Autogenous transplantation of mandibular third molar to replace tooth with vertical root fracture

Abstract

Autogenous tooth transplantation (ATT) can be considered when there is a hopeless molar tooth and suitable donor present. This report presents an unconventional case of successful ATT of a third molar replacing the adjacent fractured second molar in a 33 year old woman. This wisdom tooth had completely developed roots. Root-end filling with Calcium Enriched Mixture (CEM) cement was performed in the third molar. The second molar was extracted non-traumatically without any bone removal; the wisdom tooth was immediately transplanted into the recipient socket. No endodontic treatment was carried out either during or after the ATT. At six-month and 2-year clinical examination the patient was asymptomatic; the transplanted tooth was still functional, with no evidence of marginal periodontal pathosis. At the same follow ups, radiographic evaluation illustrated bone regeneration, normal PDL, and absence of external root resorption. Transplantation of mature third molar seems to be a promising method for replacing a lost permanent molar tooth and restoring aesthetics and function.

Keywords: Autogenous tooth transplantation; Autotransplantation; CEM cement; NEC; New material; Third molar.

Figure 1

a) Initial periapical radiograph. The second mandibular tooth had vertical root fracture and chronic apical periodontitis. The third mandibular tooth was healthy, b) Radiographic image immediately after transplantation and c) Two years after transplantation, bone and PDL regeneration was observed. Root resorption was not observed.

Figure 2

a, b and c) Lingual, occlusal and buccal aspects of transplanted tooth after six months; clinically, the tooth showed no sensitivity to percussion and presented normal occlusion, periodontal conditions and masticatory function and d) Bite-wing radiograph six months after transplantation illustrated good occlusal interrelationship with opposite tooth.