Tooth autotransplantation: an overview and case study

It is not uncommon for children or young adults to have congenitally missing teeth or early loss of teeth from trauma or caries. The restorative options are typically bridges, implants, and removable appliances. Often overlooked and misunderstood, another treatment option exists in autotransplantation, where a tooth is moved from one site to another in the same individual. Autotransplantation is well studied and has predictable results comparable to implants, with reported success rates often greater than 90%. This article will provide an overview of autotransplantation plantation, its indications, advantages, complications, and treatment considerations, along with a case of a third molar autotransplant that will serve to highlight these points.     

Autotransplantation: a viable treatment option for adolescent patients with significantly compromised teeth

Autotransplantation is the technique of transplanting embedded, impacted or erupted teeth from one site into another in the same individual. Despite current scientific evidence indicating that autotransplantation has favourable long‐term survival rates, autotransplantation is still not generally regarded as mainstream practice outside of Scandinavian countries. Successful autotransplantation can offer many advantages in a growing patient, including a normally functioning periodontium, proprioception and preservation of alveolar bone volume. In the event that the autotransplantation eventually fails, the bone and soft tissue conditions would still be likely to be favourable for subsequent implant treatment. This review article will identify and discuss the factors that influence case selection, the ideal timing for autotransplantation and the critical determinants for achieving a successful outcome. The limitations of the technique and alternative treatment options will also be discussed. It is hoped that through greater awareness and recognition by the dental profession, autotransplantation will become another viable treatment option in the management of compromised teeth in patients with significant remaining growth potential.     

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提要：自体牙移植是用外科手术的方法将自体牙在口腔内异位移植。尽管自体牙移植适用范围不广，但对于在正畸治疗中纠正个别牙错位和代替缺失牙，却有着独特的自身优势。同时，正畸治疗也对自体牙移植产生一定的影响。本文就自体牙移植的外科技术、影响自体牙移植预后的相关因素以及自体移植牙的正畸治疗等方面做一综述。     

Multiple congenitally missing teeth treated with autotransplantation and orthodontics

Treatment of children with several congenitally missing teeth is challenging, because growth and development of the oral structures must be considered. The treatment options include retaining the deciduous teeth and postponing treatment until later or extracting the deciduous teeth and doing one of the following: allowing the space to close spontaneously, closing the space orthodontically, or in patients whose growth is finished, using a prosthetic or implant replacement. One other viable option, if donor teeth are available, is autotransplantation. The treatment plan for patients with missing teeth should be based on a comprehensive evaluation of the patient's age, occlusion, and space requirements as well as on the size and shape of the adjacent teeth. This case report presents the management of a patient in the early mixed dentition with multiple missing teeth. The treatment consisted of a combination of autotransplantation of the maxillary right first premolar to the mandibular right first premolar region and orthodontic treatment with a 5-year follow-up after autotransplantation.     

自体牙移植预后的影响因素

自体牙移植是将自体牙在体内异位移植来修复牙列缺损的一种方法。尽管自体牙移植适用范围不广且预后受到很多因素的影响,但许多研究证实,自体牙移植可作为一种修复牙列缺损的理想选择。本文就自体牙移植预后的影响因素进行综述。     

Autotransplantation of a tooth using guided tissue regeneration

Abstract Autotransplanlation is an alternative treatment to replace missing or periodontally-involved hopeless teeth. A prerequisite for performing this procedure is having a recipient site with sufficient bone volume to support the transplant. Often, however, crestal bone resorption following tooth extraction or periodontitis results in a reduced alveolar ridge with inadequate dimensions to properly house the transplant. In these cases, the procedure is contraindicated. A case is presented in which the biologic principle of guided tissue regeneration was used to gain periodontal support around an autotransplanted 3rd molar. The results suggest the potential use of guided tissue regeneration in conjunction with autotransplantation. This may represent a new area in reconstructive dentistry.     

Success,Survival Rate,and Soft Tissue Esthetic of Tooth Autotransplantation

IntroductionThe aim of this retrospective study was to assess the success, survival rate, and soft tissue esthetic of autotransplanted teeth.MethodsThis study included patients with at least 1 tooth autotransplanted to the maxilla during childhood or adolescence. The autotransplantation technique included the removal of an immature tooth from a donor site and its placement in the maxilla as a replacement for a missing or extremely compromised tooth. The cases were properly restored to ensure function and esthetic. To be considered successful, the tooth should be asymptomatic at the time of assessment, no pain to palpation and percussion, have no signs of apical periodontitis or a sinus tract, have a periodontal probe ≤3, and have an absence of root resorption and development of at least 70% of the normal root. The esthetic evaluation of the soft tissue was based on the pink esthetic score and graded as very unsatisfactory, unsatisfactory, poor, fair, good, or excellent. Data were statistically analyzed at a significance level of 5%.ResultsThirty-five patients (23 males and 12 females) had 43 anterior teeth replaced, including 42 central incisors and 1 lateral incisor. The follow-up period ranged from 1–25 years. In regard to success and the survival rate, 43 teeth were assessed; 34 cases (79.07%) were considered successful and 9 (20.93%) unsuccessful. Only 1 tooth was lost, and 42 teeth remained functional (survival rate = 97.67%). In regard to the esthetic, 40 teeth could be assessed and were considered as excellent (30%), good (35%), fair (27.5%), and poor (7.5%); there were no reports of unsatisfactory or very unsatisfactory cases.ConclusionsTooth autotransplantation can be considered a valid procedure to replace lost teeth in the maxilla, presenting high survival and success rates. The overall esthetic of the patients was considered as satisfactory.     

自体牙移植术大鼠动物模型的建立

［摘要］ 目的 建立自体牙移植术的标准化大鼠动物模型,并分析其优缺点。方法 选取5周龄SD大鼠,全麻下先后拔除左上第三磨牙（供牙）和左上第二磨牙（患牙）。预备左上第二磨牙牙槽窝后将供牙放入其中试植,调整方向和咬合后进行树脂粘接固定。术后进行口内愈合情况、影像学及组织学检查。结果 大鼠可以接受自体牙移植手术操作。术后8周口内移植牙固定良好,术区软组织无红肿。组织HE染色可见移植牙牙根和牙槽骨初步愈合,CT显示有少量成骨。该模型具有实验周期较短、成本较低、可重复性较好、以及可以接受多种类型的检查和检测的优点。其缺点包括：个体偏小,实验操作空间小,精细化程度要求较高,以及有些操作不能彻底进行或无法完成。结论 大鼠可以用于自体牙移植术标准动物模型。     

Modern restorative management of patients with congenitally missing teeth: 2. Orthodontic and restorative considerations

Managing edentulous spaces in patients with congenitally missing teeth demands careful planning and, often, a multidisciplinary approach. Orthodontic tooth movement can be considered to close spaces as well as improve the distribution of available teeth. In this second paper, the advantages of a collaborative approach are discussed.     

Gingival contour and clinical crown length: their effect on the esthetic appearance of maxillary anterior teeth

Fractured, congenitally missing, or avulsed maxillary incisors can often jeopardize the esthetic appearance of the remaining maxillary anterior teeth after orthodontic treatment. In many cases the unesthetic appearance is related to the irregular clinical crown lengths of either the fractured teeth or those that have been substituted for the missing teeth. The results of five cases with either fractured or traumatically avulsed central incisors are reported. Selective tooth intrusion and restorative techniques were used during the finishing stages of orthodontic treatment to improve the final esthetic result. The advantages and disadvantages of the intrusion technique are discussed.     

The Umgeni bridge, a resin bonded pontic using a preformed fibre post an aesthetic procedure of low biological and fiscal cost.

A missing anterior tooth or open embrasures destroys the aesthetics of a smile. The replacement of a missing anterior tooth is one of the most rewarding and challenging aspects of restorative dentistry. There are a number of techniques to do this, however, most involve the use of a technician, which means additional cost to the patient and multiple visits. In today's financial climate with practice expenses climbing and medical aid remuneration dwindling, one must seek methods to reduce costs and provide patients with more affordable dentistry. In addition, in crisis situations such as the traumatic loss of a tooth an immediate replacement technique albeit temporary is necessary. To replace a missing anterior tooth directly and immediately presents a rewarding challenge to the clinician. The Umgeni bridge named after the river that flows on the north side of Durban, is particularly useful in replacing congenitally missing laterals after completion of orthodontic treatment in the case of congenitally missing laterals and cleft palates.     

Autotransplantation of an immature premolar,with the aid of cone beam CT and computer‐aided prototyping: a case report

Abstract – Autotransplantation of immature teeth has good survival rates, and has benefits over ossointegrated implants in the growing child, but is very technique sensitive. Spiral CT imaging has been previously used in adult patients to enable computer‐aided prototyping to produce a surgical template of the donor tooth, further increasing success rates. Case report: The case presented describes management of a 9‐year‐old girl with the combination of hypodontia affecting the upper lateral incisors as well as a severely ectopic maxillary canine. Cone beam CT was used in combination with computer‐aided prototyping to produce a surgical template of an immature mandibular second premolar. The surgical template was used to prepare the transplant site before the donor tooth was extracted, greatly reducing the time from extraction to implantation. By 6 months posttransplant the tooth was clinically sound, and continued root development and laying down of dentine was visible radiographically. Discussion: This paper demonstrates the use of a novel technique to aid the surgical procedure of autotransplantation of immature premolar teeth. The use of autotransplantation in this case allowed the difficult situation of two missing units in the upper left quadrant to be reduced to one unit, while retaining symmetry in the upper arch. Compared to previous studies, the use of cone beam CT to create a 3D prototype reduced radiation dose compared to spiral CT and drastically reduced the extra‐oral time of the donor tooth from extraction to transplantation.     

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。     

自体牙移植的优缺点及其与口腔多学科的关系及应用

自体牙移植是将牙齿从同一个体内的一个位置移动到另一个位置的过程。该方法具有以下优点：使用天然牙功能性修复缺失牙，早期快速恢复牙列完整，维持良好的牙及牙槽美学和生理学效果，以及后期可接受正畸矫治移动等。近年来，随着新技术的不断发展，自体牙移植在牙周病学、牙体牙髓病学、儿童口腔医学、口腔正畸学、口腔种植学等学科中得到了广泛应用，其独特的优势，得到了医患双方的认可。文章就自体牙移植的优缺点及其在口腔多学科中的应用做一介绍。     

Orthodontic treatment of an open bite case with congenitally missing teeth using premolar autotransplantation

In cases of congenitally missing teeth, it is useful to combine autotransplantation and orthodontic space closure. We treated a 12-year-old girl who showed a slight anterior open bite with congenitally missing teeth and impaction of the maxillary canine. The molar relationships were Angle Class II. We attempted traction of the maxillary canine after surgical exposure. However, we could not move it and suspected it to be ankylosed. A mandibular premolar was transplanted into the maxillary anterior region. After active treatment, a porcelain fused to metal crown was placed to restore aesthetic appearance labially. Occlusion remained stable during 4 years and 9 months of follow-up. At 8 years and 6 months post-transplantation, the donor tooth remains both clinically and radiographically healthy.     

Tooth autotransplantation. What's the limit of our possibilities in conservative treatments?

Aim

When an extraction is necessary, it is possible to choose a donor tooth and transplant it into the site of the previous extraction. Aim of the present article is to present a series of cases of tooth autotransplantation to demonstrate how it is possible to preserve natural teeth and avoid or delay implant therapy.

A patient with protrusion and multiple missing teeth treated with autotransplantation and space closure

Objective:To present a patient treated with submerging autotransplantation (SA) of an immature premolar and subsequent orthodontic space closure (OSC) and to report a 10-year follow-up result.Case and Method:A 10-year-old boy had multiple missing premolars with an asymmetric pattern (maxillary right first and second premolars, teeth 14 and 15; maxillary left second premolar, tooth 25; and mandibular right second premolar, tooth 45). After considering several treatment options, tooth 35 with immature root development underwent SA into the missing site of tooth 15 at a depth 5 mm below the occlusal plane and was stabilized with sutures to create a symmetric missing condition of the premolars in the four quadrants.Results:Three months after autotransplantation, spontaneous eruption of the transplanted tooth was observed. Nine months after autotransplantation, presence of the lamina dura of the transplanted tooth was confirmed with a periapical radiograph. Active orthodontic treatment was initiated to reduce lip protrusion by closing the missing spaces of teeth 14, 25, 35, and 45 and to correct dental midline deviation. After 33 months of active orthodontic treatment, Class I canine and molar relationships were obtained. During the 10-year follow-up, the pulp vitality of the transplanted tooth was maintained without any pathologic findings, including root resorption or pulp canal obliteration.Conclusions:In a patient with lip protrusion and multiple congenitally missing premolars with an asymmetric pattern, SA of one premolar from the normal quadrant into the quadrant missing two premolars with subsequent OSC of the missing sites of the other premolars can be an effective treatment modality.     

Surface condition of primary teeth after approximal grinding and polishing.

Mesiodistal reduction of primary teeth is necessary in cases with mild or moderate primary crowding, in patients treated with Fr?nkel appliance type I or II or in those who need to keep a primary molar as long as possible due to congenitally missing premolars. In order to minimize the risks of periodontal destruction and caries, the tooth surface should be polished after grinding. A technique for stripping permanent teeth, recently proven successful in achieving smoother enamel than untreated tooth surfaces, was slightly varied and applied to primary teeth. By means of scanning electron micrographs, it could be shown that application of this technique produces smooth surfaces on primary teeth as well. The procedure is described in detail and cases in which it should be used are presented.     

自体牙移植的临床考量

牙列缺损是患者常见的口腔问题。自体牙移植是一种将供体牙移植到缺牙区的治疗方式，除了恢复咀嚼功能外，对儿童患者还能促进其牙槽骨的生长。本文就自体牙移植的适应证与非适应证、成功率及与牙种植术的比较、临床治疗程序作一简要述评。