Influence of augmented reality technique on the accuracy of autotransplanted teeth in surgically created sockets

BACKGROUND

The objective of the present study was to evaluate the reliability of an augmented reality drilling approach and a freehand drilling technique for the autotransplantation of single-rooted teeth.

MATERIALS AND METHODS

Forty samples were assigned to the following surgical techniques for drilling guidance of the artificial sockets: A. augmented reality technique (AR) (n = 20) and B. conventional free-hand technique (FT) (n = 20). Then, two models with 10 teeth each were submitted to a preoperative cone-beam computed tomography (CBCT) scan and a digital impression by a 3D intraoral scan. Afterwards, the autotrasplanted teeth were planned in a 3D dental implant planning software and transferred to the augmented reality device. Then, a postoperative CBCT scan was performed. Data sets from postoperative CBCT scans were aligned to the planning in the 3D implant planning software to analize the coronal, apical and angular deviations. Student's t-test and Mann-Whitney non-parametric statistical analysis were used to analyze the results.

RESULTS

No statistically significant differences were shown at coronal (p = 0.123) and angular (p = 0.340) level; however, apical deviations between AR and FT study groups (p = 0.008) were statistically significant different.

CONCLUSION

The augmented reality appliance provides higher accuracy in the positioning of single-root autotransplanted teeth compared to the conventional free-hand technique.

Pulp revascularization after autotransplantation of the mandibular canines with partially resected roots. Report of five cases with follow-ups between 26 and 80 months

INTRODUCTION

Transmigrated (migrated through the midline) mandibular canines constitute a treatment challenge. Advanced transmigration can be successfully treated by autotransplantation. In developing canines, pulp revascularisation is typical after transplantation. On the contrary, the pulp of teeth with completed apex formation does not undergo revascularization. In this case, root canal treatment becomes compulsory and decreases the success of autotransplantation. The aim of this observational retrospective study was to evaluate whether partial resection of the root (performed during the autotransplantation of mature canines) would enable revascularization of the pulp after the surgery.

METHODS

Five transmigrated mandibular canines with complete apex formation before the surgery were evaluated. During the autotransplantation surgery, the resection of 2-4 mm of the root apex was performed to open the path for revascularisation of the pulp after surgery. The transplanted teeth were observed during healing after the surgery for the presence of pulp obliteration. Clinical and radiographic examinations were performed.

RESULTS

All treated canines survived the minimum observation period of two years (ranging from 26 to 80 months, mean: 55 months) without pulp healing complications. The survival was 100 percent, and the success was 80 percent. In one canine, the external cervical root resorption was diagnosed and treated one year after the surgery. At the final examination, transplanted canines presented radiographic features of pulp obliteration, normal mobility, and healthy periodontal tissues.

CONCLUSIONS

The surgical protocol proved to be successful in promoting revascularization to maintain pulp vitality, in all cases. The outcomes confirm that autotransplantation, combined with the resection of the root, constitutes as a valid treatment for mature ectopic canines.

Long term outcomes of en-block autotransplantation of a tooth

Repositioning of impacted teeth in the dental arch through en-bloc autotransplantation showed short-term efficacy of 89%. The objective of this study was to evaluate the technique for long-term efficacy. The analysis involved 23 teeth transplanted to the alveolar ridge through harvesting the tooth with the adjacent bone tissue. Development of the root was completed and the apical foramen was closed in all the teeth. The teeth were examined clinically and radiologically (CBCT) and compared to contralateral ones. The obtained data were analysed statistically. The efficacy of the procedure amounted to 81% including two teeth lost at an early stage and another two lost during follow-up. The mean age of patients upon performing the procedure was 29.8. The long-term follow-up amounted to the mean of 34.3 months. In the study group recession of 1-2 mm as well as 3-5 mm was found, which was not noted on the control group. In 11.1% of the study group teeth the external root resorption was observed. No transplanted tooth underwent root canal treatment, no periapical changes were observed at CBCT and 77.8% of those showed positive reaction to ethyl chloride. One case of ankylosis was observed in tooth 11 and in two cases increased mobility of the transplanted tooth was found. Regeneration of nerves as well as revascularization in the en-bloc autotransplantation proceeded with high predictability and the risk of ankylosis of the treated tooth seemed to be negligible. Gingival recession was observed more often in case of en-bloc transplantation compared to the control group. The long-term follow-up suggested that this the technique does not prevent external resorption in 100%.

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

OBJECTIVES

To determine the survival of intentional autotransplantation of developing teeth.

MATERIAL AND METHODS

An electronic search was carried out in the MEDLINE database, Web of Science, and Cochrane Library. The criteria used are the ones described in the PRISMA Declaration. The following MeSH terms were used: ("tooth" [MeSH Terms] OR "tooth" [All Fields]) AND ("transplantation, autologous" [MeSH Terms] OR ("transplantation" [All Fields] AND "autologous" [All Fields]) OR "autologous transplantation" [All Fields] OR "autotransplantation" [All Fields]) AND ("humans" [MeSH Terms]. Randomised clinical trials and prospective and retrospective clinical studies were included.

RESULTS

The meta-analytic study of overall survival included a total of 14 studies, yielding an overall survival rate of 97.9%. In studies with 1-year follow-ups, survival was 98%. The resulting 2-year follow-up rate was 97%, while the 5- and 10-year survival rates were 95.9% and 96.9%, respectively.

CONCLUSIONS

The autotransplantation technique performed in a single-phase and on teeth that have not completed their development is a predictable technique, with a described survival rate at a 2-year follow-up of more than 97%.

CLINICAL RELEVANCE

The technique of dental autotransplantation is considered an important resource for the resolution and rehabilitation of tooth loss in patients, especially in those who are still in a growth period. Moreover, this technique has a low complication rate and a 10-year survival rate of 96.9%. It should therefore be considered a safe and reliable procedure.

Application effect of computer-aided design combined with three-dimensional printing technology in autologous tooth transplantation: a retrospective cohort study

BACKGROUND

The activity of donor periodontal membrane is the key factor of autologous tooth healing. The application of digital aided design, 3D printing model and guide plate in autotransplantation of tooth (ATT) is expected to reduce the damage of periodontal membrane and preserve the activity of periodontal membrane, so as to improve the success rate of ATT. This study tried to prove the role of digital technology in improving the success rate of ATT, although there are differences in model accuracy in practice.

METHODS

We included 41 tooth autotransplantation cases which assisted by 3D-printed donor models and surgical guides and divided them into two groups in accordance with whether the donor tooth could be placed successfully after the preparation of alveolar socket guided by the model tooth. Then, we compared and analyzed the preparation time of alveolar socket, extra-alveolar time, and number of positioning trials of the donor tooth between the two groups. We also included a comparison of the in vitro time of the donor tooth with that of 15 min. The incidence of complications was included in the prognostic evaluation.

RESULTS

The mean preparation time of the alveolar socket, mean extra-alveolar time of donor tooth, and mean number of positioning trials with donor tooth of 41 cases were 12.73 ± 6.18 min, 5.56 ± 3.11 min, and 2.61 ± 1.00, respectively. The group wherein the donor tooth cannot be placed successfully (15.57 ± 6.14 min, 7.29 ± 2.57 min) spent more preparation time of alveolar socket and extra-alveolar time than the group wherein the donor tooth can be placed successfully (9.75 ± 4.73 min, 3.75 ± 2.57 min). The number of positioning trials with the donor tooth of the group wherein the donor tooth cannot be placed successfully (3.19 ± 0.75) was higher than that of the other group (2.00 ± 0.86). There was no significant difference in survival rates between the two groups.

CONCLUSIONS

Compared with the traditional tooth autotransplantation, the introduction of computer-aided design combined with 3D printing of the model tooth and surgical guides evidently shortens the preparation time of the alveolar socket and the extra-alveolar time of the donor tooth and reduces the number of positioning trials with the donor tooth regardless of the shape deviation between the model and actual teeth.

Aesthetic and functional restoration of the dental arch continuity in difficult cases of impacted teeth within the frontal segment

Impacted teeth are a fairly common defect with the incidence ranging from 2.9 to 13.7%. Evaluation of the efficacy and safety of various treatment modalities in patients with impacted teeth within the frontal segment of the maxilla. The retrospective evaluation covered treatment outcomes in 81 patients with impacted teeth within the aesthetic segment. The subjects were divided into 3 groups. Patients with the impacted tooth uncovered and orthodontically repositioned in the arch were assigned to group 1. Group 2 consisted of patients with the impacted tooth qualified for extraction and the gap augmented and restored with an implant. Group 3 included subjects, who underwent en-bloc autotransplantation of the impacted tooth. In 38 group 1 subjects 47 teeth were uncovered with a mean efficacy of 58.1% (96.3% and 70% in patients below 18 yoa and adults, respectively). The excellent aesthetic treatment outcome was obtained in 75% and good in 25% of patients. In group 2 twenty-six adult subjects were treated with 100% efficacy. In 65.4% of patients, augmentation with a bone block was performed and in the remaining 34.6%, implantation and augmentation with bone granulate. In 88.3% subjects a satisfying treatment outcome was obtained. In group 3 eighteen teeth in a block were grafted with the efficacy of 88.9%. Excellent aesthetics was obtained in 56.25% of cases and good in 31.25%. Orthodontic repositioning of the impacted teeth in the arch in adult patients bears the risk of failure. Surgical treatment modalities in impacted teeth are effective and provide high aesthetics of the treatment outcome improved by prior orthodontic treatment of the concomitant malocclusion and augmentation of the vertical bone atrophy before implantation.

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.

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

Background

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

Case presentation

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

Conclusion

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

Long term survival of mature autotransplanted teeth: A retrospective single center analysis

OBJECTIVE

The replacement of an irremediably compromised tooth requires an implant rehabilitation or a traditional fixed partial denture. In well-selected cases, a further therapeutic possibility is represented by tooth autotransplantation. Although dental transplants are poorly understood and practiced, the international literature agrees that it is considered the first choice when applicable. The advantages of this technique are numerous: use of an autologous element, maintenance of tissue trophism, aesthetic and functional restoration, costs reduction. Although autotransplantation is often performed with immature teeth, even mature teeth with fully formed apex can be used as donors. The aim of the present work was to analyze consecutive cases of completely formed donor teeth autotransplantations performed from 2005 to 2011 in 21 patients for evaluating the survival and success rate.

MATERIALS AND METHODS

The medical records of patients who underwent transplantation in a specialized center in Rimini (Italy) from 2005 to 2011 were checked. Only transplants of mature donor molars were considered. Patients were called up to evaluate the survival rate and success rate.

RESULTS

The mean age at the time of the surgery was 33,6 ± 7,4; mean follow up was 11,9 years ±1,9. Success rate at the time of latest recall visit was 80 % and survival 95 % of the analyzed cases.

CONCLUSIONS

The survival and success rate are in complete agreement with the most recent literature and confirm that the technique of autotransplantation is reliable when indications and protocols are rigidly followed, also using mature teeth as donors.

Endodontic management of an autotransplanted mandibular third molar: A simplified approach

BACKGROUND AND OVERVIEW

In this case report, the authors aim to review the standard protocols for endodontic treatment of autotransplanted molars and report on the 5-year follow-up of a clinical transplantation case.

CASE DESCRIPTION

The authors transplanted a mandibular third molar into the position of the adjacent second molar. The authors performed extraoral apicoectomy and retrograde restoration after atraumatic extraction of the donor tooth and before transplantation. The authors did not perform conventional orthograde root canal treatment after transplantation. The patient was followed up 5 years after the autotransplantation. Results of follow-up radiography showed a regular root surface without evidence of periapical lesions or root resorption.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

If appropriate sterility of the working field is maintained during surgery and a tight apical seal is achieved during the extraoral treatment, orthograde endodontic treatment should be delayed or avoided.

Autotransplantation of mature impacted tooth to a fresh molar socket using a 3D replica and guided bone regeneration: two years retrospective case series

Background

The aim of this study was to evaluate the clinical outcome of autotransplantation of mature third molars to fresh molar extraction sockets using 3D replicas.

Methods

Ten patients underwent teeth autotransplantation with or without GBR. We observed the mobility, percussion, radiography examination, the probing depth and the masticatory function of the transplanted teeth during 2 years following up, which were transplanted into fresh molar sockets by using 3D replicas, and GBR when it is necessary.

Results

The average extra-oral time of donor tooth had been shortened to 1.65 min when used the 3D replica. Some probing depth of the transplanted tooth were deeper than 3 mm at 4 or 5 weeks temporarily. And one patient felt slight sensitive when chewing with soft food at 4 weeks, then disappeared. The clinical examination of the autotransplantation teeth during 1 year follow-up showed no sign of failure.

Conclusions

The tooth autotransplantation using 3D replica with or without GBR is an effective method which can reduce the extra-oral time of the donor teeth and may result in less failure.

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.

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.

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.