Interdisciplinary management of orthodontic-dental implant-restorative patients

This article addresses the management of dental implants in joint orthodontic-restorative cases, emphasising the role of temporary skeletal anchorage devices and interdisciplinary treatment. Focused on complex malocclusions that require dental implants, the article navigates through critical aspects such as diagnosis, treatment planning, implant positioning challenges and the strategic role of temporary skeletal anchorage devices in cases with compromised anchorage. Effective communication, collaborative efforts and strategic planning are highlighted in determining optimal implant numbers, locations and timing of placement. A collaborative, strategic approach to managing the complexities of joint orthodontic-restorative cases involving dental implants is recommended.

AUTOTRANSPLANTATION OF TEETH WITH OPEN APICES MAY RESULT IN HIGH SURVIVAL RATES BUT EVIDENCE IS LIMITED

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

Tooth autotransplantation: an umbrella review. Tan BL, Tong HJ, Narashimhan S, Banihani A, Nazzal H, Duggal MS. Dent Traumatol 2023;39(Suppl 1):2-29.

SOURCE OF FUNDING

Open access funding provided by the Qatar National Library TYPE OF STUDY/DESIGN: Umbrella review.

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.

Three-dimensional analysis of the alveolar ridge profiles of maxillary central incisors in children for autotransplantation

BACKGROUND

Sufficient alveolar housing is fundamental to ensure the favorable prognosis of autotransplanted teeth. However, little is known about the alveolar ridge profiles of the anterior maxilla in children. Therefore, this study aimed to investigate the alveolar ridge profiles of the anterior maxilla in growing children.

METHODS

A total of 169 Korean children aged 10-13 years old were included in this retrospective study. Demographic data and cone-beam computed tomography scans of 244 maxillary central incisors were collected. For each tooth, the alveolar ridge thickness was determined at 1-, 3-, and 5-mm levels below the cemento-enamel junction. The alveolar process height and labial concavity were also evaluated. Statistical analyses were performed to evaluate differences according to age and sex.

RESULTS

The alveolar ridge thickness did not differ according to age. The alveolar ridge thickness in males was significantly greater than that in females among those aged 10 and 11 years. The average alveolar process height was 17.43 ± 2.22 mm. The alveolar process height hardly changed with age from 10-13 years, whereas the alveolar process height of males was significantly greater compared with that of females among those aged 10 years. The labial concavity was approximately 150˚, with no significant differences between age and sex.

CONCLUSIONS

Within the limits of this study, the anatomy of the alveolar ridge in the maxillary central incisors showed sufficient capacity as a recipient site for autotransplantation using mandibular premolars, especially in males. These findings serve as a valuable resource for facilitating autotransplantation in children.

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

AIM

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

Combined orthodontic and prosthodontic treatment in an adolescent patient with traumatically ankylosed incisors: A case report

Symmetric extraction of premolars is a frequently used orthodontic treatment for dental crowding and protrusion. However, when a patient has incisors with ankylosis, the establishment of a treatment protocol often plagues orthodontists. An adolescent patient with a history of incisor trauma sought treatment for dental protrusion and crowding. Upon percussion of his infrapositioned maxillary central incisors, characteristic dull metallic sounds were noted, and a lack of normal mobility of these teeth under the application of external forces was detected. Follow-up radiographs after the trauma showed replacement root resorption of the maxillary central incisors. Based on clinical and radiological findings, ankylosis of the maxillary central incisors was tentatively diagnosed. A combination of orthodontic and prosthodontic treatment options involving extraction of the maxillary central incisors and mandibular first premolars was chosen to resolve the functional and esthetic problems. After treatment, well-aligned dentition, improved smile esthetics, and a more harmonious facial profile were achieved, and these outcomes remained stable during the follow-up period. This case report illustrates a viable treatment strategy for tackling predicaments caused by ankylosed incisors, which is unusual in the literature.

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.

Interdisciplinary rehabilitation for mutilated dentition with mini-implants, autotransplants, and a dental implant

A patient with mutilated dentition was treated to an acceptable result with the help of mini-implants for anchorage, autotransplantation of 2 teeth, one dental implant, and multiple prostheses. The major problems for this mutilated dentition were multiple missing teeth, bite collapse with posterior crossbites, deepbite with a canted gummy smile, and severe skeletal discrepancy of maxillary protrusion and mandibular retrusion. Mini-implant anchorage was applied to retract and intrude the maxillary arch to reduce the protrusion and rotate the mandible counterclockwise to improve the chin projection. Two autotransplantations, one dental implant, and multiple prostheses were used to accomplish a satisfactory full mouth rehabilitation with an interdisciplinary approach, including orthodontics, periodontics, endodontics, prosthodontics, and implantology. The understanding of biological principles, improvement in surgical protocol makes it possible to preserve the periodontal ligament (PDL) cells with atraumatic extraction after loosening the donor with orthodontic force and reduce the extraoral time with the 3-dimensional print-out replica segmented from cone-beam computed tomography for trying fitness. Soft wire splinting to gain initial stabilization and root canal treatment to avoid endotoxin further reduce the risk of root resorption, loss of attachment, and ankylosis. Autotransplantation could be considered as a part of full mouth rehabilitation. Orthodontic space management is also an important procedure to confirm the site of dental implant installation in the interdisciplinary collaboration.

Mandibular premolar transplantation to replace missing maxillary anterior teeth: A multidisciplinary approach

One of the most challenging problems for orthodontists is that of multiple missing maxillary teeth in a growing patient. In many patients, a good treatment option is autotransplantation. This case report describes the multidisciplinary treatment of an 11-year-old girl with regional odontodysplasia affecting the maxillary right and left central incisors, and congenitally missing maxillary left lateral incisor and canine. Autotransplantation of the mandibular second premolars to the affected area was combined with orthodontic space closure, and the transplanted premolars were reshaped and restored with a resin composite to be in line with the left central and lateral incisors. After completion of the orthodontic treatment, gingivectomy was performed to obtain an even gingival contour and symmetrical gingival tissue. Space closure of the maxillary anterior teeth was achieved. Autotransplantation enabled the patient to retain her natural teeth rather than having a prosthesis or dental implant. The autotransplanted tooth allows for alveolar bone growth in synchrony with neighboring teeth and the formation of normal interdental papilla while adapting to functional stimuli and confers a high survival rate in the long term.

A conservative approach for an adult patient with a fractured tooth and crowding: Autotransplantation at the fracture site

Autotransplantation of a mature premolar in adults can be a treatment of choice for tooth replacement when combined with well-planned orthodontic treatment. This case report describes the successful treatment of a 39-year-old patient with severe crowding and a hopelessly fractured tooth on the maxillary left side. Maxillary dental crowding was relieved by extraction of a premolar on the right side, and this extracted tooth was autotransplanted to replace the fractured tooth. A mandibular incisor was extracted to correct anterior crossbite. The total treatment period was 20 months. The treatment results showed a good long-term prognosis after transplantation of a mature premolar with normal surrounding alveolar bone level for over 6 years of follow-up. Occlusion and periodontal health were excellent in the long term.

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

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

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.

Alternative treatment plan for congenitally missing teeth in an adolescent patient: A case report

BACKGROUND AND OVERVIEW

Mandibular second premolars are the second most commonly missing teeth, and there are various treatment alternatives to restore the space of the missing teeth. However, in growing patients, implants are contraindicated because they prevent growth of bone.

CASE DESCRIPTION

In this case report, the authors describe a 13-year-old girl with Class II malocclusion with congenitally missing mandibular second premolars. Autotransplantation of 2 maxillary premolars to the missing teeth site was performed considering the presence of crowding in the maxillary anterior segment. The teeth were fixed with a semirigid splint for 3 months. The patient had an acceptable occlusion at the end of the orthodontic treatment, which lasted 20 months.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

The autotransplanted right premolar showed normal physiological adaptation, whereas the tooth on the left side was ankylosed. The short-term results show that autotransplantation, which requires high technical sensitivity, may provide a biological and economical alternative to tooth replacement.

Autotransplantation of teeth with incomplete root formation: a systematic review and meta-analysis

OBJECTIVES

The objective of this systematic review and meta-analysis was to determine the rates of survival and success and the complications related to autotransplantation of teeth with incomplete root formation. Additionally, we attempted to identify the prognostic factors that influence the outcome of tooth autotransplantation.

MATERIALS AND METHODS

A literature search for all data published until July 2016 was conducted. Inclusion and exclusion criteria were specified. Risk of bias was assessed with the Newcastle checklist. Meta-analysis was performed by using the DerSimonian-Laird random effect model. The 1-, 5-, and 10-year survival rates and the weighted estimated survival, success, and complication rates per year were calculated.

RESULTS

Thirty-two studies were included for analysis. The survival rates reported after 1, 5, and 10 years were 97.4, 97.8, and 96.3%, respectively. The annual weighted estimated survival rate (98.2%), success rate (96.6%), and complication rates in terms of ankylosis (2.0%), root resorption (2.9%), and pulp necrosis (3.3%) were analyzed. No firm conclusions could be drawn with respect to the prognostic factors due to insufficient evidence of high quality.

CONCLUSION

The survival and success rates of autotransplantation of teeth with incomplete root formation were high (> 95%), with a low rate of complications (< 5%).

CLINICAL RELEVANCE

Current evidence from the literature on autotransplantation of teeth with incomplete root formation shows favorable survival and success rates and low complication rates, indicating it is a reliable treatment option.

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.

Autotransplantation of an impacted premolar using collagen sponge after cyst enucleation

INTRODUCTION

We report a case of successful autotransplantation of a premolar impacted with a dentigerous cyst and transplanted with collagen plugs for initial support.

METHODS

An 18-year-old man had an impacted premolar accompanied with a large dentigerous cyst. The tooth was extracted surgically and transplanted to an edentulous alveolar ridge, and a collagen sponge was inserted to ensure proper healing and initial support. Root canal treatment was performed 3 weeks after the surgery.

RESULTS

The previous lesion was healed, and the transplanted tooth was functional without any pathologic signs.

CONCLUSIONS

Our protocol provides a viable option for saving an impacted tooth in the case of cyst enucleation.

Successful autotransplantation of a mature mesiodens to replace a traumatized maxillary central incisor

AIM

This case describes the successful transplantation of a mature mesiodens tooth to replace a traumatized maxillary central incisor.

SUMMARY

A 17-year-old male attended 1 week after a traumatic injury to his left maxillary central incisor (tooth 21). Radiographs revealed a horizontal root fracture and a poor prognosis. The tooth was atraumatically removed and replaced with a mesiodens lying in the same region. After stabilization, root canal treatment was performed and aesthetics were restored with a tooth coloured restoration. A 2-year follow-up revealed the tooth had good aesthetics and function.

KEY LEARNING POINTS

A supernumerary nonfunctional tooth such as a mesiodens can be successfully used to replace a missing permanent tooth by autotransplantation. Autotransplantation has a high success rate if case selection is good, appropriate surgery is carried out and excellent hygiene is maintained. Autotransplantation should be considered as one of the most biologic techniques for replacing a missing tooth with minimal cost. Autotransplantation can be carried out even after complete root formation in the donor tooth.

Survival rate in autotransplanted premolars with complete root formation: a retrospective clinical survey

The purpose of this study was to analyze the survival rate in autotransplanted premolars with complete root formation in dental clinics. Participating dentists were requested to provide information on transplantations they had undertaken between 1 January 1990 and 31 December 2010. Data on a total of 708 teeth from 637 patients were collected. Data for other tooth types and for teeth with incomplete root formation were eliminated. In this study, data on 40 teeth in 35 patients were analyzed. Participants consisted of 17 men and 18 women ranging from 24 to 79 years in age (mean age, 43.7 years). The cumulative survival rate was 100% at the 5-year mark and 72.7% at 10 years, as calculated by the Kaplan-Meier method. Single-factor analysis revealed that "transplanted to the molar regions" was a significant risk factor (p<0.05) influencing the survival of transplanted teeth. However, a Cox regression analysis showed no significance. The results of this study suggest that, in cases where there is a suitable donor tooth and the oral condition is good, premolar autotransplantation is a viable treatment option, even when there is complete root formation in the donor teeth.

Regional odontodysplasia: orthodontic treatment and transplantation of premolars

Regional odontodysplasia is a rare and unique dental anomaly involving both dentitions, but mostly the teeth of 1 quadrant. This report describes the combined surgical and orthodontic treatment of a boy with regional odontodysplasia. The mandibular right central and lateral incisors and the canine (as well as the deciduous predecessors) were affected. In a 2-step procedure, the maxillary right and left second premolars were autotransplanted to the affected area. The extraction sites in the maxilla were closed, and a good functional occlusion was established.

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

OBJECTIVE

To evaluate the success rate of autotransplantation of teeth in consecutive patients and to analyze factors affecting the outcome.

MATERIALS AND METHODS

The subjects consisted of 215 consecutive patients (101 women and 114 men; aged 9.1-56.4 years, median age 15.2 years [P(10) = 11.4, P(90) = 19.7]) who had undergone transplantation of a total of 269 teeth, all by the same surgeon. In patients with multiple transplants, only the first transplant was included, to ensure that all transplanted teeth were independent units. The transplants were recorded as unsuccessful if the tooth had been extracted or was surviving but with root resorption or ankylosis. The interval between transplantation and final follow-up was a median 4.8 years (P(10) = 2.0, P(90) = 5.5) for successful transplants and a median of 2.4 years (P(10) = 0.4, P(90) = 7.7) for unsuccessful transplants.

RESULTS

One-hundred seventy-five (81%) of the transplantations were recorded as successful and 40 (19%) as unsuccessful. Twenty-five teeth had been extracted and 15 had survived but did not fulfill the criteria for success.

CONCLUSIONS

The success rate of 215 consecutively transplanted teeth was 81%. The highest success rate was for transplantation of premolars to the maxillary incisor region (100%). Complications at surgery such as difficult extraction, deviant root anatomy, or damaged root periodontium affected the outcome. During growth, a successful transplant preserves alveolar bone.