial and Forensic Implications

Third molar extraction is the most common procedure in oral and maxillofacial surgery. Third molars are considered less functional than other teeth and are often extracted. Sometimes, they are also used for auto-transplantation for the benefit of oral rehabilitation. Since many biological factors are involved in this surgical approach, herein, we outline a review of the biological characteristics of medico-legal/forensic interest, in addition to presenting a successful clinical case. A scoping review of currently available research data (following the principles of PRISMA-ScR or the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) on third molar auto-transplantation was conducted by drawing upon the main databases (Scopus, PubMed, Google Scholar and LILACS) to evaluate biological and clinical characteristics possibly relatable to forensic issues. All the collected data were summarized and elaborated on for the purpose of this article. A patient underwent extraction of the right upper first molar and auto-transplantation of the unerupted ipsilateral third molar. Many biologic and clinical factors are involved in the success of this clinical procedure. Knowledge of third molar anatomy, of its development and viable surgical approaches are all essential elements; just as important are the treatment of the tooth before and after transplantation and the integrity of the periodontal ligament. Follow-up of the clinical case for 5 years made it possible to verify the stability of the procedure over time. Third molar auto-transplantation is feasible and cost-effective. However, the use of third molars as donor teeth in auto-transplantation may have medico-legal implications. The lack of official protocols and consistent evidence-based guidelines for operators still prevent such a procedure from becoming mainstream; therefore, it is viewed with suspicion by clinicians and patients, even though the biological factors herein detected point to a reasonably high degree of safety. The understanding of many specific biological and clinical factors involved in the stability of third molar auto-transplantation allows for a thorough understanding of the forensic implications relevant to clinical practice. Effective communication and information provision are therefore of utmost importance, in the interest of both patients and doctors.

Guided Autotransplantation of an Immature Premolar to the Maxillary Incisor Region with Immediate Restoration of Esthetics: A Case Report

This case report describes the treatment of two maxillary central incisors following a traumatic injury with tooth #8 developing replacement resorption and #9 developing inflammatory root resorption. A 10-year-old girl presented complaining of pain in her maxillary central incisors. Upon clinical examination, teeth #8 and #9 were tender to percussion and palpation of the buccal soft tissues. Thermal and electrical pulpal sensitivity tests for teeth #8 and #9 were negative. An intraoral periapical radiograph revealed resorptive defects in tooth #8, which were filled with bone-like tissue, while tooth #9 had radiolucent resorptive defects along the root surface and a periapical radiolucency. A diagnosis of replacement resorption was made for tooth #8 and external inflammatory root resorption for tooth #9. Tooth #8 was treated with a multidisciplinary approach utilizing a guided template for premolar autotransplantation with an immediate veneer restoration, while tooth #9 was managed with root canal treatment using a tricalcium silicate cement to fill the canal. At the 1, 4, 8, 12, and 24-month follow-ups, the patient remained asymptomatic, and there was no radiographic evidence of root or periapical pathosis on either tooth. The root-end of the donor tooth transplanted to the #8 site continued to develop. This case report highlights successful interdisciplinary management of two forms of root resorption using modern treatment strategies that provided immediate function and esthetics to the maxillary central incisors in a young patient following trauma.

The cantilever contact-point resin bonded bridge; adhesion 2.0

AIM

When young patients are congenitally missing anterior teeth, different treatment modalities can be used to complement the dental arch. This article proposes a new treatment modality for the replacement of anterior teeth, the cantilever contact-point resin bonded bridge (CCP-RBB).

MATERIALS AND METHODS

In this proof of principle study, CCP-RBB's delivered by one operator were clinically assessed. Patients who were missing maxillary incisors and had suitable intra-oral conditions for a contact-point cantilever RBB were included. Three cases are presented to describe all adhesive steps. This proof of principle clinical study is presented with up to 60 months follow-up of the cantilever contact resin bonded bridges.

RESULTS

A total of 19 CCP-RBB's were evaluated after a mean period of 29.8 months. None of the restorations exhibited failure, carious lesions or fractures during the follow-up periods, demonstrating an absence of restoration debonding or the need for repair.

CONCLUSION

The new cantilever contact-point resin bonded bridge exhibited an excellent treatment modality without failure or debonding up to 5 years. More and extended duration in vivo studies are needed to evaluate this new treatment modality.

CLINICAL SIGNIFICANCE

In this proof of principle the new cantilever contact-point resin bonded bridge obtained excellent results up to 5 years of clinical follow-up.