Autotransplantation of human premolars. A clinical and radiographic study of 100 teeth

The purpose of the present study was to identify factors which might influence the success of autotransplantation, such as root development, root resorption, pulp condition and tooth eruption. The material consisted of 100 human premolars transplanted in 87 patients. The observation period ranged from 3-18 years, with a mean value 6.3 years. Clinical and radiographic examinations were performed. The transplanted premolars were divided into 7 stages of root development. At the final control, 93 teeth remained and 7 teeth were extracted. Periodontal healing without root resorption was related to stage of root development. It decreased from 93% in teeth with 3/4 root development to 37% in teeth with fully developed roots. Inflammatory root resorption was seen in 7 cases and replacement root resorption in 12 cases. Pulp revascularization was observed in 100% in stages with initial root development to 1/2 root development and decreased to 0% for teeth with fully developed roots. Pulp obliteration was observed in all cases with revascularized pulp tissue. The gingival condition was similar to contralateral, not transplanted premolars or adjacent teeth. Root growth increased with the stage of root development at the time of transplantation. It is concluded that transplantation of premolars with 1/2-3/4 root development provides a good chance of pulp survival, limited risk of root resorption and ensures sufficient final root length, and is thus recommended.     

拔牙同期自体牙即刻移植的临床研究

目的:探讨拔牙后自体牙即刻移植的方法和临床效果。方法:对临床上有自体牙移植条件和愿望的43例患者进行术前评估。将最终接受自体牙移植的31例患者随机分为根管治疗组、非根管治疗组、人工骨移植组、非人工骨移植骨组。随访6～30月,对比临床效果。结果:31例移植牙经随访6～30月,均获得稳定和满意的咀嚼功能,X线影像未发现牙根吸收。根管治疗与否对移植的预后没有显著影响(P>0.05)。人工骨(Bio-Oss)移植有利于移植牙的骨性愈合和早期稳定,并能减缓牙槽骨的吸收(P<0.05)。结论:拔牙后自体牙即刻移植是修复牙列缺损的可行方法。     

Long-term evaluation of autotransplanted maxillary canines with completed root formation

Autotransplantation of 33 maxillary canines was followed up in 29 patients with an average age of 27.5 years. The mean follow-up period was 6.0 years. Endodontic treatment was performed in 23 teeth. Signs of root resorption were found in an increasing number of canines during the follow-up period. At the last examination eight canines showed no signs of resorption. External and internal resorption of inflammatory type were the most frequent forms of resorption and were also found to be the most hazardous factors for the prognosis of the transplanted tooth. Extraction of the transplant was necessary in four cases because of root resorption or poor bone regeneration.     

Pre-autotransplantation alveolar process augmentation and premolar autotransplantation as a treatment method for single tooth replacement in adolescents

The treatment of young patients with missing teeth and an atrophied alveolar process after trauma or agenesis of a tooth can be challenging. The aim of this study was to evaluate autotransplantation of a premolar after pre-autotransplantation alveolar process augmentation (PAPA) as a treatment option for these patients. A retrospective cohort study was implemented to analyse the PAPA procedure and subsequent autotransplantation procedure. Alveolar process augmentation was performed using different types of autologous bone grafts. Subsequent autotransplantation of one or more premolars was performed approximately 4 months later. Nine patients with a mean age of 12 years were included. Twelve premolars were transplanted after a PAPA procedure: seven in the maxillary incisor region, four in the mandibular premolar region, and one in the mandibular incisor region. Initially all transplanted teeth functioned well. However, one mandibular premolar that was transplanted in the maxillary incisor region was lost because of resorption after 6 years of follow-up. The other 11 transplanted teeth functioned well. The mean follow-up was 6 years (range 3–13 years). The results showed that autotransplantation can be facilitated by PAPA with a high chance of success. It can therefore be a valuable addition to other existing treatment options.     

Tooth transplantation after dental injury sequelae in children

Abstract –  Ten immature autotransplanted lower premolars from six patients from 7 to 12 years of age were studied and assessed clinically and radiographically at Regional Clinical Hospital in Temuco between January 2004 and April 2006. All transplantations were performed both because of a missing anterior tooth by dental trauma or by healing complications after injuries. The mean age at the time of the surgery was 10 years (range 7–12 years) and the postoperative follow-up period varied from 5 to 27 months with a mean of 16.9 months. All teeth were stabilized with flexible composite resin wire splints. Within the follow-up period, clinical evaluation was made through percussion and mobility tests. At radiographic evaluation, pulpal canal obliteration (PCO), presence of perirradicular area, inflammatory root resorption (IRR), replacement resorption (RR), stage of root development, lamina dura formation, outline of the periodontal membrane, and arrest in root growth were registered. Pulp healing was observed in 6 of 10 teeth; the other transplanted teeth developed pulp necrosis after 6–8 months possibly related to operative aesthetic procedures. Four teeth showed different grades of PCO at radiographic examination. None of transplanted teeth developed replacement resorption or ankylosis. In this 27-month follow-up period, the survival rate was 100%, regarding aesthetics, function, clinical appearance, and radiographic image of alveolar process.     

Autotransplantation of premolars to premolar sites. A long-term follow-up study of 40 consecutive patients.

This article describes the long-term outcome of 40 consecutive patients having transplanted premolars. The objective of this ongoing study is to investigate survival rate, pulp survival rate, periodontal condition, and root development of autotransplanted premolars in orthodontic patients. This report covers 17 years; 32 orthodontic patients had 40 premolars transplanted into contralateral or opposing jaw quadrants where a premolar was missing. The teeth were examined systematically with clinical and radiographic measures at 1, 2, 6, 12, and 60 months or more after autotransplantation. The observation time varied from 2 years 5 months to 22 years 3 months, with a mean of 10 years 4 months. Bonded.018-in edgewise appliances were used, subjecting 87.5% of the transplanted teeth to normal orthodontic forces. One tooth was removed because of root fracture during the observation period, and 2 more had complications possibly related to the transplantation. The remaining 37 teeth and their supporting structures were all healthy at the last examination--a 92.5% success rate. Transplants with closed apices received endodontic therapy, but, in those with open or half-open apices, a 66% pulp survival rate was observed. No teeth in the sample had signs of replacement resorption or developed periodontal attachment loss. Inflammatory resorption in 2 teeth was arrested after endodontic treatment. Root formation, when not complete, continued on transplanted teeth, giving normal root form and adequate root length for normal function. It is concluded that autotransplantation of premolars combined with orthodontic treatment should be the first treatment alternative in cases of missing premolars, when a suitable donor tooth is available.     

自体牙移植的临床研究

目的 评价自体牙移植的临床效果。方法 对19颗牙进行自体牙移植,其中,埋伏阻生牙移植15颗,前磨牙移植前牙缺失区4颗。将埋伏牙或前磨牙完整拔出后移植于缺牙 区,方丝弓托槽和澳大利亚圆丝固定6～8周,移植4周时行根管治疗。结果 经1.5～5年的随访,19颗移植牙均未发现牙根吸收、松动等并发症。结论 自体牙移植临床效果满意,在前牙缺失和埋伏阻生牙无法正畸治疗时,是一种较好的治疗方法。     

Effects and distribution of the enamel matrix derivative Emdogain® in the periodontal tissues of rat molars transplanted to the abdominal wall

Abstract – The enamel matrix derivative Emdogain^® (EMD) has been found to promote regeneration of lost periodontal tissues. We have studied the effects and distribution of EMD in the periodontal tissues of maxillary rat molars transplanted to a subcutaneous position in the abdominal wall. The molars were transplanted with or without EMD either immediately after extraction or after drying for 30 min. After 2 days, 1, 2 or 4 weeks the rats were killed and the teeth were examined by means of light microscopy and immunohistochemistry with anti-amelogenin antibodies. Teeth transplanted immediately after extraction showed formation of alveolar bone separated from the dental roots by a periodontal space, regardless of the use of EMD. Among the teeth that were transplanted with EMD after drying for 30 min, new alveolar bone was formed in five out of eight teeth after 2 and 4 weeks. None of the teeth that were dried for 30 min and transplanted without EMD showed alveolar bone formation. Only one tooth transplanted with EMD showed root resorption after drying, while resorption was noted in all teeth transplanted without EMD. All teeth that were transplanted with EMD and none of the teeth that were transplanted without EMD showed an immunohistochemical reaction for amelogenin. After 2 days, amelogenin was precipitated on all surfaces exposed at the transplantation procedure. Later, the immunoreactive material was redistributed to cells at the root surface, where it was still demonstrable after 4 weeks. In conclusion, EMD is accumulated in cells at the root surface and promotes regeneration of the periodontal tissues of the transplanted teeth. It also seems to promote healing of root resorption.     

Evaluation of a mixture of zinc oxide, calcium hydroxide, and sodium fluoride as a new root canal filling material for primary teeth

Endodontic treatment was performed on 25 pulpally involved mandibular primary molars in 4 to 9-year-old children; the root canals were obturated with a new root canal filling material consisting of a mixture of calcium hydroxide, zinc oxide, and 10% sodium fluoride solution, using hand-operated lentulo-spirals. All cases were evaluated clinically every 3 months and also radiographically every 6 months to assess the success of the treatment; we also examined the resorption of the root canal filling material from the root canals and the status of overpushed material, if any, as the tooth resorbed with the passage of time. At 6 months, endodontic treatment in 2 of the 25 teeth had failed and one tooth had exfoliated; the remaining 22 teeth were without any signs or symptoms. At the end of 2 years, 14 teeth could be evaluated; out of these 12 had physiologically exfoliated. It was observed that the rate of resorption of this new root canal obturating mixture was quite similar to the rate of physiologic root resorption in primary teeth. In three cases, where there was an overpush of the mixture, a gradual partial resorption was noted.     

Autogenous free tooth transplantation with a two-stage operation technique

If tooth transplantation is to succeed, it is crucial to preserve the vitality of the cells on the root surface of the tooth transplant. Insufficient postoperative nutrition to the cells on the root surface of the tooth transplant was thought to contribute to their devitalization of these cells. Impaired nutrition may be a result of poor contact between the recipient bed and the root surface of the transplanted tooth, and development of an interposed blood clot. To improve postoperative nutrition to the root surface cells, teeth were transplanted to the recipient beds in which the tissues were regenerated during a 14 day period, i.e., using the two-stage transplantation technique. In a clinical study of this technique, a total of 95 autogenous teeth with fully developed roots were transplanted in 84 patients, and examined both clinically and radiographically for up to 13 years after the transplantation. In a dog model, a comparative experimental study was made between teeth transplanted to beds left to heal for 5 days and teeth transplanted to beds prepared immediately before the transplantation. The clinical study showed a low prevalence of tooth graft loss and root resorption even when infection of the root canal occurred. Periodontal attachment loss of less than 3 mm was found in 97% of 6 defined surfaces around the transplanted teeth. Transplanted teeth which were later extracted were often hypermobile, and signalled pain when provoked with heavy loading. Excessive extraction trauma, fixation failure, and excessive plaque accumulation after transplantation were all shown to be detrimental to tooth transplant. Transplanted teeth were used as abutments for fixed partial dentures and provided the necessary dental support for crowns and bridges even in patients with atrophic alveolar bone. The experimental histological study showed no differences between test and control teeth in terms of the prevalence of root resorption, which was suspected to be caused by traumatic injuries to the roots during extraction and non-rigid fixation of the transplanted teeth.     

3种不同时期的牙槽窝行自体牙移植的初步研究

目的:对比研究拔牙后即刻、早期或延迟3个不同时间行自体牙移植疗效评价.方法:选择2019年6～12月就诊于新疆医科大学附属口腔医院颌面外科门诊且后牙缺失患者,共64例,并将其通过缺牙时间进行分组,分别为:新鲜牙槽窝组22例、早期牙槽窝组21例、人工牙槽窝组21例.3组分别进行自体牙移植,术中记录供牙离体时间和拟合次数,...     

Root resorption associated with autotransplanted maxillary canine teeth

A brief review of the published results of autotransplanting maxillary canine teeth has been presented together with the results of a prospective study in which 141 maxillary canine teeth were surgically repositioned in 113 patients, but not root-treated unless resorption occurred. Attention was given to assessing factors (age, sex, tooth positions, surgical difficulty, time out of mouth, acute infection, periodontal disease, caries, occlusion, formation of lamina dura) associated with root resorption of the transplanted teeth but no particular factor of significance emerged. It has been speculated that early post-operative root canal treatment and/or a two-stage technique might reduce the incidence of root resorption of autotransplanted teeth.     

26例乳牙挫入性外伤后保留患牙的回顾性分析

目的:分析乳牙外伤挫入后保留患牙的预后及影响因素.方法:回顾2018年3月-2019年10月间因乳牙挫入性移位就诊于上海交通大学医学院附属第九人民医院儿童口腔科的病例,根据纳入和排除标准,选择采用保留挫入牙且病史完整可回溯的26例36颗乳牙的病历资料,回顾再萌出情况及牙髓预后,分析其与患儿年龄及挫入程度的相关性.采用S...     

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??Objective    To study the mechanism of periodontal tissue repair of transplanted tooth by analyzing the imaging and histological changes of autogenous transplanted tooth in Beagle dog. Methods    For a 8-months-old beagle??the left mandibular premolar region was used as receptor region for autologous tooth transplantation of anterior teeth. X-ray examination was done after operation to observe the periodontal healing of transplanted teeth. Results    X-ray at one month after operation showed that the No.1 tooth ??left mandibular second premolar?? has a narrowed periodontal gap??a small periapical radiolucency and external resorption at tooth neck; No. 2 tooth ??the left mandibular first premolar?? has a internal resorption in the upper 1/3 root canal. Two-month post-operative X-ray examination indicated the periodontal healing of transplanted teeth was perfect. The external resorption of No. 1 tooth enlarged and internal resorption of No. 2 tooth remained the same. HE staining results showed that new fibrous bundle was formed at the root tip. A large number of lymphocytes and some plasmocytes exited at the tooth neck??pulp cavity and root tip. Conclusion    Autogenous tooth transplantation can achieve good periodontal membrane healing. It is important to reduce the mechanical damage to tooth neck while pulling out the teeth. The timing of the dental pulp treatment after transplantation is one of the key elements to reduce postoperative complications.     

Tooth transplantations: a descriptive retrospective study

The aim of the present study was to perform a retrospective study of autogeneously transplanted teeth in order to examine the influence of clinical criteria such as the type of the donor tooth, the root length at the time of transplantation, donor eruption stage and others on the overall success rate of the transplantation. The material of this study consisted of 194 patients in whom 273 teeth were transplanted. The mean age at the time of autotransplantation was 18.1 years with a standard deviation of 7.5 years. Transplantations were performed in two hospitals. The follow-up period varied from 15 days to 11 years, and the mean follow-up time was 3.8 years. 58/273 teeth showed one or other form of resorption, 37/273 teeth showed ankylosis, 30/273 showed no important changes in pulp chamber size, 104/273 showed major discoloration after transplantation, 92/273 teeth showed positive results for cold test after transplantation and 26/273 teeth showed clinically unacceptable pocket depth. Clinical and radiological evaluations were performed. An association was found between successful transplantation and donor tooth type (P<0.01), root length at the time of transplantation (P<0.0001) and recipient tooth site (P=0.03). There was a borderline association between successful transplantation and donor eruption stage (P=0.05). In conclusion, autotransplantation of teeth performed with a careful surgical procedure at the stage of 1/2-3/4 of their intended or expected root length can render a very useful service to patients.     

Autotransplantation of maxillary canine teeth. A follow-up of 35 cases up to 4 years

35 cases of autotransplantation of nonendodontically treated maxillary canines were followed for up to 4 years and were assessed according to loss of the transplanted tooth, onset of sensibility, mobility, intact lamina dura and presence of tooth resorption. The results of this study compare favourably with other studies and favour the hypothesis that little is to be gained by not endodontically treating autotransplanted teeth immediately after splint removal. It is also suggested that immobilization by means of a rigid splint, removing the tooth from occlusal forces, may account for the relatively low incidence of resorption in this series.     

A clinical and radiographic study of 76 autotransplanted third molars

Abstract— The present investigation is a clinical and radiographic study of 76 auto-transplantations of third molars. The observation period ranged from less than one up to six years (average 3.7 years). In 58 cases the teeth were transplanted after extraoral root filling whereas 18 teeth were transplanted without endodontic intervention. At re-examination of the transplanted molars the marginal and the periapical conditions were examined clinically and radiographically. Third molars transplanted without root filling showed significantly less progressive root resorption and less increase in pocket depth as compared to teeth transplanted after extraoral root filling. A multivariate analysis was applied to examine the relationship between 17 clinical factors and the dependent variables - progressive root resorption, pocket depth, and periapical radiolucency - in 56 teeth transplanted after extraoral root filling. Progressive root resorption was found in 44 cases (79%), and this complication was found significantly related to the variables approximal grinding of donor tooth, extraoral period, and observation period. Increased pocket depth around the transplant was registered in 30 cases (52 %) and found significantly related to the period of splinting. Periapical radiolucency was found in 16 cases and was significantly related to the variable extraoral period.     

Autotransplantation of teeth in cases with agenesis or traumatic loss of maxillary incisors.

The purpose of this study was to investigate the prognosis of 50 consecutively autotransplanted teeth to the maxillary incisor region. Thirty-five were transplanted in cases of traumatic injuries, eleven in cases of agenesis and four in cases with impaction of maxillary canines. The average follow-up time was 7 years and 6 months (range 4-17 years). The transplants were examined clinically in respect of tooth vitality and radiographically in respect of root canal obliteration, periradicular changes, root formation, and root length. The results show a success rate of 82 per cent. It is concluded that the procedure of tooth transplantation has the advantage of maintaining or restoring alveolar bone volume and gives the opportunity to replace a missing tooth without involvement of neighbouring teeth as prosthetic abutments.