Autotransplantation in combination with orthodontic treatment

Abstract

Introduction: Autotransplantation is a surgical method in which a tooth is repositioned within the same patient. It can be described as a controlled reimplantation of an extracted tooth into a new, surgically prepared socket. The key to success of this treatment is the preservation and regeneration of the periodontal ligament. It is an underutilized technique which, if conducted with a multidisciplinary team, can be an ideal treatment option for patients with failing or missing teeth.

Objectives: The detailed clinical procedures, indications for this technique, and the factors affecting its success are discussed.

Keywords: Autotransplantation; recipient site; reimplantation; success rate.

Figure 1

Pre- (a) and posttreatment (b) photographs of a patient; the arrows indicate the donor tooth and the tooth after transplantation

Figure 2

(a and b) Pediatric patient with traumatic loss of upper right central and lateral incisor in bicycle accident. (c and d) Autotransplant of lower right first premolar into position of upper right central incisor (British Dental Journal)[18]

Figure 3

(a) Palatal occlusal view of the widened alveolar cleft after orthodontic preparatory stage of premaxillary expansion and protraction. (b) Postsurgical bone grafting with maxillary left canine eruption in grafted alveolar cleft area in a mesioangular position. (c) Maxillary canine orthodontically drifted into alveolar grafted area with a distal contact point with maxillary left central incisor creating adequate space for donor tooth transplantation next to the cleft area. (d) Post-autotransplantation intervention (Journal of Cranio-Maxillo-Facial Surgery)[22]

Figure 4

Radiographic evaluation of cleft affected candidate for autotransplantation. View of the recipient (maxillary left lateral incisor) and donor site (mandibular left second premolar), revealing mandibular premolar root development that exceeds two-thirds of the complete root length – the appropriate dental age for autotransplantation procedures. (a) Panoramic radiograph. (b) Periapical radiograph of recipient site. (c) Postsurgical bone graft and pre-autotransplantation intervention – CBCT view. (d) Periapical radiograph of the donor site. (Journal of Cranio-Maxillo-Facial Surgery)[22]

Figure 5

Prediction of optimal root development, pulpal survival, and periodontal healing (i.e., without root resorption) as related to stage of root development at time of transplantation. Graph is based on the results from a long-term study of 370 autotransplanted premolars

Figure 6

Pre- (a) and posttreatment (b) photographs of case 3 patient; the arrow indicates the transplanted tooth