Autotransplantation of premolars to replace maxillary incisors: a comparison with natural incisors.

The published literature contains no comprehensive studies that compare the outcome of premolar autotransplantation to the maxillary anterior region with natural incisors in the same patients. This article describes the gingival and periodontal conditions around premolars transplanted to the maxillary incisor region, subsequent to restoration. Forty-five premolars autotransplanted to the maxillary incisor region in 40 adolescent patients were evaluated after a mean observation period of 4.0 years. Mean age at surgery was 11.0 years. Established clinical criteria were used to assess tooth mobility, plaque and gingival indexes, probing pocket depth, and percussion. Recession and hyperplasia of interproximal gingival papillae were assessed according to a recently proposed index. Standardized radiography was used to evaluate presence of pathosis, pulp obliteration, root length, and crown-root ratios. Clinical variables for transplants did not differ from those of the natural incisors, except for increased mobility and more plaque in a few transplanted premolars. The interproximal gingival papillae adjacent to all transplanted teeth were normal or slightly hyperplastic. Radiographically, all transplants showed varying degrees of pulp obliteration, but no signs of pathosis. Crown-root ratios were similar for natural and transplanted teeth as were distances from cementoenamel junction to marginal bone. The overall status of the transplanted premolars and surrounding tissues indicated that this treatment modality may be recommended when maxillary incisors are missing in adolescents. In addition, tooth transplantation represents an inherent potential for bone induction and reestablishment of a normal alveolar process.     

Nonprosthodontic management of alveolar clefts with 2 incisors missing on the cleft side: A report of 5 patients

A treatment combining autotransplantation of developing premolars and orthodontic space closure is described as an alternative to prosthodontics in the management of patients with alveolar clefts when 2 cleft-side incisors are missing. We report on 5 consecutive patients with unilateral clefts in whom 2 cleft-side incisors were congenitally missing, severely malformed, ectopically erupting, or lost because of trauma. In each instance, a mandibular premolar with a partly developed root was transplanted to the central incisor region (3 patients had previously undergone alveolar bone grafting). Root growth continued in all transplants. After an observation period of 2 years 6 months to 7 years 8 months, all transplanted teeth were present and fulfilled the established success criteria. The physiologic status of the transplanted premolars compared favorably with that of the central incisor on the noncleft side. The appearance of the reshaped transplants was found to match the noncleft incisor in 3 patients and deviated somewhat in 2. We concluded that an acceptable clinical outcome can be obtained by tooth transplantation combined with orthodontic space closure in patients with alveolar clefts and 2 missing cleft-side incisors.     

Mandibular premolar autotransplantation in cleft affected patients: The replacement of congenital missing teeth as part of the cleft patient's treatment protocol

BackgroundTooth autotransplantation has developed into a safe and predictable procedure, which preserves the continuity of the dental arch and the alveolar process and provides an acceptable aesthetic and physiological outcome.AimTo describe our experience with autotransplantation of the developing mandibular premolar to the iliac crest grafted alveolar cleft as part of the cleft patient's treatment protocol.Material and methodsFour cleft affected patients were referred to the Orthodontic and Craniofacial Department, Rambam Health Care Campus, Haifa, Israel due to loss of teeth in the cleft area. In all cases, orthodontic closure of the missing teeth space in the maxillary dental arch was considered inappropriate and therefore autotransplantation of the extracted mandibular premolar to the bone-grafted alveolar cleft site was conducted.ResultsNone of the transplanted teeth in the reported cleft affected patients had signs or symptoms of progressive root pathology, gingival disease or advanced tooth mobility. Long-term clinical follow-up examination revealed improved facial aesthetics and occlusal relationships along with increased self-esteem and welfare of the patients' with no need for future dental restorative treatment.ConclusionAutotransplantation of mandibular premolars should be considered an alternative to prosthodontics in cleft affected patients as an integral part of the cleft patient's treatment protocol.     

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.     

Treatment of an avulsed maxillary permanent central incisor by autotransplantation of a primary canine tooth

Aim  To present a case in which an avulsed permanent maxillary central incisor was replaced by autotransplantation of a primary canine tooth.
Summary  The present case describes transplantation of a primary canine tooth into the space left by an avulsed permanent maxillary central incisor after a delay of several days. After root canal treatment, the primary canine tooth was extracted and placed into the prepared socket. To provide better adaptation of the donor tooth, the recipient alveolar site was remodeled using surgical burs. Semi-rigid splinting was maintained for 15 days. The crown of the primary canine was reshaped with composite resin and with an interim prosthesis, preventing movement of the lateral incisor tooth into the space of the transplanted canine. After 24-month follow-up the autotransplanted primary canine showed ankylosis but the tooth was in an acceptable state. The use of permanent tooth autotransplantation has been well documented. However a literature search revealed only one case report on the autotransplantation of primary teeth.
Key learning points • Long term results of primary tooth autotransplantation are scarce but the procedure in this case report could be considered as a temporary space maintainer for the treatment of a patient with a lost permanent incisor under 10 years of age.
• Success of primary tooth autotransplantation may be affected by several factors, such as case selection, extra oral time, surgical and endodontic procedures.     

Treatment of lower second premolar agenesis by autotransplantation: four-year evaluation of eighty patients.

The frequency of agenesis of the second lower premolar is 2.5-4%. In growing patients, early extraction of the deciduous molar and subsequent closure of the space is a common therapy, but in some cases space closure is deemed unlikely and autotransplantation is an alternative. The aim of the study was to analyze the outcome of autotransplantation in replacing missing lower second premolars and to evaluate the associated presurgical orthodontic treatment. The material consisted of records of all patients with teeth transplanted to the lower second premolar region during the period 1988-89 at the Department of Oral Surgery, Eastman Institute, Stockholm. The following variables were registered: sex, age, number of transplanted teeth, donor tooth, root development, recipient site, orthodontic treatment, persisting temporary molar, total number of congenitally missing teeth, the surgeon responsible, and clinical and radiological follow-up variables. Of 110 transplanted teeth, 99 had not completed root formation, and in 11 teeth the root formation was completed. The success rates after 4 years were 92% and 82%, respectively. Both premolars and molars served as donor teeth, but the main donor tooth was the upper second premolar. Fourteen percent had been orthodontically treated only because of the transplantation, i.e. to open the space for the donor tooth. Treatment of agenesis of the second lower premolar by autotransplantation has a good prognosis. In growing individuals the transplant not only maintains growth and development of the alveolar ridge but also provides a permanent solution to the agenesis.     

An occlusal and cephalometric analysis of maxillary first and second premolar extraction effects

The purpose of this study was to examine dimensional changes in the maxillary arch following the extractions of maxillary first or second premolars. Pre- and posttreatment records of 71 patients treated by one experienced orthodontist were randomly selected from completed premolar extraction cases. Forty-five patients involved the extraction of maxillary first premolars; of these, 15 also had extractions of mandibular first premolars and 30 had extractions of mandibular second premolars. Twenty-six patients involved the extraction of maxillary second premolars, and all of these also had extractions of mandibular second premolars. Pretreatment factors that seemed to suggest a basis for the extraction choice in this sample included incisal overjet, molar relationship, and maxillary incisor protrusion. Mean reductions with treatment in the anteroposterior arch dimension were similar within all premolar extraction groups. There was evidence of greater mean maxillary intermolar-width reduction following the extractions of maxillary second premolars than following extractions of maxillary first premolars. Greater mean maxillary incisor retraction was found in the maxillary first premolar extraction group than in the maxillary second premolar group. A wide range of individual variation in incisor and molar changes did, however, accompany treatment involving both maxillary premolar extraction sequences.     

Autotransplantation of maxillary second premolars to mandibular recipient sites where the primary second molars were impacted,predisposes for complications

Abstract

Objective. The aim of the study was to elucidate whether ankylosis of a transplanted permanent tooth can be predicted based on an evaluation of the primary and permanent dentitions. Materials and methods. The study comprised 162 maxillary second premolars and 49 third molars transplanted to the mandibular second premolar region in 157 patients treated in the period 1980–2003. Selection criteria: panoramic radiograph available; agenesis of the mandibular permanent premolar/s; persistence of the primary molar at the recipient site. The 211 transplanted teeth were observed for a period of between 1–29 years. Results. Seven per cent (95% confidence interval, CI = 3–11%) of the transplanted second premolars ankylosed during the first 10 years after operation. The success rate for transplantation of the third molar to the mandibular second premolar region was significantly lower (p = 0.001), as 40% (95% CI = 24–57%) of the third molars had ankylosed 10 years after operation. A significant association (p = 0.022) was found between ankylosis of a second premolar and infra-position of the primary second molar located at the recipient site. The infraposition group had 13% (CI = 4–23%) ankylosis after 10 year, whereas the non-infraposition group had 5% (CI = 1–9%) ankylosis after 10 years. Conclusions. The present study concludes that there is an increased risk of ankylosis of the transplanted permanent tooth if the primary tooth at the recipient site is in infraposition. This observation may be decisive for treatment planning, especially in young individuals in whom excessive growth of the alveolar process is expected from the cephalometric analysis.     

Bone augmentation and autogenous transplantation of premolar to the site of the fissure in a cleft palate patient

This article presents a case report of autogenous tooth transplantation to the site of the fissure, in addition to bone augmentation with graft of autogenous bone harvested from the iliac crest, performed in a cleft palate patient, who had insufficient bone volume. A non‐syndromic 10‐year‐old girl, with a unilateral cleft lip and palate, incisal transforamen fissures, agenesis of the maxillary left central incisor and both maxillary lateral incisors, was treated with autogenous bone graft in the cleft area. The orthodontic treatment plan was to replace the missing lateral incisors with the maxillary canines and to extract the mandibular first premolars. One of the mandibular premolars was extracted from its site with 2/3 of its root formation completed and transplanted to the maxillary left central incisor area. After orthodontic treatment, the anatomic crowns were characterized with composite resin. Autogenous tooth transplantation can be performed in the area of the fissure in young cleft palate patients, by performing bone graft augmentation before transplantation of the tooth, to gain sufficient recipient alveolar bone volume. A multidisciplinary approach is mandatory for the success of this clinical procedure, especially in cleft palate patients.     

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.     

Autotransplantation of first premolar to replace a maxillary incisor – 3D-volume tomography for evaluation of the periodontal space

Abstract –  The anterior maxilla is the most traumatized region during childhood and tooth loss is frequently involved. Space closure with implants is contraindicated in growing patients and maintenance of space is necessary over a long period. Transplantation of premolars from the mandible with two-third to three-quarter root formation wide open foramen provides the best prognosis for permanent survival.
Case report:  This report describes the management of a 10 year old girl with autotransplantation to replace an upper incisor by a lower premolar under consideration of special care for the periodontal ligament during surgical procedure. A 3-D imaging with digital volume tomography (DVT) was used 20 months after transplantation to evaluate the periodontal morphology.
Discussion:  Autotransplantation of premolars with incomplete root formation to replace maxillary incisor is a treatment alternative after traumatic loss of teeth. There were no signs of pathosis like resorption or ankylosis and a normal periodontal space demonstrated with DVT. There is no need for endodontic treatment before transplantation. In this case of autotransplantation of a premolar, the DVT after 20 months gives evidence of a successful regeneration of the periodontal ligament.     

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.     

Autotransplantation as a treatment option after loss of a maxillary permanent incisor tooth. A case report

A case is described of the management of a maxillary left permanent incisor, damaged by several traumatic injuries, in a 13-year-old girl. The traumatized incisor tooth required extraction and as part of an orthodontic treatment plan, a mandibular left second premolar was surgically transplanted to the prepared extraction socket at the maxillary anterior alveolus. After splinting, the transplanted tooth underwent endodontic treatment, because of pulpal necrosis. Orthodontic treatment commenced 3 months post-transplantation. Permanent root obturation was provided after orthodontic treatment and a porcelain veneer was placed to restore aesthetic appearance. The case emphasizes the importance of correct case selection, a multidisciplinary approach to treatment planning, and regular follow-up for transplanted teeth.     

Patient with nonsyndromic bilateral and multiple impacted teeth and dentigerous cysts

This article reports the successful treatment of a patient with the unusual occurrence of bilateral and multiple dentigerous cysts of the premolars. One impacted mandibular premolar was moved by traction orthodontically. On the opposite side, the impacted premolar was autotransplanted after space was created through mesial movement and hemi-sectioning of the neighboring molars. The impacted maxillary premolar was extracted. Miniscrews were additionally used for anchorage reinforcement to prevent unintended counteractions and solve the problem of space management after autotransplantation. We also reviewed the clinical implications of the diagnosis, planning, and treatment of cyst-associated impacted teeth in young adult patients.     

Multidisciplinary Approach for Autotransplantation and Restoration of a Maxillary Premolar into an Area of an Avulsed Anterior Tooth: A Case Report with a 6-Year Follow-up

The loss of an anterior tooth because of avulsion has been reported in up to 3% of dental injuries. Management alternatives, such as implant-supported restorations and a fixed partial denture, are contraindicated in growing patients because of the continuous growth of the alveolar process. At the same time, orthodontic treatment for gap closure will result in asymmetry and will require adjustment of the adjacent healthy teeth. Therefore, restoring a missing tooth imposes a treatment challenge, especially in children and young adults. Tooth autotransplantation is a treatment modality with high reported survival and success rates that overcome these mentioned limitations. It might also help to preserve the alveolar bone and the soft tissues. This case report describes a multidisciplinary approach for managing a 13-year-old boy who lost his right maxillary central incisor because of a fall. Management included autotransplantation of the left maxillary second premolar to the site of the lost right maxillary central incisor, management of external inflammatory resorption with an endodontic treatment, orthodontic treatment, and aesthetic restoration of the area with composite resin crowns that can be adapted to the expected changes of the jaws during the craniofacial growing period. At the 6-year follow-up, the teeth demonstrated a positive outcome.     

上颌牙槽突颊舌向生理倾斜角的锥形束CT研究

目的    采用锥形束CT（CBCT）影像测量上颌牙槽突颊舌向生理倾斜角,为种植体植入位置和方向的确定提供参考。方法    按照事先制定的纳入与排除标准,从中国人民解放军总医院口腔医学中心影像数据库中随机抽取2014年11月至2015年11月初次就诊患者拍摄的CBCT影像51份（均由NewTom 5G设备拍摄）。采用NewTom 5G自带软件进行重建,重建区域上下边界与上颌牙牙合平面平行,采用0.5 mm层厚、5 mm层间距,在牙列弧形线上对牙槽突进行垂直切割,获得上颌牙槽突的24个等间距的颊舌向断面。使用NNT 5.6软件测量每个颊舌向切面的牙槽突倾角。结果    按从右上颌最后一个层面（第2层）到左上颌最后一个层面（第23层）的顺序,上颌各层面牙槽突倾角平均值或中位值分别为：0°、0°、0°、0°、10.2°、17.4°、23.9°、31.9°、40.7°、42.3°、31.8°、32.6°、41.7°、40.7°、31.8°、22.9°、16.1°、8.2°、0°、0°、0°、0°。左右对称层面牙槽突倾角差异无统计学意义（P > 0.05）。男女之间的牙槽突倾角差异无统计学意义（P > 0.05）。第2～5层和第20～23层（对应于磨牙区）中,牙槽突倾角为0°的牙槽突比例高于颊侧倾斜牙槽突（P < 0.05）。结论    前牙区牙槽突倾角最大,前磨牙区倾角次之,磨牙区倾角逐渐递减为0。前牙区和前磨牙区牙槽突向唇、颊侧倾斜,磨牙区牙槽突在多数情况下呈垂直向,其次为向颊侧倾斜。了解牙槽突倾角有助于种植体植入位置和方向的确定,在不具备种植手术导板的情况下,其参考作用尤其明显。     

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。     

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??Objective    To measure the anatomic buccolingual angulation values of the maxillary alveolar process based on CBCT images in order to form a basis for the implant treatment planning?? including the design of implant position and angulation. Methods    A random sample of 51 CBCT images were selected and analyzed. The NewTom 5G CBCT data sets were reformatted at a 0.5-mm spacing?? with the inferior border of the region of interest parallel to the occlusion plane of maxillary teeth. Twenty-four buccolingual cross-sectional images of the maxillary alveolar process were obtained for buccolingual angulation measurements. Results    Mean or median values of the buccolingual angulation of maxillary alveolar process ranged from about 0 degree to more than 40 degrees. Cross-sections distal to the premolar region showed a statistically higher proportion of vertical process ??angulation equals to 0 degree???? compared to cross-sections corresponding to maxillary premolars and anterior teeth region ??P < 0.05??. There were no statistical differences between the angulation of alveolar process both from the right side and left side and from males and females patients ??P > 0.05??. Conclusion    The buccolingual angulation of maxillary alveolar process decreases from anterior teeth region through the premolars region to the molars region?? with the lateral incisor and canine region being the most inclined bucally and a high proportion of the molars region being nearly vertical. Knowing average values of buccolingual angulation of maxillary alveolar process before dental implantation may help the clinician plan the position and orientation of implants?? especially when an implant surgical template is not available.     

Clinical conditions for eruption of maxillary canines and mandibular premolars associated with dentigerous cysts.

The aim of this study was to investigate the eruption of teeth associated with dentigerous cysts in the mandibular premolar and maxillary canine regions in preadolescents. Fifty-eight cyst-associated teeth, including 47 mandibular premolars and 11 maxillary canines, were examined retrospectively by using normalized panoramic radiographs and histological materials. The subjects were divided into 2 groups: the erupted group, in which the teeth had erupted successfully after marsupialization, and the nonerupted group, in which the teeth had undergone orthodontic traction or cystectomy with removal of the cyst-associated tooth. Eighty-one percent of the mandibular premolars and 36% of the maxillary canines in the cysts erupted successfully about 100 days after marsupialization without traction. The eruption of a mandibular premolar was significantly related to a shallow position in the alveolar bone, shallow angulation of the tooth, and young age of the patient but not to cyst size and dental space for the eruption. The eruption of the maxillary canine was significantly related to the small size of the cyst and the patient's age. The cyst walls of the erupted group showed severe inflammatory cellular infiltration. These findings present a treatment guideline for dentigerous cysts associated with mandibular premolars and maxillary canines in preadolescents.     

Autotransplantation of premolar teeth to replace missing maxillary central incisors

Orthodontic treatment decisions when maxillary central incisors are absent or are of poor prognosis, are discussed. Autotransplantation of mandibular first premolars to the incisor region is suggested as an approach in selected cases. The literature is reviewed, surgical technique described and case selection summarized. Cases are reported where autotransplantation of premolars to the maxillary incisor region has produced good functional and aesthetic results.