Basic Problems of Regeneration and Transplantation

Abstract

This description of the difficulty relative to the transplantation of teeth has been merely a survey of the problems encountered in many experiments in our laboratory.’ Similar problems have been encountered by many investigators, 11 Some of these problems will be solved by a continuing trial-an derror type of experimentation in human patients. Progress will be slow, but careful records and clear reporting of these records by many clinicians will be helpful to all investigators. 1. factors associated with successful transplantation are: a. Care and gentleness in the handling of the soft and hard tissues. b. Preparation of a host socket that allows the transplant to be positioned without contacting the bony walls. c. Close proximity of the transplant to socket walls to assure good circulation and rapid organization of the clot between the alveolus and the tooth. d. Positioning of the transplant so that it is not traumatized by an opposing tooth immediately after surgery but close enough to the occlusal plane to become functional within a few weeks. e. The inherent ability of the gingival tissues to reattach quickly and thus minimize the danger of infection. f. Careful selection of patients. 2. Factors associated with failures are: a. Selection of teeth for transplantation with crowns too largo or too small to fill the space in the dental arch, b. Loss of socket walls. c. Placement of transplant in areas where the roots will project into large bony defects created by infections or cysts. d. Use of teeth with insufficient root development. e. Lack of patient cooperation. 3. Human gingival reattachment and pulpal survival have been exceptionally good. 4. The major basic problems that must be solved before tooth transplantation can become a common practice are root resorption and regeneration of alveolar bone. The basic problems of cell survival and altered cellular physiology following transplantation will of necessity be studied in experimental animals. At the present time they are the only source of sufficient material for study. Newer techniques in the field of tissue culture, histochemistry, electron microscopy, microradiography, bone and tooth physiology and period ontology will contribute to the solution of the basic problems of resorption and repair and thus to increasing success in tootli transplantation.