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

Abstract

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.

Figure 1

The initial clinical presentation of #18 with gross caries extending to the subgingival margin.

Figure 2

Periapical radiograph at the initial appointment. Large periapical radiolucency was present on the second molar. The gross caries reached to the almost alveolar bone level on the radiograph. This was deemed as a nonrestorable tooth.

Figure 3

Panoramic radiograph showed that horizontal impaction of #17 was noted. The apical part of #17 was fully formed.

Figure 4

Immediate after of minimal traumatic extractions of #17 and 18. #17 was kept in the saline until this was used.

Figure 5

Tooth #17 was transplanted into the #18 site. Interrupted sutures were rendered to proximate the gingival tissues.

Figure 6

One year follow-up from the surgical procedure. Slight apical radiolucency was noted in the transplanted tooth. Soft tissue healing was uneventful. Slight inadequate root canal filing material was noted on the distal root of the transplanted tooth.

Figure 7

Ten-year follow-up after the transplantation. The size of the apical radiolucency reduced from one year after the procedure.

Figure 8

Twenty-eight years after the transplantation. Probing depth was less than 3 mm and gingival health was confirmed. There is no alveolar bone loss that was noted around the transplanted tooth. A radiolucency was noted in the pulp chamber which reached to the furcation area. However, no clinical pathological changes were noted.

Figure 9

CBCT revealed the presence of buccal and lingual bone on both mesial (a) and distal (b) roots of the transplanted tooth.

Figure 10

Twenty-nine years after the procedure, this patient maintains good oral hygiene and gingival health.

Figure 11

Panoramic radiograph demonstrated the no sign of alveolar bone loss on the transplanted tooth. This patient has maintained all the teeth for almost 30 years from initial appointment.