Tooth autotransplantation: An umbrella review

Tooth autotransplantation is a versatile procedure with several clinical applications among patients across different age groups. The success of this procedure depends on multiple factors. Despite the wealth of studies available, no single primary study or systematic review is able to report on every factor affecting the outcomes of autotransplantation. The aims of this umbrella review were to evaluate treatment-related and patient-related outcomes of autotransplantation and to assess the pre-, peri- or post-operative factors that could affect these. An umbrella review was conducted according to the PRISMA statement. A literature search of five databases was performed up to 25 September 2022. Systematic Reviews (SR) with and without meta-analysis evaluating autotransplantation were included. Calibration among reviewers was carried out prior to study selection, data extraction and Risk of Bias (RoB) assessment. Study overlap was calculated using corrected covered area. Meta-meta-analysis (MMA) was performed for suitable SRs. The AMSTAR 2 critical appraisal tool was used to evaluate the quality of evidence. Seventeen SRs met the inclusion criteria. Only two SRs were suitable for conduct of MMA on autotransplantation of open apex teeth. The 5-year and 10-year survival rates were >95%. A narrative summary on factors that could affect autotransplantation outcomes and comparisons of autotransplantation to other treatment options were reported. Five SRs were rated as ‘low quality’ and 12 SRs were rated as ‘critically low quality’ in the AMSTAR 2 RoB assessment. In order to facilitate a more homogenous pool of data for subsequent meta-analysis, an Autotransplantation Outcome Index was also proposed to standardise the definition of outcomes. Autotransplantation of teeth with open apices have a high survival rate. Future studies should standardise the reporting of clinical and radiographic findings, as well as the definition of outcomes.     

Tooth autotransplantation as a treatment option: a review

Autotransplantation can provide patients with all the benefits of a natural tooth, but is seldom considered as a treatment option, in large part because of a lack of knowledge about periodontal tissue or the anatomy of teeth. The authors conducted a literature search using the PubMed database. They searched for key words including "autotransplantation," "clinical indications," "sequence and treatment procedures," "healing factors and prognosis" and "treatment options". Autotransplantation demonstrates as a viable treatment alternative, especially in growing adolescents. It provides a biological and economical treatment option for tooth replacement.     

Central hemangioma: an overview and case report

Central hemangioma of the mandible and maxilla is extremely rare. Although the mucosal and soft tissue lesions are readily suspected by their clinical appearance, the intrabony lesions may be difficult to distinguish visually. The clinical and radiographic presentation is relatively nonspecific; therefore, a proper diagnosis has to be made. The management of central hemangioma is difficult because of the abundant vascular network in this region. Various therapies have been considered, but surgery has most frequently been used. A case report of an 8-year old boy with central hemangioma of the left mandibular body with vague clinical features but a characteristic radiographic and histological picture of central hemangioma is presented here. Also presented is a literature review that includes: (1) clinical features; (2) radiographic appearance; (3) histology; and (4) possible treatment modalities. Enbloc resection of the mandible was performed, followed by the insertion of a reconstruction plate, which will later be replaced by an autogenous graft.     

Tooth autotransplantation with 3D-printed replicas as part of interdisciplinary management of children and adolescents: Two case reports

The management of missing teeth as a result of dental trauma or associated with hypodontia in children and adolescents presents as a clinical challenge for the dental team. One of the options that is regaining popularity is dental autotransplantation. To improve autotransplantation outcomes, careful interdisciplinary planning, surgical simulation using cone beam computed tomography images and three-dimensional-printed teeth replicas should be undertaken for presurgical preparation. This case report showcases two applications of autotransplantation, with emphasis on interdisciplinary management, presurgical preparation and postsurgical orthodontic and aesthetic management to deliver a good long-term, sustainable, biological outcome, as a part of a comprehensive rehabilitation treatment plan in children.     

Tooth loss treatment in the anterior region: autotransplantation of premolars and cryopreservation

Avulsed and lost anterior teeth are common in young people. Using autotransplantation, it is possible to move problems in dental arches to regions where they are more easy to solve orthodontically. Transplantation of premolars with three-quarter root formation or full root formation with wide-open apical foramina provides the best prognosis for long-term survival. This article describes the use of autotransplantation and orthodontic treatment, together with cryopreservation, in connection with complicated trauma in the anterior region of an 8-year-old girl.     

Posterior tooth autotransplantation: a case series

Tooth autotransplantation is the technique of transplanting embedded, impacted or erupted teeth from one site into another in the same individual. Autotransplantation can provide a long‐term, cost‐effective and biological solution for adolescent patients with congenitally missing teeth or significantly compromised teeth when a suitable donor tooth is available. Successful autotransplantation of immature teeth can offer many advantages for a growing patient, including a normally functioning periodontium, proprioception and preservation of alveolar bone volume. Even in the event that an autotransplanted tooth does eventually fail, the bone and soft tissue conditions are likely to be conducive for subsequent implant treatment. Despite the significant physiological and cost‐benefit advantages, tooth autotransplantation remains relatively underutilized, as the procedure is considered to be technique‐sensitive. Although carefully considered individual case selection and surgical skill are the critical determinants for success, advances in three‐dimensional computed tomography and rapid prototyping have the potential to simultaneously reduce the technique sensitivity and increase the predictability of the autotransplantation procedure. It is hoped that this case series will provide greater awareness and an appreciation of the tremendous value of autotransplantation for the management of patients with congenitally missing or significantly compromised posterior teeth.     

Tooth autotransplantation using an interdisciplinary approach to rehabilitation in a young patient: Case report with 7-year follow-up

This case report demonstrates the possibility of functional and aesthetic rehabilitation using an interdisciplinary approach in a child following avulsion of a tooth. Autotransplantation after the development of calcific metamorphosis of the pulp and acute apical periodontitis provided satisfactory repair after root canal treatment. A 7-year-old white boy avulsed the right maxillary central incisor (tooth 11). The extra-alveolar time exceeded 60 minutes, and this triggered external replacement resorption of the avulsed tooth. At 11 years of age, the child underwent tooth autotransplantation. After 4 years of follow-up, intraoral clinical and radiographic examination led to the diagnosis of calcific metamorphosis of the pulp and acute apical periodontitis. The patient had minimally invasive root canal treatment, orthodontic treatment and esthetic rehabilitation with a porcelain crown. Control periapical radiography and tomography of the autotransplanted tooth after 7 years revealed bone repair in the periapical region. This case report indicates that tooth autotransplantation can be used to replace anterior teeth after avulsion followed by replacement resorption. Interdisciplinary management helped to maintain the esthetics and function of the rehabilitated area.     

Tooth enamel dust as an asthma stimulus: A case report

A case report of a first-year dental student with asthma, who experienced exacerbation of symptoms and a severe asthmatic crisis in the course of her preclinical dental training, is presented. Dust generated as a result of preparing natural teeth triggered the bronchoconstrictive response. Her subsequent medical and preventive measures are cited. This case identifies, for the first time, enamel dust as an asthma stimulus, thus serving as a precaution to prospective dental students and personnel afflicted with the disease and emphasizing the importance of effective face masks in dental laboratories during dust-generating procedures.     

Tooth autotransplantation as a pillar for 3D regeneration of the alveolar process after severe traumatic injury: A case report

In dental traumatology, the loss of teeth and the supporting alveolar bone in children compromise the proper development of maxillofacial structures and also limit the solutions that can be offered. In this case report, multidisciplinary management is described of a child with a significant loss of alveolar bone and associated teeth due to a traffic accident at 8 years of age. The management involved staged teeth autotransplantation into surgically prepared sites with bone expanders, orthodontic treatment and dental implants. The 3D regeneration of the alveolar process was successfully stimulated by teeth autotransplantation. At the 4‐year follow‐up visit, evaluation of the autotransplanted teeth and the implants indicated a successful outcome for the patient.     

Tooth discoloration by blood: an in vitro histochemical study

Abstract An in vitro model, using a modification of a technique devised by Freccia & Peters, was developed to investigate tooth staining following pulpal haemorrhage. Samples of whole blood, erythrocytes, plasma and platelet concentrate and saline were individually placed in the pulp chambers of groups of five teeth and centrifuged twice daily for 25 min over a period of 3 consecutive days. This confirmed that the blood pigment responsible for the staining was found only in those samples containing erythrocytes. Teeth stained with packed red cells were then prepared for histological examination and subjected to four histochemical tests: (1) benzidine, (2) zinc leuco, (3) Perl's and (4) Turnbull Blue to analyse some of the biochemical changes following haemorrhage into the pulp chamber. These tests showed that, following haemolysis of erythrocytes within dentine, haemoglobin was found either intact or as one of the haematin molecules with no further breakdown of the haem structure and no evidence of any free ferric ions or haemosiderin.     

Tooth autotransplantation in a free iliac crest graft for prosthetic reconstruction

This report documents successful tooth autotransplantation to a free iliac crest graft in an exemplar case. A 14-year-old male patient was operated thrice with increasing amounts of resection for recurrent odontogenic myxoma. When mandibular continuity resection finally was performed, a free iliac crest block autotransplant was used for reconstruction. Upon metal removal 5 months later, 3 wisdom teeth with two-thirds complete root development were transplanted to the free graft and retained by fixed orthodontic appliances including skeletal anchorage with orthodontic microscrews. Tooth graft taking was awaited for 8 weeks with retention. Following undisturbed healing without occlusal forces, 6 months of orthodontic treatment intentionally extruded the autotransplanted teeth to antagonist contact. The third and most dorsal tooth became mobile after 3 months and was lost. The surviving 2 teeth were fitted by a prosthetic bridge as extrusion into the occlusal plane was not completely successful. This exemplar case shows benefit of tooth autotransplants in selected cases of jaw reconstruction with distal bone autotransplants as alternative to dental titanium implants and suprastructures. Orthodontic microscrews can moreover support tooth movement and positioning as anchorage device in altered anatomy.     

正畸力对自体移植牙牙周愈合影响的实验研究

目的 观察术后施加正畸力时间对犬移植牙牙周愈合的影响,以期为临床提供参考.方法 将4只犬的32颗上下颌切牙进行自体移植手术,分为术后不加力组(对照组)和术后1、2、4周加力4组,术后8周处死动物,将移植牙及牙周组织制作脱钙标本,以垂直于牙长轴方向进行切片,光镜下分别计算每颗牙根表面3种形态:正常牙周膜、牙根吸收和骨性粘连的观察点占全部240个观察点的百分比,比较各组百分比.结果 与对照组相比,术后2周加力组牙根吸收和骨性粘连百分比均降低,骨性粘连降低至2.1％,与对照组(12.5％)差异有统计学意义(P＜0.05).虽然术后1周加力组骨性粘连百分比(6.3％)降低,但牙根吸收增加为68.8％,与对照组(12.5％和41.7％)差异均有统计学意义(P＜0.05).术后4周加力组正常牙周膜的百分比与对照组差异无统计学意义(P＞0.05).结论 术后2周加力更有利于牙周愈合,过早加力反而不利于牙周愈合.     

Application of enamel matrix derivative in autotransplantation of an impacted maxillary premolar: a case report

BACKGROUND: The success of tooth transplantation or replantation depends on the viability of periodontal ligament in the planted tooth. Mechanical injury to periodontal tissues frequently results in dental root resorption and dental ankylosis, which leads to the failure of transplantation or replantation. Enamel matrix derivative (EMD) has been recently used to induce periodontal regeneration. In this report, we show a clinical case of EMD application in the transplantation of an inversely impacted and immature tooth. METHODS: An impacted second premolar was found in the right maxilla of a 16 year-old girl. The tooth was inversely impacted and the dental root was incomplete. When transplantation was carried out, EMD was applied to the periodontal tissues of the extracted premolar. The tooth was fixed at the correct position and the clinical condition was followed for evaluation for 6 months. RESULTS: Radiographs after 3 months exhibited new bone formation surrounding the transplanted tooth. After 6 months, considerable growth of dental root was evident, periodontal ligament-like radiolucency appeared, the vital reaction of the planted tooth was detected, and there were no signs of root resorption or ankylosis. CONCLUSION: Short-term results from this case indicate that EMD application was effective in the transplantation of an inversely impacted and immature tooth and that EMD might contribute to the growth of dental root and to the prevention of ankylosis.     

Paramolar tubercle in endodontics: An overview,case report and specimen study

Paramolar tubercle is an additional cusp occurring on the buccal surface of a permanent maxillary molar. Due to their overall low occurrence, there is limited information about root anatomy of paramolar tubercles. Periapical radiographs do not always image the root canal associated with the paramolar tubercle. Teeth with paramolar tubercle can promote problems like dental caries, gingivitis, periodontitis, and may pose problems to the clinician in procedures like orthodontic banding and rubber dam placement. Although, small paramolar tubercles may not have pulp tissue, a very large tubercle may contain separate pulp chamber and associated root canal. For successful management of such teeth requiring endodontic or periodontal therapy, advanced radiographic diagnostic aids should be used. In this paper this anatomical variation in maxillary second molar, was studied (i) by clinical examination, radiographic examination using intra-oral radiography and (ii) macroscopic examination, radiographic examination and by clearing technique in vitro.