Transplanting teeth successfully: autografts and allografts that work

Successful auto-transplantation of a mandibular third molar: A case report on restoring esthetics and function in a 66-year-old patient

Key Clinical Message

This article describes a successful case of auto-transplantation of a mandibular third molar to replace a non-restorable second molar, highlighting the efficacy of this procedure in restoring function with factors like asepsis, surgical technique, and postoperative care contributing to the success.

Abstract

This case report describes successful auto-transplantation of a mandibular third molar to replace a non-restorable second molar in a 66-year-old patient. The procedure involved atraumatic extraction, repositioning, and stabilization of the donor tooth, followed by postoperative care and 1-year follow-up. The favorable outcome highlights the potential of mature third molar transplantation as an effective approach for replacement of missing or non-restorable permanent molar teeth to restore esthetics and function. The success of the procedure was attributed to factors such as asepsis, atraumatic surgical technique, preservation of the periodontal ligament (PDL) vitality, minimal extraoral time, optimal occlusion, and adequate fixation. At the 1-year follow-up, the patient was asymptomatic with stable occlusion, highlighting the optimal efficacy of the procedure.

Long-Term Survival Rate of Autogenous Tooth Transplantation: Up to 162 Months

Background and Objectives: The purpose of this study is to observe the usefulness of autogenous tooth transplantation by examining the cumulative survival rate according to the period of auto-transplanted teeth as pre-implant treatment. Materials and Methods: This study was conducted on 111 patients who visited Kyungpook National University Dental Hospital and underwent autogenous tooth transplantation between November 2008 and January 2021 (about 13 years). The cumulative survival rate of autogenous tooth transplantation according to the causes of extraction of the recipient tooth (caries, periapical lesion, crack, crown fracture, periodontitis) and condition of opposing teeth (natural teeth vs. fixed prosthesis). The cumulative survival rate of autogenous tooth transplantation according to the age (under 30 vs. over 30) was also investigated and it was examined whether there were any differences in each factor. Results: The average follow-up period was 12 months, followed by a maximum of 162 months. The 24-month cumulative survival rate of all auto-transplanted teeth was 91.7%, 83.1% at 60 months and the 162-month cumulative survival rate was 30.1%. There were no statistical differences between the causes of extraction of the recipient's teeth, differences in the condition of the opposing teeth, and differences under and over the age of 30. Conclusions: The survival rate of autogenous tooth transplantation appears to be influenced by the conditions of the donor tooth rather than the conditions of the recipient tooth. Although autogenous tooth transplantation cannot completely replace implant treatment, it is meaningful in that it can slightly delay or at least earn the time until implant placement is possible.

Unusual Indications of Teeth Transplantation: A Literature Review

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

Interventive dental therapy in Ancient Egypt (ca. 2686 BCE - AD 323): A critical review

OBJECTIVE

This paper critically reviews the history of research concerning ancient Egyptian interventive dental therapy between the Old Kingdom - Graeco-Roman Period (c. 2686 BCE-AD 323), concentrating on the published osteological evidence.

MATERIALS

Eight osteological examples reportedly exhibiting markers of interventive dental therapy, including a mandible presenting purported evidence for a drilling procedure for the relief of an abscess; four dental bridges; a maxilla with multiple teeth extracted; and two carious lesion fillings.

METHODS

Previous claims are critically reviewed using a qualitative research method involving collecting and critiquing published data, both primary evidence and relevant secondary literature.

CONCLUSIONS

Without further scientific analysis, only four specimens can currently be plausibly attributed to ancient Egyptian interventive dental therapy including the Tura el-Asmant Bridge, the enucleation described for a Graeco-Roman child, and two carious lesion fillings identified in the mummified individuals known as the 'Redpath Mummy' (RM2718) and 'Sekhem' (AIG3343).

SIGNIFICANCE

Several enduring historiographical and museological problems within the discourse are identified, revising our understanding of the nature and scope of ancient Egyptian interventive dental therapy based on currently known osteological evidence.

LIMITATIONS

This review relies on the published documentation for each osteological example, namely images, which in several cases are poor quality.

SUGGESTIONS FOR FURTHER RESEARCH

There is significant opportunity for further scientific analysis of the osteological evidence discussed. In each case, specific potential methods to improve our understanding and interpretation have been identified.

Knowledge, attitude, and practice of autotransplantation among the practicing pediatric dentists in Chennai - A questionnaire study

Background

Autotransplantation is a minor surgical procedure which involves transplantation of teeth within the same oral cavity. For children, autotransplantation may be considered as a provisional measure with good survival probability. It offers a viable biological approach for replacing the missing teeth and also for orthodontic treatments in children.

Aim

The aim of this study is to assess the knowledge, attitude, and practice of autotransplantation among pediatric dentists in Chennai, India.

Methods

An 18-item questionnaire was developed, piloted, and distributed among 100 practicing pediatric dentists in Chennai, India. Descriptive statistical analysis was done using Chi-square test.

Results

Seventy valid responses from the practicing pediatric dentists were obtained. Among them, 39.7% had an experience of 5-10 years, 47.1% practiced less than 5 years, and 13.2% had experience more than 10 years. Analysis of the responses showed that 76.5% of the pediatric dentists were aware of the procedure but have not observed autotransplantation being done. Among the respondents, 95.6% have not performed this technique and 40.6% of them were not sure of the prognosis. Atraumatic extraction of donor tooth was considered to be a major limitation in autotransplantation by 41.8% of the pediatric dentists. From the responses received, 95.6% were interested in gaining more information with majority opting for more hands on workshops on the technique of autotransplantation.

Conclusion

Though most of the respondents were aware of autotransplantation procedure, they have not practiced it due to inadequate training.

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.

Use of computer-aided three-dimensional prototyping to surgically assist in tooth autotransplantation

Autotransplantation is a surgical technique in which a donor tooth belonging to the same individual is repositioned into a surgically prepared socket or site of previous tooth extraction. It is beneficial in patients with teeth affected by agenesis, trauma, significant caries, and in teeth in a non-restorable condition or prognostically poor due to other pathology. It is particularly useful in paediatric patients, as properly transplanted teeth have a vital periodontium that allows for continuous growth and functional adaptation leading to preservation of the alveolar ridge. Technological advances in rapid prototyping combined with three-dimensional (3D) computed tomography (CT) have the ability to revolutionise autotransplantation. Preoperative planning for atraumatic extraction of the donor tooth and precise preparation of the recipient site with a rapid prototyped surgical template of the donor tooth considerably reduces the extra-alveolar time, and also reduces manipulation of the root sheath and periodontal ligament, and related trauma. This case series demonstrates the efficient and successful autotransplantation of various types of teeth with the use of a rapid prototyped surgical template produced from 3D CT. The use of this technology is expected to refine the surgical technique and improve treatment outcomes.

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.

Retrospective Evaluation of Immediate Impacted Third Molars Autotransplantation After Extractions of Mandibular First and/or Second Molars With Chronic Periapical Lesions

PURPOSE

To evaluate the success rate of simultaneous autotransplantation of the immature impacted third molars with the guidance of computer-aided rapid prototyping (CARP) to the place of mandibular first or second molars with extraction indication due to the untreatable radiographic periapical lesions.

PATIENTS AND METHODS

Twelve radiographically and clinically hopeless mandibular first or second molars with periapical lesions of 10 patients between the ages of 15 to 21 were included in this retrospective clinical study. Cone-beam computed tomography (CBCT) images were used to produce the CARP models of the donor impacted third molars. Following the extractions of the mandibular first or second molars with periapical lesions, sockets were curetted and prepared with proper burs until a suitable infraocclusal fit of the CARP models. The donor teeth were transplanted synchronously with their surgical extractions. Postoperatively patients were followed clinically and radiographically in the 3rd and 6th months and every 6th month thereafter for at least 18 months. Clinically, the mobility, periodontal plaque, bleeding on probing, percussion sensitivity, periodontal pocket, vitality, and occlusion, and radiographically, the root resorption, ankylosis, presence of lamina dura, and healing of periapical lesion were assessed.

RESULT

By the end of 12th month, and thereafter, all transplanted teeth were in occlusion and functioning properly with no clinical or radiological signs of pathology. All of the autotransplantation cases involved in this clinical study were successful within a mean follow-up period of 20.4 months with the least one of 18 months.

CONCLUSION

Immediate autotransplantation of the immature third molars to the place of mandibular first or second molars with extraction indication due to the periapical lesion can be a proper treatment option for adolescent patients.

Autotransplantation of third molars: a literature review and preliminary protocols

Tooth autotransplantation (the movement of a tooth from one site to another in the same person) is a technique with a history dating back many centuries. However, the use of third molars as donor teeth is perhaps less well-recognised and less documented. A review of the current literature was undertaken with particular attention to the use of the third molar as the donor tooth. The selection process, surgical procedure and follow-up pathways were summarised in the review. Appropriate patient selection was found to be a key factor in the success of the technique. Other prognostic factors were also discussed. The findings from the available literature suggest that autotransplantation is a viable and cost-effective technique. However, the literature relating to the use of third molars as donor teeth for autotransplantation is limited and there are currently no evidence-based guidelines or protocols relating to the technique. This paper discusses the literature and protocols the authors implement for autotransplantation of wisdom teeth.

Endodontic considerations of survival rate for autotransplanted third molars: a nationwide population-based study

AIM

To investigate whether the timing of root canal treatment (primary aim) or other endodontic parameters (secondary aim) is associated with the survival probability of autotransplanted third molars, using a nationwide population-based database.

METHODOLOGY

A total of 1811 third molars autotransplanted between 2000 and 2013 met the inclusion criteria and were followed until the end of 2016. The teeth were classified into three groups on the basis of timing between root canal treatment and the autotransplantation: preoperative, extraoral and postoperative treatment groups. Univariate and multivariate Cox proportional hazards models were used to estimate the association between the timing of root canal treatment and the risk of tooth extraction after autotransplantation.

RESULTS

Of the 1811 autotransplanted third molars, 462 were extracted, yielding a 17-year survival probability of 0.578. The survival probability of autotransplanted teeth that received postoperative root fillings after 17 years was 0.583, which was significantly higher than the 0.434 and 0.566 for teeth that received preoperative and extraoral root fillings, respectively (P = 0.0013). After adjustment for potential confounding factors, teeth that received postoperative root fillings were associated with a significantly lower tooth extraction hazard ratio (HR) compared with those that received extraoral root fillings (adjusted HR, 1.43; 95% confidence interval [CI], 1.14-1.78) and those that received preoperative root fillings (adjusted HR, 2.13; 95% CI, 1.19-3.82). Furthermore, the use of a rubber dam during postoperative root filling was associated with a significantly lower extraction rate after autotransplantation (adjusted HR, 0.54; 95% CI, 0.43-0.69).

CONCLUSIONS

Postoperative root canal treatment resulted in a significantly lower extraction rate than did preoperative or extraoral root canal treatment amongst autotransplanted third molars during a mean follow-up period of 8.33 years. Rubber dam use is recommended during postoperative root canal treatment to improve the outcomes of autotransplantation.

Orthodontic management of patients with congenitally missing permanent teeth

Dental agenesis is one of the most common developmental anomalies in humans. It occurs as part of a genetic syndrome or as an isolated sporadic or familial finding. Third molars, second mandibular premolars and maxillary lateral incisors are the most frequently targeted teeth of the permanent dentition. Clinically, patients with congenitally missing permanent teeth seeking treatment present with unesthetic diastemas, midline deviation and tilting of adjacent teeth in the edentulous areas. The impact of tooth agenesis reflects on esthetics, function, psychological and social well-being of the individuals affected. Orthodontics can contribute to the treatment plan selected by rearranging the present teeth so as to open spaces for prosthetic restorations or close spaces by reshaping teeth if needed. Following orthodontic space opening/maintaining, the usual alternatives involve single implants, two-(cantilever) or full coverage(cantilever) prostheses. Less frequently, the treatment modality of autotransplantation is proposed with a good esthetic result but feasible only in young patients where the roots of the premolars are still developing. In orthodontic space closure, treatment is accomplished sooner without waiting for the completion of growth of the patient. Depending on various factors such as the malocclusion, the dento-skeletal profile, the smile line, the space requirements, the teeth missing, the periodontal issues, the age of the patient and any financial issues, the clinician will determine the most appropriate treatment approach. The final esthetic and functional result should resemble an intact natural dentition.

Effect of cryopreservation of teeth on the structural integrity of dentin

The autotransplantation of teeth after cryopreservation has become an increasingly viable method for whole tooth replacement. While the immediate success rates are quite high, damage introduced by cryopreservation within the dentin or enamel could be detrimental to the durability of these teeth.

OBJECTIVE

to determine whether cryopreservation alters the microstructure of dentin or causes a reduction of its resistance to mechanical failures.

METHODS

Third molars were obtained from young donors (18≤age≤30yrs) and subjected to a cryopreservation protocol involving storage for 10days in cryoprotectant solution at -196°C. After treatment, the mid-coronal dentin was characterized in terms of its elastic modulus, strength and fatigue behavior. Scanning electron microscopy and Raman spectroscopy were used to evaluate the microstructure and integrity of collagen after cryopreservation.

RESULTS

There was no significant difference in the elastic modulus or flexural strength between dentin from the cryopreserved and non-cryopreserved (control) teeth. However, the cryopreservation treatment caused a significant decrease in the fatigue strength of dentin with respect to the controls, with average reduction of nearly 20%. While there were no differences apparent in the collagen matrix or fracture surfaces between the cryopreserved and control groups, the microstructure of dentin from the cryopreserved teeth exhibited unique features and damage that appear to have caused the decrease in durability.

SIGNIFICANCE

Autotransplantation of cryopreserved teeth may be a viable option for whole tooth restorations, but hidden damage within the dentin could render these teeth more susceptible to mechanical failures by fatigue and fracture.

A review of nanostructured surfaces and materials for dental implants: surface coating, patterning and functionalization for improved performance

The emerging field of nanostructured implants has enormous scope in the areas of medical science and dental implants. Surface nanofeatures provide significant potential solutions to medical problems by the introduction of better biomaterials, improved implant design, and surface engineering techniques such as coating, patterning, functionalization and molecular grafting at the nanoscale. This review is of an interdisciplinary nature, addressing the history and development of dental implants and the emerging area of nanotechnology in dental implants. After a brief introduction to nanotechnology in dental implants and the main classes of dental implants, an overview of different types of nanomaterials (i.e. metals, metal oxides, ceramics, polymers and hydrides) used in dental implant together with their unique properties, the influence of elemental compositions, and surface morphologies and possible applications are presented from a chemical point of view. In the core of this review, the dental implant materials, physical and chemical fabrication techniques and the role of nanotechnology in achieving ideal dental implants have been discussed. Finally, the critical parameters in dental implant design and available data on the current dental implant surfaces that use nanotopography in clinical dentistry have been discussed.

Autotransplantation of mature and immature third molars in 23 Chinese patients: a clinical and radiological follow-up study

BACKGROUND

We investigated the clinical and radiographic outcomes of autotransplanted teeth over a follow-up period of 2 to 8 years, and summarize the findings of other relevant studies with regard to the primary factors that influence a good prognosis in such patients.

METHODS

Twenty-three patients (6 men, 17 women) who attended Tanggu Stomatological Hospital, Tianjin, China, from 2008 through 2013, were included in the study. These patients presented with a variety of dental problems, including tooth loss, residual crowns, missing first or second molars, dental trauma, tooth fracture, and unrestored teeth. A total of 26 third molars, including 2 immature molars, were autotransplanted in these patients. The success rate of autotransplantation was assessed on the basis of clinical and radiographic outcomes after follow-up periods ranging from 2 to 8 years.

RESULTS

Clinical examination revealed stability of all 26 transplanted teeth, with satisfactory masticatory function and no patient discomfort. Radiographic examination revealed normal periapical tissues and an intact lamina dura surrounding the tooth root, indicating adequate healing of periodontal tissues.

CONCLUSIONS

Autotransplantation achieved good results in the Chinese sample population investigated, and was associated with an excellent prognosis. Rigorous case selection, adequate protection of the periodontal ligament, and proper oral hygiene contribute significantly to the long-term success of the procedure.

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

BACKGROUND

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

PURPOSE

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

MATERIAL AND METHODS

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

RESULTS

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

CONCLUSIONS

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

Autotransplantation of third molars with completely formed roots into surgically created sockets and fresh extraction sockets: a 10-year comparative study

The aim of this study was to analyze and compare the long-term clinical outcomes of mature third molar autotransplantation in surgically created sockets and fresh extraction sockets with regard to survival and functional success rates. A total of 65 third molars with completely formed roots were autotransplanted in 60 patients (average age 33.1 years). Thirty-six of the teeth were autotransplanted into surgically created sockets with or without guided bone regeneration (GBR; delayed autotransplantation), while 29 were autotransplanted into fresh extraction sockets (immediate autotransplantation; control group). All patients underwent annual clinical and radiographic examinations (average follow-up 9.9 years, range 7-13 years). The survival rates for the control, GBR, and no GBR groups were 93.1%, 95.2%, and 80.0%, respectively, with no significant differences among the groups. There were no statistically significant differences among the groups with regard to the frequency of inflammatory root resorption or root ankylosis. Age did not influence the clinical outcomes. These results suggest that the autotransplantation of third molars with completely formed roots is effective in both surgically created and fresh extraction sockets and provides a high long-term success rate if cases are selected and treated appropriately.

The Management of the Dilacerated Impacted Maxillary Central Incisor

The clinical problem of how best to manage a dilacerated, impacted maxillary central incisor will only be encountered rarely. The treatment aim should be to achieve results that are indistinguishable from normal appearance in a way that is appropriate for the patient. This article discusses the incidence of dilacerations in maxillary incisors and describes the treatment approaches available − orthodontic alignment or surgical removal and management of the resulting space, considering orthodontic repositioning, autotransplantation and various prosthetic replacements. Treatment indications, advantages and disadvantages, restorative and surgical implications, as well as the evidence-base relating to the various treatment modalities will be presented, along with clinical case examples. Clinical relevance: This paper discusses a problem that, if not managed appropriately, can lead to poor results for the patient. Even for practitioners who may not undertake the treatment mentioned, it will enable them to have more in-depth discussion with their patients should the situation arise.

Autotransplantation

Autogenous tooth transplantation refers to the repositioning of autogenous teeth in another tooth extraction site or a surgically formed recipient site to replace missing teeth due to congenital deformity, grossly decayed carious teeth, mobile teeth due to periodontal disease, teeth lost due to trauma, endodontic failure or any other reason when a suitable donor tooth is available. This is a case report of autotransplantation of impacted #38 with complete root formation into the extraction site of grossly decayed, unrestorable #37 with 18 months follow-up showing excellent periapical healing and tooth stability. In autogenous tooth transplantation, even if the donor's tooth has complete root formation, a high success rate can be achieved if the cases are selected and treated properly. Chances of root resorption are there because of necrotic pulp and periodontal irritation during manipulation. However, autogenous tooth transplantation should always be considered as a good treatment modality in feasible cases.

Tooth auto-transplantation as an alternative treatment option: A literature review

Rapidly evolving implantation and alveolar ridge reconstruction techniques created a new area in modern dentistry where tooth loss is no longer a problem. Endless variations of implant's length, diameter, surface, and design along with autogenous, alogenous, aloplastic, or xenogenous bone substitutes made it possible to recreate physiological occlusion, esthetic and masticatory function. However, none of nowadays technologies in implant dentistry have the potential to adapt to a growth and development changes of a child's jaw. Therefore, patient's young age is a restriction for implantation and a particular challenge for a dentist willing to restore missing tooth. Thus, tooth auto-transplantation can be a good choice for treatment. The objective of this review is to underline the biologic principles required for successful auto-transplantation of teeth. Limits, indications, technique, and prognosis will be analyzed.

Autotransplantation of a supernumerary tooth to replace a misaligned incisor with abnormal dimensions and morphology: 2-year follow-up

Autotransplantation is a viable treatment option to restore esthetics and function impaired by abnormally shaped teeth when a suitable donors tooth is available. This paper describes the autotransplantation and 2-year follow-up of a supernumerary maxillary incisor as a replacement to a misaligned maxillary incisor with abnormal crown morphology and size. The supernumerary incisor was immediately autotransplanted into the extraction site of the large incisor and was stabilized with a bonded semirigid splint for 2 weeks. Fixed orthodontic therapy was initiated 3 months after autotransplantation. Ideal alignment of the incisors was accomplished after 6 months along with radiographic evidence of apical closure and osseous/periodontal regeneration. In autogenous tooth transplantation, a successful clinical outcome can be achieved if the cases are selected and treated properly.

Autotransplantation of mandibular third molar: a case report

Autogenous transplantation is a feasible, fast, and economical option for the treatment of nonsalvageable teeth when a suitable donor tooth is available. This paper presents successful autotransplantation of a mature mandibular left third molar (38) without anatomical variances is used to replace a mandibular left second molar (37). The mandibular second molar was nonrestorable due to extensive root caries and resorption of distal root. After extraction of mandibular second and third molars, root canal therapy was done for the third molar extraorally, and the tooth was reimplanted into the extracted socket of second molar site. After one year, clinical and radiographic examination revealed satisfactory outcome with no signs or symptoms suggestive of pathology. In selected cases, autogenous tooth transplantation, even after complete root formation of the donor tooth, may be considered as a practical treatment alternative to conventional prosthetic rehabilitation or implant treatment.

Minimizing the extra-oral time in autogeneous tooth transplantation: use of computer-aided rapid prototyping (CARP) as a duplicate model tooth

OBJECTIVES

The maintenance of the healthy periodontal ligament cells of the root surface of donor tooth and intimate surface contact between the donor tooth and the recipient bone are the key factors for successful tooth transplantation. In order to achieve these purposes, a duplicated donor tooth model can be utilized to reduce the extra-oral time using the computer-aided rapid prototyping (CARP) technique.

MATERIALS AND METHODS

Briefly, a three-dimensional digital imaging and communication in medicine (DICOM) image with the real dimensions of the donor tooth was obtained from a computed tomography (CT), and a life-sized resin tooth model was fabricated. Dimensional errors between real tooth, 3D CT image model and CARP model were calculated. And extra-oral time was recorded during the autotransplantation of the teeth.

RESULTS

The average extra-oral time was 7 min 25 sec with the range of immediate to 25 min in cases which extra-oral root canal treatments were not performed while it was 9 min 15 sec when extra-oral root canal treatments were performed. The average radiographic distance between the root surface and the alveolar bone was 1.17 mm and 1.35 mm at mesial cervix and apex; they were 0.98 mm and 1.26 mm at the distal cervix and apex. When the dimensional errors between real tooth, 3D CT image model and CARP model were measured in cadavers, the average of absolute error was 0.291 mm between real teeth and CARP model.

CONCLUSIONS

These data indicate that CARP may be of value in minimizing the extra-oral time and the gap between the donor tooth and the recipient alveolar bone in tooth transplantation.

Effect of basic fibroblast growth factor on root resorption after delayed autotransplantation of tooth in dogs

OBJECTIVES

The aim of this study was to investigate the effect of basic fibroblast growth factor (FGF-2) on root resorption after delayed autotransplantation in dogs.

STUDY DESIGN

Mandibular second and third premolars of beagle dogs were extracted to create sites for autotransplantation. After 2 months, in the experimental sites the first and fourth mandibular premolars were extracted and air dried before autotransplantation with the application of recombinant FGF-2; the control sites received teeth without FGF-2. At 2, 4, or 8 weeks after surgery, the animals were killed and specimens collected and processed for histologic examination.

RESULTS

Autotransplantation with FGF-2 yielded formation of new periodontal ligament-like tissues with inserting collagen fibers, associated cementum, and bone. The occurrence of replacement resorption in the FGF-2 treated group was significantly lower than in the control group (P < .01).

CONCLUSIONS

It was demonstrated that topical application of FGF-2 reduced the occurrence of ankylosis and root resorption after delayed autotransplantation in this experimental model.

Autogenous tooth transplantation as a treatment option

Autogenous tooth transplantation is the surgical movement of a tooth from one location in the mouth to another in the same individual. Though done for years but it has achieved variable success rates. Although the indications for autotransplantation are narrow, careful patient selection coupled with an appropriate technique can lead to exceptional esthetic and functional results. This article discusses the reviews of previous works done and highlights the criteria and factors influencing the success of autotransplant along with reports of two cases of transplantation of impacted and malposed canine. How to cite this article: Chugh A, Aggarwal R, Chugh VK, Wadhwa P, Kohli M. Autogenous Tooth Transplantation as a Treatment Option. Int J Clin Pediatr Dent 2012;5(1):87-92.

Think before you extract--a case of tooth autotransplantation

Renewed interest in autotransplantation has resulted in additional options in the treatment for rehabilitation of missing anterior teeth. Premolar teeth have been commonly used after extensive modifications while a supernumerary tooth from the anterior region when present would be a more suitable option. This case presents such a scenario, with a successful outcome ensuring adequate restoration of function, economical viability and aesthetic satisfaction for both the patient and clinician.

Alveolar bone changes in autogenous tooth transplantation

OBJECTIVE

To assess the alveolar bone formation after autogenous tooth transplantation by conventional radiographic method and digital subtraction radiography.

STUDY DESIGN

This retrospective study was done in 54 of 136 patients who received the third molar tooth transplantation and attended the first week, as well as the 1-, 3-, 6-, 9-, and 12-month follow-up. Postoperative periapical radiographs were subsequently evaluated by direct visual interpretation and digital subtraction radiography. The data were analyzed by using McNemar test and 1-way repeated-measure analysis of variance as well as Bonferroni multiple comparison.

RESULTS

Fifty-four cases of transplantation were studied. Most of them had normal wound healing. The direct radiographic interpretation and digital subtraction radiography found significant alveolar bone formation in the first-and the third-month follow-ups (P < .05). Lamina dura appeared in the third month and kept increasing until the sixth month.

CONCLUSIONS

Postoperative radiographs revealed the distinctive bone formation up to the third month. The clinical and radiographic assessment found that the third molar transplants could bear a normal chewing load within 3 months.

Pulpal regeneration following allogenic tooth transplantation into mouse maxilla

Autogenic tooth transplantation is now a common procedure in dentistry for replacing a missing tooth. However, there are many difficulties in clinical application of allogenic tooth transplantation because of immunological rejection. This study aims to clarify pulpal regeneration following allogenic tooth transplantation into the mouse maxilla by immunohistochemistry for 5-bromo-2'-deoxyuridine (BrdU) and nestin, and by the histochemistry for tartrate-resistant acid phosphatase (TRAP). The upper right first molar (M1) of 2-week-old mice was extracted and allografted in the original socket in both the littermate and non-littermate after the extraction of M1. Tooth transplantation weakened the nestin-positive reactions in the pulp tissue that had shown immunoreactivity for nestin before operation. On postoperative Days 5-7, tertiary dentin formation commenced next to the preexisting dentin where nestin-positive odontoblast-like cells were arranged in all cases of the littermate group until Day 14, except for one case showing immunological rejection in the pulp chamber. In the non-littermate group, bone-like tissue formation occurred in the pulp chamber in addition to tertiary dentin formation until Day 14. The rate of tertiary dentin was 38%, and the rate of the mixed form of dentin and bone-like tissue formation was 23% (the remainder was immunological rejection). Interestingly, the periodontal tissue recovered even in the case of immunological rejection in which the pulp chamber was replaced by sparse connective tissue. These results suggest that the selection of littermate or non-littermate is decisive for the survival of odontoblast-lineage cells and that the immunological rejection does not influence the periodontal regeneration.

Autotransplantation of a supernumerary incisor as a replacement for fused tooth: 24-month follow-up

This case report describes the technique and 24-month follow-up of autotransplantation of a well-shaped, healthy supernumerary maxillary central incisor as a replacement for a fused maxillary incisor. Because the alignment of the teeth neighboring the fused incisor was not suitable as an abutment for post-transplantation splinting, a custom palatal splint that took anchorage from permanent first molars was fabricated. Following extraction of both teeth, the supernumerary incisor was immediately autotransplanted into the extraction site of the fused incisor. The autotransplanted tooth was secured to the custom splint with acid-etch composite, and the splint was removed 2 weeks later. Closure of the apex was observed at 18 months. Both the esthetics and function were restored to an ideal level in the absence of postoperative complications, as evidenced by 24-month clinical and radiographic findings.

Time of endodontic treatment in autogenic transplants of mature teeth: Histological study in dogs

OBJECTIVE

Root canal therapy is often recommended after mature tooth transplantation. The aim of this work was to histologically evaluate, in dogs, the best time for root canal treatment in autogenic transplants of teeth with complete root formation.

STUDY DESIGN

Mandibular lateral incisors of 8 dogs were extracted and transplanted to the homologous alveolus, endodontically treated after 15 (Group I) or 40 (Group II) days, and processed for routine histological evaluation. Tissue responses on the root surface were evaluated by light microscopy and classified as normal periodontium, active inflammatory root resorption, favorable healing, and unfavorable healing.

RESULTS

The mean of normal periodontal tissue was in 88.6% in Group I and 79.4% in Group II. There were no significant statistical differences between the groups in all analyzed parameters.

CONCLUSION

The results indicated that endodontic therapy can be postponed for 40 days postoperatively when the tooth stability is higher.

Autogenous transplantation of teeth with complete root formation: two case reports

AIM

Autotransplantation is an alternative treatment for replacing lost teeth when suitable donor teeth are available. This paper presents two cases of successful autogenous tooth transplantation.

SUMMARY

Two third molars with complete root development were autogenously transplanted from their original sockets into new recipient sites on the same side of the mouth, one in the maxilla and one in the mandible. In both cases, the third molars were transplanted immediately after the first molar extractions. To provide better adaptation of the donor teeth, the recipient alveolar sites were remodelled using surgical burs. Semi-rigid splints were maintained for 45 and 15 days, respectively. Root canal treatment commenced one a week after transplantation and the canals were medicated with a calcium hydroxide paste before they were filled. Clinical and radiographic findings after 5 and 3 years of follow-up, respectively, are discussed in relation to the literature.

KEY LEARNING POINTS

Autogenous transplantation of teeth with complete root formation may be considered as a viable treatment option to conventional prosthetic and implant rehabilitation for both therapeutic and economic reasons. Careful surgical and endodontic procedure, together with careful case selection may lead to satisfactory aesthetic and functional outcomes.

Treatment of external inflammatory root resorption after autogenous tooth transplantation: case report

This paper describes a case of autogenous tooth transplantation. An external inflammatory root resorption developed in a 30-year-old female patient and was successfully treated with the placement of calcium hydroxide-based intracanal dressings. Autotransplantation of tooth 32 into the extraction socket of tooth 30 was carried out with no intraoperative complications and uneventful postoperative course. However, the patient did not appear on the 14th postoperative day to initiate endodontic therapy of the transplanted tooth. She did not return for 3 months, at which time the clinical and periapical radiographic examinations revealed the presence of external inflammatory root resorption. Endodontic treatment was initiated immediately. Root canals were prepared and filled with a calcium hydroxide-based intracanal dressing (Calen paste), changed every 21 days during a 6-month period, and were thereafter obturated with Sealapex calcium hydroxide-based sealer and gutta-percha points. After 2 years of follow-up, the transplanted tooth was symptom free with no exacerbated sensibility to percussion, normal mobility, occlusion, and masticatory function. Probing revealed no periodontal pockets or other pathological signs. Radiographic examination showed the periradicular area with normal appearance, completely healed resorption areas, and presence of an intact lamina dura.

Evaluation of the prognosis and causes of failure in 182 cases of autogenous tooth transplantation

OBJECTIVES

Autotransplantation is a viable option for treating missing teeth when a donor tooth is available. The aim of this study was to evaluate the prognosis in addition to the causes of failure in 182 autotransplanted teeth.

STUDY DESIGN

A total of 182 cases of autotransplantation were analyzed. All the transplants were performed according to a computer-aided rapid prototyping technique with an average extraoral time of 7.58 minutes. These cases were followed for 2 to 60 months after surgery. The prognosis was divided into 4 groups, complete healing, incomplete healing, uncertain healing, and failure. The initial stability, root resorption, and ankylosis were also analyzed.

RESULTS

Most transplanted teeth showed complete healing between postoperative 2 months and 8 months. The transplanted teeth with a good initial stability showed better initial healing than those with a poor initial stability. The average extraoral time was 7.58 min (range: immediately after extraction up to 25 min). There was no relationship (P > .05) between the extraoral time and either root resorption (4 cases, 2.4%) or ankylosis (18 cases, 10.7%) within this experimental time period. Nine cases (4.5%) failed.

CONCLUSION

This study showed a 4.5% failure rate during the short to intermediate observation period. Autotransplantation is a very useful method for replacing missing teeth, provided that the extraoral time and other factors are well controlled.

Autotransplantation of immature third molars into edentulous and atrophied jaw sections

The aim of the present study was to assess the results after transplantation of 85 immature third molars. Recipient site conditions varied and different surgical techniques were used. The long-term results after preparation of a new alveolus, splitting osteotomy of the alveolar process or use of free bone autografts were compared with the results after transplantation into a fresh extraction site (control group). Transplantations into prepared sockets showed equal results to the control group (94% respectively). Transplantations in connection with free bone autografts (84%) or after splitting osteotomy of the alveolar process (63%) showed poorer success rates, the differences between the latter and the control group being statistically significant. A possible correlation to revascularization disturbances of the pulp due to an insufficiency of the recipient site or to postoperative infection is suspected. The results show that transplantation of immature third molars is a safe, useful procedure when appropriate conditions of the recipient site are present. Where the alveolus is atrophic, a splitting osteotomy should be performed only in exceptional cases and preference should be given to alternative methods such as primary bone augmentation or bone-regenerative procedures.

[Root growth after wisdom tooth transposition. Case documentation with proposal for a radiologic method to quantify growth]

OBJECTIVES

To introduce a method for assessment of root growth on panoramic radiographs exemplified by a case report on an autotransplanted lower third molar.

MATERIAL AND METHODS

A lower left third molar (T) with incomplete root formation was transplanted for replacement of the lower left first molar in an 18-year-old woman. T was monitored clinically and, together with its neighboring lower second molar (37) with constant root length, also radiographically by means of two panoramic radiographs (OPGs) produced 12 days and 20 months postoperatively. A method for calculation of the root length as a multiple of the crown length is introduced, using accurately reproducible landmarks defining the coronal and apical endpoints of the examined tooth in all OPGs of the series. This method minimizes error due to different magnifications within the set of radiographs.

RESULTS

Using the method introduced, the root length of the constant tooth 37 varied at 2.7% within the set of OPGs, whereas it revealed a 5.6% variation when the evaluation was based on direct measurement. Based on the described method, T revealed a postoperative root growth of approximately one-third of its final length and showed clinically no pathological findings during the observation period.

CONCLUSIONS

Our results indicate that with the described method root growth assessment on panoramic radiographs is more accurate than with direct measurement.

Use of third molar transplantation for closure of the oroantral communication after tooth extraction: a report of 2 cases

OBJECTIVE

This clinical report introduces a promising and unique method for the immediate closure of the oroantral communication (OAC) after tooth extraction: the use of the transplanted third molar with closed apices.

STUDY DESIGN

In 2 adult patients, OAC caused by the extraction of an upper molar was immediately closed by using a transplanted third molar with complete root formation. After tooth extraction at the recipient site, OAC with perforated mucosa of the sinus floor was confirmed and the donor third molar was transferred to the prepared recipient socket. Endodontic therapy of the transplanted third molar began at 3 weeks after surgery, and prosthetic treatment was completed at 5 months after the operation. These 2 patients were carefully observed both clinically and radiographically.

RESULTS

Closure of the OAC was successfully performed, and the transplanted teeth became fixed with the passage of time in these 2 patients. Root resorption did not occur, and good functional results were obtained without any complications.

CONCLUSIONS

Tooth transplantation of a mature third molar for closure of the OAC is a simple and excellent method because the transplanted tooth not only closes the communication to the maxillary sinus, but it also satisfactorily functions at the recipient site during mastication, even in adult patients.

Functional fixation of autotransplanted tooth germs by using bioresorbable membranes

OBJECTIVE

The purpose of this study was to evaluate the contribution of a bioresorbable membrane placement to the healing of immature teeth after autotransplantation of tooth buds.

STUDY DESIGN

Six cases were selected: 2 transplantations of wisdom teeth, 2 for premolar agenesis, 1 for ectopia, and 1 premolar in an incisor position. The crown of each tooth germ and the marginal alveolar bone were covered with a resorbable membrane.

RESULTS

The radicular edification was nearly complete, neither ankylosis nor inflammatory resorption was observable, the pulp vitality was preserved, and the periodontal integration was identical to that of other teeth. The membrane ensured contention and stabilization of the transplant, allowed functional stimulation, permitted protection of the coagulum and periodontal cells, and kept the epithelium at a distance.

CONCLUSIONS

The transplantations of immature teeth were improved by the use of a resorbable membrane, which caused an optimal functional fixation of the transplanted tooth.

Autotransplantation of immature third molars: influence of different splinting methods and fixation periods

Different data were published documenting the influence of fixation methods and periods on the outcome of autotransplantations of teeth. Besides studies reporting increased ankylosis and disturbances of pulpal revascularization following rigid or extended fixation, there are studies revealing no connection in this matter. The clinical and radiological results of 76 transplanted germs of third molars were to be assessed after a rigid fixation for 4 weeks or after a suture splinting for 7 days and compared with each other. The choice of fixation method depended on the initial stability of the transplant. After a mean observation period of 3.4 years (range 1.0-6.1 years), 92.9% of the teeth stabilized with a suture, but only 73.5% fixed with an acid-etch composite and wire splint could be classified as successful (P = 0.029). The significant increases in ankylosis (P = 0.036) and pulp necrosis (P = 0.041) were the factors for the less favorable results of the rigidly fixed teeth. Our data support the results of other experimental and clinical studies with regard to the negative influences of an extended and rigid fixation on the success of tooth transplantation. However, apart from a correlation with the method and period of fixation, we also suspect the influence of an incongruity between the transplant and recipient site.