Autotransplantation of teeth in 215 patients. A follow-up study

"In Their Own Words": Families' Experiences With Tooth Autotransplantation for the Replacement of Maxillary Incisors in Children

OBJECTIVES

To examine families' experiences, including motivation and barriers to undergoing tooth autotransplantation (AT), and their perceptions of associated esthetic and functional outcomes.

METHODS

Semi-structured, in-depth-interviews (IDIs) were conducted in person with families who had children that underwent the AT procedure. Interviews were audio recorded and transcribed. Transcripts were coded and thematically analyzed both deductively and inductively. A facilitators and barriers matrix and journey maps were created to draw inferences on patterns arising from main themes.

RESULTS

Twenty families selecting AT as a solution for a missing maxillary incisor were recruited and interviewed. Overall, all families interviewed had a positive experience with the AT procedure. Motivating factors for undergoing the AT procedure included wanting an earlier intervention for the missing incisor, wishing to mitigate negative psychosocial effects, and the anticipated positive outcomes that would last into adulthood. Barriers to uptake of the AT procedure included the lack of dental practitioner awareness of AT as a potential solution and a large number of appointments and travel. Families were also initially concerned over potential complications that could arise from their child undergoing this procedure. The cost of the procedure was both a barrier and a facilitator for treatment.

CONCLUSIONS

The study results demonstrate that the overall AT is favorably considered by the families of growing children for the replacement of maxillary incisors and highlight factors that may act as motivators or barriers to its uptake.

Tooth autotransplantation with adjunctive application of enamel matrix derivatives using a digital workflow: A prospective case series

OBJECTIVES

Digital protocols and bioactive materials may reduce complications and improve tooth autotransplantation (ATT) success and survival rates. This prospective study assesses the performance of a fully digital autotransplantation protocol of close-apex molars with the adjunctive application of Enamel Matrix Derivatives (EMD).

METHODS

Twelve adult patients with 13 hopeless molar teeth were replaced with autotransplantation of closed apex third molars. Outcomes, including success and survival rates, clinical, endodontic, radiographic, patient-reported outcome measures (PROMs), and digital image assessments, were conducted over a two-year follow-up period.

RESULTS

Survival and success rates were 100% and 91.2%, respectively, with no progressive inflammatory or replacement root resorption (ankylosis) except for one tooth presenting radiographic furcation involvement. A significant probing depth reduction of 2.4 ± 2.58 mm and CAL gains of 2.8 ± 3.03 mm were observed in transplanted teeth compared to the hopeless receptor teeth. Radiographic bone levels remained stable throughout the study period (-0.37 ± 0.66 mm), and digital image assessments showed minimal alveolar ridge width changes (-0.32 to -0.7 mm) and gingival margin changes (-0.95 to -1.27 mm) from baseline to last visit. PROMs indicated very high patient satisfaction.

CONCLUSION

The use of a digital ATT protocol with adjunctive use of EMD in closed-apex third molars demonstrated promising short-term high success and survival rates. Additionally, this type of therapy adequately preserves the dimensions of the alveolar ridge in the receptor site.

CLINICAL SIGNIFICANCE

This is the first prospective clinical study examining the effect of a digital tooth autotransplantation protocol combined with the application of EMD. It demonstrates that this approach is an effective treatment for replacing hopeless teeth and also validates the digital assessment of ATT alveolar ridge preservation at the recipient site.

Long-term survival of 57 premolars consecutively transplanted to premolar sites

INTRODUCTION

The objective of this study was to report the long-term outcome of autotransplantation of premolars to other premolar recipient sites.

METHODS

The sample was limited to adolescents seeking orthodontic treatment, and all had 1 or 2 premolars transplanted to a recipient site in which a premolar was congenitally missing. The transplantations were performed between 1980 and 2008, comprising 29 premolars in 22 males and 28 premolars in 22 females. Systematic clinical and radiographic follow-up varied from 1 year to 36.8 years, with a mean observation time of 18.9 years and a median of 19.2 years. Of the 57 transplanted teeth, 52 were subjected to orthodontic forces.

RESULTS

A total of 9 of 57 teeth (15.8%) were lost during the observation period, and 8 of 9 lost teeth had been functional for at least 9 years posttransplantation. Of the 48 surviving transplants, 6 did not meet the criteria for success, giving an overall success rate of 73.7%. Complications were diagnosed within 5 years from the transplantation in 4 of 57 teeth (7.0%) and later in 11 of 57 (19.3%). The Kaplan-Meier survival curve shows that the complication-free proportion of transplants decreased at a constant rate over the observation time. The average survival time, taking censoring into account during follow-up of 36.8 years, was estimated as 28.5 years. The complications in the 15 teeth were classified into 4 categories: periapical lesions (6 teeth), inflammatory resorption (5 teeth), abrupt fracture (2 teeth), and ankylosis (2 teeth).

CONCLUSIONS

Overall, premolar transplants in all stages of root formation have high success and survival rates. Transplants with complications may survive temporarily and preserve critical arch space and alveolar bone. Transplants with normal healing may have latent weaknesses that can eventually affect long-term survival.

Computer-aided design and computer-aided manufacturing poly (methyl methacrylate) interim veneers for immediate esthetic restoration of autotransplanted teeth

Autotransplanted teeth in the maxillary anterior region should be restored or reshaped as soon as possible for functional and esthetic reasons as well as the well-being of the patient. However, such tooth restorations are frequently not carried out immediately after tooth transplantation because the process could have a negative impact on the healing process. The development of a simple, immediate, and atraumatic esthetic interim restoration would be of great benefit to both the clinician and patient and address all the concerns caused by immediately preparing the tooth postoperatively and cementing a permanent restoration. This report describes the use of CAD-CAM technology to create poly (methyl methacrylate) veneers preoperatively that can be cemented extraorally on the extracted donor tooth for the immediate and interim recontouring of autotransplanted anterior teeth.

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.

Clinical Assessment of Immediate Autotransplantation of Mandibular Third Molars: An In Vivo Study

INTRODUCTION

Transplanting a tooth from one area of the mouth to another is known as autogenous tooth transplantation. It is a great choice for restoring young patients' teeth with developing alveolar bone because it uses the patient's own tooth as the replacement rather than a false one. This study aims to evaluate pain, infection, mobility, resorption, ankylosis, and success rate in the replacement of mandibular non-restorable molars through an immediate autotransplantation of the nonfunctional impacted mandibular third molar.

MATERIALS AND METHODS

In this in vivo study, 20 patients between the ages of 22 and 50 were selected. The cases in which the first or second mandibular molar was nonrestorable and had an impacted third molar for transplantation were selected. In all the cases, the nonrestorable molar was extracted and replaced with a nonfunctional, impacted third molar. All the cases were evaluated for pain, infection, mobility, ankylosis, and resorption at the postoperative second week, one month, third month, and six months. The pain was assessed on the visual analog scale (VAS), infection was assessed by the presence of purulent discharges, mobility was assessed on a clinical examination of tooth movements, ankylosis was seen radiographically as the obliteration of the periodontal ligament space, and the absence of the lamina dura and resorption were seen radiographically as radiolucency on the root surface. All the readings were tabulated and statistically analyzed.

RESULTS

Pain was seen to be maximal at two weeks and minimum at six months. Infection was not seen at all time intervals. Mobility was reduced with time. There was no significant ankylosis or resorption. Out of the 20 cases, four patients required extractions due to resorption and grade 3 mobility. One patient showed ankylosis. The success rate of the autotransplantation was 75%. Fifteen patients showed well-defined lamina dura without ankylosis or resorption.

CONCLUSION

Autotransplantation is a valuable tooth replacement option and more economical, especially when provided with proper case selection.

An evaluation of 1654 premolars transplanted in the posterior region-A retrospective analysis of survival, success and complications

AIM

The aim of this retrospective analysis was to evaluate the survival, success and possible complications of transplanted premolars in the posterior region subdivided by developmental stage and patient age.

MATERIALS AND METHODS

This study included patients who underwent tooth transplantation between April 2004 and December 2021. A total of 1654 premolars were transplanted into 1243 patients. Tooth mobility, oral hygiene and periodontal parameters were clinically evaluated. Intraoral radiographs were used to evaluate pulpal and periodontal healing, and root formation. The cumulative survival rate was calculated using the Kaplan-Meier method.

RESULTS

Data were subdivided into three groups based on the stage of root development and patient age. The mean age at surgery was 14.5 years. The main indication for transplantation was agenesis, followed by trauma and other indications, such as impacted or malformed teeth. A total of 11 premolars were lost during the study period. The overall survival and success rates in the immature premolar group after an observation period of 10 years were 99.7% and 99.4%, respectively. High survival and success rates (95.7% and 95.5%, respectively) were also observed when fully developed premolars were transplanted into the posterior region of adolescents. In adults, the success rate after 10-year follow-up is 83.3%.

CONCLUSIONS

Transplantation of premolars with developing and fully developed roots is a predictable treatment modality.

Tooth autotransplantation gives teeth a second chance at life: A case series

Traditional transplantation, surgical extrusion and intentional replantation procedures are important treatment options that clinicians may consider performing in their daily clinical practice. There should be a well-constructed treatment plan for teeth with problems. In this paper, we present a series of case reports on three treatment methods used in autologous tooth transplantation and a literature review on the prevention of postoperative complications and the advantages of autologous tooth transplantation compared to dental implantation. The purpose of this study was to improve the understanding of autologous tooth transplantation.

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.

Intentional Replantation of Single-Rooted and Multi-Rooted Teeth: A Systematic Review

The technique of intentional replantation can provide a second chance to save teeth that would be destined for extraction. Therefore, the present systematic review aimed primarily to estimate tooth survival after intentional replantation and secondarily to compare treatment outcomes in single-rooted and multi-rooted teeth. The study protocol was developed before the analysis according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Articles were electronically searched in PubMed/MEDLINE, the COCHRANE library and Google Scholar by two independent reviewers, and those that met the eligibility criteria were included. A statistical analysis using the chi-square test with a p-value of <0.05 was performed on the reported outcomes of intentional replantation. A total of 44 single-rooted replanted teeth with five failures (11.36%) and 42 multi-rooted replanted teeth with six failures (14.28%) were reported in the literature, corresponding to a survival rate of 88.64% and 85.57%, respectively. The overall survival rate for the replantation procedure was 86.7%, indicating that intentional replantation can be considered a safe therapeutic choice, with no statistically significant difference between the survival rates of single-rooted and multi-rooted replanted teeth.

Surgical transpose of an impacted maxillary canine with bone flap replacement

Introduction: Management of an edentulous area when the tooth is impacted is often a challenge. Usually, treatments are by far orthodontic traction followed by tooth removal with dental implant placement. With piezosurgery, minimally invasive auto-transplantation can be an alternative. Observation: A 27-year-old patient presenting terminal mobility of the tooth no°63 consulted for replacement. Among the different therapeutic solutions, a surgical transposition of her impacted tooth no°23 with a conservative bone window replacement was decided. After a 12-month follow up period, X-rays showed no sign of ankylosis, root resorption or apical pathology, while clinical criteria such as tooth function, mobility and aesthetic integration were all satisfying. Commentaries: Space closure, dental implant and bonded bridge were alternatives. The interest of this clinical case is to restore the functional and aesthetic roles of the canine without compromising any potential implant placement later. Also the patient can still have the possibility to opt for an implant-supported crown in the long-term thanks to the bone volume maintained. Conclusion: When orthodontic realignment is considered as not possible, auto-transplantation of a tooth can be a good choice before going on dental implant therapeutic.

What Are the Complications, Success and Survival Rates for Autotransplanted Teeth? An Overview of Systematic Reviews and Metanalyses

Background: Autotransplantation is the surgical repositioning of a tooth within the same patient. It can be thought of as the controlled avulsion and re-implantation of a tooth and can be a viable alternative to other dental rehabilitation options. This review aimed to evaluate the survival rate (SR), major complications such as ankylosis rate (AR) and infection-related root resorption (RR), and overall success and failure rate (FR) in autotransplanted teeth. Methods: Six databases were accessed up to January 2021 to obtain all systematic reviews and meta-analyses (SRs and MAs). Study selection: After title and abstract reading, data extraction was performed from eligible SRs. The methodological quality was calculated for the included SRs using the risk of bias in systematic reviews (ROBIS) tool. Results: Six SRs were included in this review. The overall failure rate ranged from as low as 2.0% to 10.32%. The 1-year survival was very high (97.4–98.0%). The 5-year survival rate ranged from 81 to 98.2%. Major complications of AR ranged from 1.2 to 6.2%, and RR ranged from 2.1 to 10.4%. Conclusion: The overall findings from these SR and MA are promising; however, all the SRs include only single-arm prospective or retrospective studies, the SRs are of overall low methodological quality, and for the heterogeneity of the included SRs, well-designed comparative studies with a long-term follow-up are recommended.

Surgical Management of Impacted Lower Second Molars: A Comprehensive Review

Impacted lower second molars (ILM2) are rarely reported in the literature, but various studies have been done for its treatment. Apart from solely orthodontic approaches, different surgical management techniques were reported to have successful outcomes. Surgical intervention of ILM2 can help expose the tooth for further orthodontic purposes, simplifying complex treatment methods, and reducing treatment time. This review illustrates the comprehensive evaluation and updated methods of surgical uprighting, repositioning, and transplantation of ILM2 with future directions for better understanding and treatment planning in the clinical setting. The successful outcome of surgical intervention depends on case selection, root development of ILM2, careful surgical manipulation, and adherence to sound biological principles.

Long-Term Outcome of Autotransplantation of a Complete Root Formed a Mandibular Third Molar

Autogenous tooth transplantation is a procedure to reposition an autogenous tooth to another extraction area or surgically created recipient site. The autotransplantation procedures have been documented well in the literature, and the survival rate of the transplanted teeth was reported to be more than 90% after ten years. Therefore, autotransplantation might have been overlooked as a treatment option. The purpose of this case report is to evaluate the long-term (29-year) success and periodontal stability of the tooth autotransplantation from the mandibular third molar to the second molar. A 24-year old female presented to a clinic with a large caries lesion with periapical radiolucnecy on to tooth #18. The tooth was extracted with the site and treated with autogenous tooth transplantation from #17 with a complete root form. Endodontic treatment was completed 3 months post autotransplantation; the final prosthesis was placed 6 months postoperatively. The patient has shown excellent oral hygiene care and high compliance with the regular maintenance recall program. The transplanted tooth has been still functioning without any symptoms. Radiographic and clinical examinations revealed stable periodontal and endodontic conditions over the 29 years after the procedure. This case report showed the long-term success of autotransplantation of the mandibular third molar with a closed root apex to the second molar site. Autotransplantation can be an option when an adequate donor site is available to reconstruct the occlusion after the tooth extraction.

Orthodontic treatment of a skeletal Class III malocclusion with severe root resorption of the maxillary anterior teeth. Autotransplantation using a 3-dimensional printed replica of the donor tooth

This case report describes the successful orthodontic treatment of a 12-year-old girl with skeletal Class III malocclusion and severe root resorption of the maxillary anterior teeth. Ectopic eruption and mesial inclination of the bilateral maxillary canines caused severe root resorption of the right central and lateral incisors and the left lateral incisor. These 3 teeth were extracted, and traction was applied to the maxillary right and left canines toward the extracted right central incisor and left lateral incisor, respectively. In the mandibular arch, the bilateral first premolars were extracted, and the crowding was corrected. The extracted mandibular right first premolar was transplanted after extraction of the maxillary right lateral incisor. To prepare for the tooth transplantation, a cone-beam computed tomography image was used to fabricate a 3-dimensional printed replica of the donor tooth. The crown shape of the maxillary anterior teeth was corrected, and the patient achieved functional occlusion with pleasing esthetics. Root resorption was negligible in the transplanted tooth. This study demonstrates the satisfactory treatment outcome and an effective 3-dimensional simulation for tooth transplantation.

Pre- and peri-operative factors influence autogenous tooth transplantation healing in insufficient bone sites

Background

The amount of bone remaining at the transplant site for autogenous tooth transplantation can facilitate successful healing. Therefore, this retrospective study evaluated the factors influencing the healing of 50 successful autogenous tooth transplantations with insufficient bone support at the transplanted site without a bone graft.

Methods

The factors were classified as pre- and peri-operative factors, and the healing outcomes were clinical and radiographic observations. The factors were statistically analyzed using the chi-square test to identify correlations between the pre- and peri-operative factors and the clinical and radiographic outcomes. The T-test or one-way analysis of variance was used to compare the percent bone change in each factor.

Results

The results indicated that gingival healing was delayed in the intra-arch transplantations, and pulp obliteration was seen earlier when transplanted in the maxilla. Patients under 18-years-old demonstrated a greater percent bone change than the over 18-year-old patients, while the peri-operative variables did not have a relationship with clinical healing and the amount of bone change over 12 months. Furthermore, the percent bone change significantly increased during the first three months.

Conclusions

In conclusion, pre-operative factors, age and transplant site, influenced the healing rate of autogenous transplanted teeth. In contrast, the peri-operative factors were not related with the clinical and radiographic outcomes. Generating the least trauma to the periodontal ligament cells is the most important concern.

Guided tooth autotransplantation in edentulous areas post-orthodontic treatment

OBJECTIVE

Tooth autotransplantation with a complete root formation to replace one or more lost teeth is indicated as a cost-effective alternative to implants. The aim of this case report was to describe a successfully guided autotransplantation of a maxillary third molar with fully formed roots into a surgically created socket after orthodontic space opening.

CLINICAL CONSIDERATIONS

A guided autotransplantation of the maxillary left third molar into the missing maxillary left first molar site was chosen. After virtually orientating donor tooth to confirm its optimum fit, it was deemed necessary to open 4 mm the mesiodistal space. Following the orthodontic movement, a 3-dimensional (3D)-guiding template and a milled surgical guide were manufactured to allow the donor tooth to be transplanted exactly in the planned position. The 2-year follow-up periapical radiograph showed a continuous periodontal space with no signs of apical periodontitis or root resorption.

CONCLUSIONS

Virtual planning and 3D-printed tooth replica combined with guided surgery can simplify the autotransplantation technique for both the clinician and the patient, particularly when the socket has been completely created during surgery.

CLINICAL SIGNIFICANCE

Virtual digital planning, which can accurately calculate the exact space to open orthodontically before an autotransplantation, could prove essential to enhancing the precision of 3D placement of the donor tooth in the recipient site.

Third molar autotransplant planning with a tooth replica. A year of follow-up case report

The advantages of dental autotransplantation and its high level of clinical success mean that it should be considered as a therapeutic option when replacing a lost tooth. In order to achieve optimum results, it is necessary to know the technique of dental autotransplantation, promoting its use whenever the clinical conditions to perform it are present. The objective of this article is to describe the technique in detail by means of a clinical case of a dental autotransplant whose donor tooth was a third unerupted molar. A 39-year-old male patient with no medical history of interest. On clinical examination, tooth 2.6 shows vertical fracture with indication of exodontia. A compatibility study is carried out using a CBCT and after this, a subsequent preparation of a 3D-printed replica of the donor tooth 2.8 is made. A step-by-step description is given of the autotransplantation technique from 2.8 to 2.6. After this, antibiotic coverage, semi-rigid splinting and root canal treatment are carried out in a short time. Results are shown at 12 months. The main factor for the success of this technique is the preservation of periodontal ligament cells. The unerupted teeth are the only ones that fully preserve the periodontal ligament, but they require greater surgical skills. Autotransplantation is a predictable treatment alternative to dental implants, being above all an option indicated to replace teeth with dental fissures or vertical root fractures or poor restorative and/or endodontic prognosis. The third molars are the most used teeth for transplantation, due to their indications for extraction in a high percentage preserving the entire periodontal ligament. The diagnosis by CBCT and the use of 3D- printed replicas of the tooth to be transplanted have meant a highly significant improvement in the prognosis and predictability of the technique. Key words:Dental autotransplant, tooth replica, third molar.

Third Molar Autotransplantation: An Alternative to Dental Implant - 9 Years Follow up of a Case

Autogenous tooth transplantation is the surgical movement of tooth from one location in the mouth to another in the same individual. It is an excellent option with good functional and esthetic outcome for rehabilitating young patients with growing alveolar bone and replaces missing tooth with a natural tooth rather than a prosthesis or an osseointegrated implant. This case reports discusses a 9 years follow up of a successful autotransplantation case of third molar in place of first molar justifying autotransplantation to be a viable treatment option in present day implant dentistry practice.

The management of mesially inclined/impacted mandibular permanent second molars

Mesially impacted mandibular second molars are a common occurrence in orthodontic practices, especially those using the lingual arch or lip bumper for alleviating anterior crowding. Horizontally impacted second molars, on the other hand, occur so infrequently that most practitioners have limited experience in treating such a patient. Because of this there is little consensus on the management of these cases. As opposed to vertically impacted molars that may be associated with ankylosis or other factors preventing eruption, the mesially angulated, horizontally impacted mandibular second molar usually has eruption potential, because its impaction is more commonly due to lack of space and/or abnormal eruption path. Hence, orthodontic uprighting shows the most promise and can commonly be done without extracting the third molar or surgically exposing the impacted second molar. Modern clinicians have at their disposal a myriad of biomechanical choices that can be used to successfully reposition these teeth and enable finishing with an optimal occlusion.

Intentional replantation - a clinical review of cases undertaken at a major UK dental school

Introduction Intentional replantation (IR) may offer a solution for persistent periapical lesions associated with endodontically treated teeth in select cases. This case series demonstrates the use of IR as an alternative treatment approach to both orthograde and surgical endodontic retreatment. The indications, contraindications, benefits and risks of IR are discussed, and the clinical procedure is outlined.Setting Restorative Department, University Dental Hospital of Manchester, UK.Case reports Of the 13 cases presented, the follow-up period before discharge ranged from 3-28 months. Only one tooth which presented intra-operative challenges required extraction three months after IR due to post-operative mobility.Conclusion In select cases, IR may provide a simple, less invasive and cost-effective alternative to both endodontic retreatment and extraction alone following appropriate training.

Autotransplantation of a surgically removed canine using a customised 3D-printed surgical template

Autotransplantation is a treatment option with high reported survival rates to replace failing teeth in the anterior maxilla. This treatment requires a multidisciplinary approach from orthodontists, paediatric dentists, restorative dentists, and oral and maxillofacial surgeons to achieve successful outcomes. Success is dependent on many factors including stage of root development, handling of the periodontal ligament, extra-alveolar time and splinting. This case report presents the novel use of digitally designed and three-dimensional (3D) printed surgical templates to aid intraoperatively and reduce the extra-alveolar time. A preoperative cone-beam computed tomography scan allowed digital planning and construction of surgical templates that replicated the exact root dimensions of impacted maxillary canines. These templates were subsequently 3D printed in resin, sterilised and utilised intraoperatively to aid socket preparation before the surgical 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.

Orthodontic management of agenesis of mandibular second premolars

Agenesis of mandibular second premolar is reported to be 2.4–4.5%. The diagnosis can be set on at average 9 years of age. Early treatment in the form of extraction of the second primary molar and in some cases also the remaining three second premolars and comprehensive orthodontic treatment are often a good treatment solution. In vertical deep bite cases, cases with spacing in the dental arch, mandibular posterior rotation and for extractions disadvantageous growth pattern, a treatment with retaining of the primary molar must be taken in consideration. When there is no or minor infraocclusion, root resorption less than half of the root length, and no caries or fillings at the age of 12–13 years, there is a good prognosis for longtime survival of the primary molar.

Survival probability of dental autotransplantation of 366 teeth over 34 years within a hospital setting in the United Kingdom

INTRODUCTION

The purpose of this retrospective study was to evaluate 34 years' experience of autotransplantation of teeth during orthodontic treatment.

METHODOLOGY

Treatment was completed at Queen Mary's Hospital, Sidcup, Kent, UK, during the period 1969-2003. A total of 366 teeth were transplanted in 314 patients.

RESULTS

Canines totalled 78 per cent of all autotransplanted teeth; mean age of patient was 19.4 years. Survival probability for the first 5 years post-autotransplantation was 95 per cent, 94 per cent for the subsequent 5 years, and 88 per cent after 15 years. The maximum observation period was 34 years, the median was 2.0 years, and the mean was 3.51 (standard deviation = 3.68) years. Of the observed teeth, 10 failed and these were lost due to unsuccessful periodontal ligament regeneration and persistent mobility grade III (or greater). Apical pathology was observed in 16 per cent of all autotransplanted teeth. In 79 per cent of this subgroup, apical pathology was evident in the first 3 years post-operatively. Seventy per cent of all external resorption also occurred within the first 3 years. Internal resorption was rare but its occurrence was mostly observed between the second and sixth year post-transplantation. A minority of autotransplanted teeth [14 per cent (n = 51)] needed root canal therapy, and this was completed within the first 6 months post-transplantation.

CONCLUSIONS

Autotransplantation can be a justified procedure with good survival probability. It can be considered an alternative to other treatments, such as prosthodontic replacement of teeth.

Autogenous transalveolar transplantation of maxillary canines: a systematic review and meta-analysis

Background and objectives

The objective was to systematically review transalveolar transplantation of maxillary canines and the long-term outcome for an average follow-up period of 2 years or more.

Data collection and analysis

A systematic review of the currently available literature until December 2017 was conducted, using Medline, Cochrane Central, Web off Science, and PubMed. Articles were screened for 1. indications, 2. contra-indications, 3. surgical planning, 4. surgical technique, 5. associated risk factors, and 6. long-term outcome for transalveolar transplantation of maxillary canines with the following outcome measures: bone-related outcomes, tooth-related outcomes, soft tissue-related outcomes, and aesthetic outcome measures. Descriptive statistics, as well as a quality assessment of included articles, were performed. Following study retrieval and selection, relevant data was extracted and the risk of bias was assessed using the Methodological index for non-randomized studies (MINORS).

Results

Twelve articles were included in this review. These studies included outcome data for 783 autotransplanted maxillary canines, with long-term studies indicating a clinically acceptable overall outcome.

Limitations

Since the lack of randomized controlled trials considering this topic, the quality of the evidence in the present review is considered low. However, impacted maxillary canines are a rare anomaly and different aspects, such as position of the impacted canine, patient’s age and patient’s demands, and expectancies must be taken into account, it is practically impossible to randomize treatment.

Conclusions

There is sufficient evidence to justify the transalveolar transplantation of maxillary canines as a legitimate treatment technique for impacted maxillary canines deemed difficult to treat with surgical exposure and subsequent orthodontic alignment. Long-term studies have shown that a good overall outcome is to be expected. There is no clear agreement in the literature on the indications and contra-indications for transalveolar transplantation of maxillary canines.

Implication of key findings

It is highly desirable that further research on this issue be undertaken, high-quality observational studies are recommended.

Registration

PROSPERO (CRD42017056348)

Autotransplantation of premolars and space closure in a patient with inflamed sinuses

Congenital absence of permanent teeth can be treated by means of dental implants and prosthetics. Tooth autotransplantation is an alternative in growing patients because continued eruption of the transplanted tooth and associated alveolar bone growth can be expected. This clinical report presents tooth autotransplantation in a 10-year-old boy with chronic maxillary rhinosinusitis, diagnosed by the department of otorhinolaryngology. The patient's mandibular second premolars were transplanted to a congenitally edentulous maxillary premolar region. There was insufficient alveolar bone during transplantation because of pneumatization, but normal root development with vertical alveolar bone growth was observed during a 3-year follow-up. Healing of the transplant in the right side without closing of the apex and without signs of obliteration after 4 years is exceptional.

Development and validation of the autotransplanted maxillary canine radiological index

The purpose of this study was to propose and validate an index evaluating 2D and 3D radiographic variables of autotransplanted maxillary canines. Setting and sample population are from the Department of Oral and Maxillofacial Surgery at University Hospitals Leuven. Eight oral-maxillofacial surgeons rated 12 autotransplanted maxillary canines and adjacent bone using 11 rating variables. A new autotransplanted maxillary canine radiological index (AMCRI) was proposed. It consisted of 11 variables. These variables were based on 2D (intraoral) and 3D Cone Beam Computed Tomography (CBCT) radiographs. Intraclass correlation coefficient (ICC) and Fleiss's kappa statistics were performed to analyze intrarater and interrater agreement. Considering cumulative assessment of the AMCRI, the mean ICC value for the interrater agreement of the eight examiners was 0.94, representing an excellent agreement. Intrarater agreement was 0.91. The AMCRI is an objective tool in rating radiological outcome of autotransplanted canines and adjacent bone, when compared with the contralateral canine.

Autotransplantation, Surgical Repositioning of Retained Canine, and Apical Filling of Two Incisors with Root Resorption

The purpose is to show the autotransplantation and surgical repositioning of a retained canine, and the apical filling of central and lateral resorbed incisors from a 12-year-old female patient, healthy and with clinical absence of left maxillary canine. Radiographically, the retained canine between the resorbed central and lateral incisors was observed. Root canal treatment of the canine was performed after 8 weeks; apical curettage and placement of bovine graft in inter-incisal zone was done after 4 months. During 6 months, orthodontic traction of the canine was carried out with no positive results, and 12 months after the autotransplantation, surgical repositioning was performed. Clinical-radiographic control at 30 days and 24 months showed absence of inflammation, restoration and integration of the tooth-supporting structures. Autotransplantation combined with surgical repositioning of the retained canine and the apical filling of two incisors achieved the harmonious, aesthetic, functional, dental and psychological preservation of the patient.

Clinical application of 3D technology for tooth autotransplantation: A case report

This report presents two cases of tooth autotransplantation using cone-beam computed tomography (CBCT), the three-dimensional (3D) simulation dental planning software and a computer-aided rapid prototyping (CARP) model. Two hopeless teeth of adult patients were replaced as their third molar teeth. Before deciding the autotransplantation, diagnostic CBCT images were acquired and imported to SimPlant software. The SimPlant dental program was used for surgical simulation prior to autotransplantation, which created 3D images of the available donor teeth and recipient site tooth and superimposed the images to display their morphological similarity. Efficient modification of the recipient socket was designed preoperatively. The CARP model of the donor tooth was prepared as a substitute for the donor tooth that would be fit into the new recipient socket during bone preparation. Autotransplantation was favourably performed in 5-6 min. Transplanted teeth healed up without clinical abnormality. The postoperative follow-up time was up to 6 years.

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.

Autotransplantation of a Premolar with Incipient Root Development, an 18-Year Follow-Up

In young patients, premature tooth loss in the anterior maxilla after trauma is challenging for the patient and the dental professional, with serious implications from aesthetic and functional points of view, as well as from a craniofacial growth aspect perspective. Premolars autotransplanted into the maxillary anterior region have been shown to be a biological alternative in this situation. This report describes the clinical management of a case of premature loss of a maxillary central incisor after traumatic injury. A mandibular premolar at the stage of initial root development was transplanted into the alveolar socket of the lost incisor. After 18 years, the transplanted tooth remained responsive to pulp sensibility tests and the periradicular bone and soft tissues were within normal limits. Autotransplantation of premolar teeth into the maxilla could be considered an excellent treatment choice with many biological advantages over implants or fixed dentures as long as proper case selection is followed.

[Treatment of complex crown-root fracture]

With the development of the oral clinical technology and materials, the concept of complex crown root fracture has become more scientific and developed. Epidemiological characteristics, causes and clinical features of this disease are generalized. Aesthetic, functional and minimally invasive coordination is reflected by expounding the diagnosis of complex crown-root fracture, recommendation of treatment and techniques, and characteristics of immature permanent teeth to systematize the treatment strategy, and to guide the clinical therapy of complex crown-root fracture.

Adhesion of human periodontal ligament cells by three-dimensional culture to the sterilized root surface of extracted human teeth

Residual periodontal ligament (PDL) and cement mass on the roots of extracted teeth are factors that considerably affect tooth transplantation. Therefore, when normal extracted teeth are used for autologous transplantation, it is necessary to regenerate the PDL of the root surface. Here we describe a method to examine human PDL cell adhesion on sterilized root surfaces. Sample teeth were extracted during orthodontic treatment. PDL cells were obtained from healthy periodontal tissue explants from teeth extracted for orthodontic reasons. We developed a method for adhering PDL cells to sterile root surfaces using three-dimensional culture for 3 weeks. We evaluated the adhesion of human PDL cells to the sterilized root surfaces biochemically and histologically. The adherent PDL cells presented new projections on the sterile root surfaces. Therefore, PDL cells can adhere to sterile root surfaces.

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 Ectopic Permanent Maxillary Incisors

The report presents examples of successful cases of autotransplantation of ectopic teeth as donor in the treatment of clinically missing maxillary anterior teeth in young patients. The transplanted teeth were either severely ectopic, inverted, rotated or in an unfavourable position that they are commonly sacrificed as a result. Details of surgical technique as well as clinical and radiographic assessments were discussed.

Posterior Open Bite Due to Failure of Maxillary Molar Eruption

Posterior open bite can cause problems with occlusion. It arises from systemic or local factors such as physical or functional interference, ankylosis, and failure of eruption. Primary failure of eruption (PFE) is a rare condition that is difficult to differentiate from ankylosis and requires complex treatment strategies. Here we report a 12-year-old girl who was referred to our hospital by her dentist for re-evaluation of eruption failure of the left maxillary secondary premolar and first and second molars with congenitally missing maxillary lateral teeth. The maxillary first molar was extracted for a therapeutic diagnosis. The left maxillary secondary premolar and second molar reacted well to subsequent orthodontic treatment. Auto-transplantation of the mandibular premolar to the maxil-lary arch was carried out to achieve optimal overjet, overbite, and occlusion. The active treatment period spanned 4 years and 1 month. Assessment of the patient's medical and dental history, prior trauma, and clinical conditions resulted in a therapeutic diagnosis of PFE. Satisfactory orthodontic treatment results were achieved.

Orthodontic traction of a transmigrated mandibular canine using mini-implant: a case report and review

The patient in this case is an 11-year-old girl, whose mandibular left canine was transmigrated. The traction to the arch was assisted by using a temporary skeletal anchorage device. After 5 months of poor response to traction, the biomechanics were re-adjusted, obtaining effective traction in to the arch in 12 months. After this period, the treatment was completed with fixed orthodontic appliances.

Occlusal rehabilitation in patients with congenitally missing teeth-dental implants, conventional prosthetics, tooth autotransplants, and preservation of deciduous teeth-a systematic review

Background

Implant patients with congenitally missing teeth share some common charateristics and deserve special attention.

Methods

The PICO question was “In patients with congenitally missing teeth, does an early occlusal rehabilitation with dental implants in comparison to tooth autotransplants, conventional prosthetics on teeth or preservation of deciduous teeth have better general outcomes in terms of survival, success and better patient centered outcomes in terms of quality of life, self-esteem, satisfaction, chewing function?”

After electronic database search, a total of 63 relevant studies were eligible, of which 42 qualified for numerical data synthesis, 26 being retrospective studies. A data synthesis was performed by weighted means for survival/success/annual failure rates.

Results

The mean survival of implants was 95.3 % (prosthesis survival 97.8 %), autotransplants 94.4 %, deciduous teeth 89.6 %, and conventional prostheses 60.2 %. The implant survival in children, adolescents, and adults was 72.4, 93.0, and 97.4 %. Annual failure rates of implants 3.317 %, autotransplants 1.061 %, deciduous teeth 0.908 %, and conventional prostheses 5.144 % indicated better results for natural teeth and more maintenance needs for the both prosthetic treatments. The mean OHIP score was 27.8 at baseline and a mean improvement of 14.9 score points was reported after implant prosthetics. The mean satisfaction rates were 93.4 (implants), 76.6 (conventional prostheses), 72.0 (autotransplants), and 65.5 % (orthodontic space closure).

Conclusions

In synopsis of general and patient-centered outcomes, implants yielded the best results, however, not in children <13 years. Autotransplants and deciduous teeth had low annual failure rates and are appropriate treatments in children and adolescents at low costs. Conventional prosthetics had lower survival/success rates than the other options. Due to heterogeneity and low number of studies, patient-reported outcomes in this review have to be interpreted with caution.

Replantation of a displaced incisor in a boy with a cleft lip and alveolus: a case report

BACKGROUND

Tooth replantation after traumatic avulsion or transplantation is a challenge in oral surgery. A special method named auto-alloplastic replantation, in which a titanium post is used after extraoral endodontic treatment, combines several advantages. The treatment is performed in one step with no further endodontic intervention, no wide root canal instrumentation, no recontamination, and reduced endodontic infection. This is the first report on replantation of an ectopic tooth in a patient with a cleft lip and alveolus using this method.

CASE PRESENTATION

This case report presents the treatment of a 13-year-old white boy with a cleft lip and alveolus who had an ectopic incisor in the cleft region. His rehabilitation was performed by a tooth transposition using the auto-alloplastic replantation technique. After preparation of the displaced incisor from the vestibule, extraoral endodontic treatment followed using a titanium post prior to replantation in a newly formed socket. In the follow-up, the tooth is still in place and functioning after 2 years.

CONCLUSIONS

This method can be used to bridge the years while a patient is young and jaw growth is incomplete until bone augmentation and implantation can be performed. The tooth will preserve the remaining alveolar ridge and help the adolescent psychologically.