Autotransplantation Of Premolars Research Articles

Guided Autotransplantation of an Immature Premolar to the Maxillary Incisor Region with Immediate Restoration of Esthetics: A Case Report

This case report describes the treatment of two maxillary central incisors following a traumatic injury with tooth #8 developing replacement resorption and #9 developing inflammatory root resorption. A 10-year-old girl presented complaining of pain in her maxillary central incisors. Upon clinical examination, teeth #8 and #9 were tender to percussion and palpation of the buccal soft tissues. Thermal and electrical pulpal sensitivity tests for teeth #8 and #9 were negative. An intraoral periapical radiograph revealed resorptive defects in tooth #8, which were filled with bone-like tissue, while tooth #9 had radiolucent resorptive defects along the root surface and a periapical radiolucency. A diagnosis of replacement resorption was made for tooth #8 and external inflammatory root resorption for tooth #9. Tooth #8 was treated with a multidisciplinary approach utilizing a guided template for premolar autotransplantation with an immediate veneer restoration, while tooth #9 was managed with root canal treatment using a tricalcium silicate cement to fill the canal. At the 1, 4, 8, 12, and 24-month follow-ups, the patient remained asymptomatic, and there was no radiographic evidence of root or periapical pathosis on either tooth. The root-end of the donor tooth transplanted to the #8 site continued to develop. This case report highlights successful interdisciplinary management of two forms of root resorption using modern treatment strategies that provided immediate function and esthetics to the maxillary central incisors in a young patient following trauma.

The outcomes of auto-transplanted premolars in the anterior maxilla following traumatic dental injuries.

Tooth auto-transplantation is a treatment option, which is often not considered to replace anterior maxillary incisors in children and adolescents. There are multiple prognostic factors that may influence the outcomes of premolar auto-transplantation, but there is limited evidence from human studies. The aim of this study was to report the outcomes of auto-transplanted premolars in the anterior maxilla following traumatic dental injuries (TDIs) and to identify their prognostic factors. The clinical records of patients who had premolars transplanted in the anterior maxilla following TDI, with appropriate radiographs and a minimal of 1-year follow-up, were reviewed retrospectively. A specific data extraction form was developed, tested and used to collect information for the prognostic factors and outcomes. The cohort included 120 patients with 144 auto-transplanted premolars. The mean age was 12.2 years (±2.0), and the mean observation period was 3.7 years (±1.8). The success rate was 80%, and the survival rate was 93%. Unfavourable outcomes included external replacement resorption in 12.5%, uncontrolled external inflammatory resorption in 2.7%, and both resorption types in 4.9% of teeth. Periodontal healing was significantly associated with donor tooth root maturity, graft handling at the time of surgery including ease of donor tooth extraction and placement at the recipient sites, recipient site alveolar bone status, and post-operative transplant mobility. Seventy-four teeth (53.4%) were immature at the time of transplantation where pulp revascularisation was anticipated, and 52 (70%) of those had radiographic and clinical signs of pulp healing. Pulp healing was significantly related to donor tooth eruption stage, ease of extraction of donor tooth, and ease of placement in the recipient site. Good outcomes were observed for premolar teeth auto-transplanted in the anterior maxilla. The main prognostic factors were ease of extraction of donor tooth and ease of placement in the recipient sites and donor tooth root maturity.

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.

Autotransplantation of Premolars and Esthetic Rehabilitation in a Traumatized Teenage Patient with Challenging Oral Problems: A Case Report

The loosely structured periodontal ligament and low mineralized bone surrounding erupting teeth provide minimal resistance to an extrusive force. The maxillary central incisors are the most frequently avulsed due to trauma. The prognosis of replanted teeth is affected by extra-alveolar period and conditions. Implant-supported restorations are contraindicated in adolescent patients with poor prognosis traumatized teeth. Autotransplantation of premolar to the anterior region provides a viable treatment alternative.<br/>This case report describes the autotransplantation of premolars and esthetic rehabilitation in a teenage patient with traumatized incisors, poor oral hygiene, and severe crowding. Comprehensive and long-term treatments were performed to improve complex and challenging oral problems.

Root Elongation After Autotransplantation in 58 Transplanted Premolars: The Radiographic Width of the Apex as a Predictor

Autotransplantation of premolars with incomplete root development is a reliable treatment option for tooth replacement. Nevertheless, little is known about root development after transplantation of teeth. The aim of this study was to evaluate preoperative root development stage and radiographic width of the apex as predictors for root elongation after autotransplantation. A retrospective cohort study was implemented and composed of patients who underwent autotransplantation of at least 1 premolar. Using panoramic radiographs (orthopantomograms), calibrated measurements were taken to record the root development stage of the donor tooth, width of the apex, and root length of the transplanted tooth. Forty-five patients (58 transplants) were included. Mean follow-up time was 12months (range, 4 to 26months). Fifty-three transplanted teeth (91.4%) showed root elongation. Mean root elongation at end of follow-up was 1.9mm (range, 0.0 to 4.3mm). A wide-open apex before transplantation was significantly associated with root elongation after autotransplantation (P<.01). Root development stage (P=.82) did not show significant associations with root elongation. A wide-open apex (>2.0mm) is an important predictor of root elongation after autotransplantation of premolars. This might be a better predictor for root development than preoperative root development stage.

Autotransplantation of premolars: does surgeon experience matter?

Autotransplantation of premolars is a well-established method to rehabilitate aplasia of premolars. Nevertheless, with the introduction of titanium implants, not all surgical units offer this procedure. The aim of this study was to examine the predictability of autotransplantation of premolars on orthodontic indication as suggested by Andreasen et al., when performed by surgeons with or without prior experience of this procedure. A prospective protocol was implemented in 2001. All patients treated with autotransplantation of premolars during the years 2001–2015 were recalled to evaluate the long-term status of the teeth. The state of root development, need for endodontic treatment, presence of an apical pathology or ankylosis, and tooth loss were recorded. The results were divided into two groups according to the surgeon’s experience: senior surgeons with prior training and experience in the procedure and junior surgeons without prior experience. A total of 89 teeth (66 patients) were treated. The mean observation time was 10.1 years (range 1.0–15.1 years). The long-term survival rate was 95%. No statistically significant difference between the results of the two groups of surgeons was found. Autotransplantation of premolars on orthodontic indication could be adopted successfully in the hospital setting regardless of surgeon experience.

Autotransplantation of Premolar to Replace an Anterior Tooth

Autotransplantation of Premolar to Replace an Anterior Tooth

Autotransplantation of premolars and molars using a three-dimensional printed replica of the donor tooth as a surgical guide: a prospective study

Autotransplantation of premolars and molars using a three-dimensional printed replica of the donor tooth as a surgical guide: a prospective study

Premolar autotransplantation in juvenile dentition: quantitative assessment of vertical bone and soft tissue growth

Premolar autotransplantation represents an effective therapeutic option for the treatment of juvenile dentition with either aquired or congenital hypodontia. The objective of this prospective clinical study was to quantitatively assess bone and soft tissue levels after autogenous premolar transplantation by clinical and radiographic parameters. In the study, 26 premolars were transplanted in 20 patients after traumatic tooth loss (n=16) or congenital aplasia (n=10) in the anterior maxilla. Based on standardized photographic documentation, the relative soft tissue level was measured compared to the healthy adjacent teeth. Radiographic findings included evaluation of root resorption, pulp canal obliteration, and relative bone height. Average survival rate of transplanted premolars (n=26) was 100% over a follow-up period of 29months (range 10-60months). The relative soft tissue level significantly increased by+1.1mm(P<.01). Radiographs showed a tendency toward vertical bone growth. Continuous root development and signs of pulpal healing were observed postoperatively in 18 transplants (69.2%). Autogenous premolar transplantation represents a safe method to ensure functional and aesthetic rehabilitation in the anterior maxilla irrespective of the nature of tooth loss.

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 easier 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 female child.

Autotransplantation of Premolars With a 3-Dimensional Printed Titanium Replica of the Donor Tooth Functioning as a Surgical Guide: Proof of Concept

Autotransplantation of premolars is a good treatment option for young patients who have missing teeth. This study evaluated the use of a preoperatively 3-dimensional (3D)-printed replica of the donor tooth that functions as a surgical guide during autotransplantation. Five consecutive procedures were prospectively observed. Transplantations of maxillary premolars with optimal root development were included in this study. A 3D-printed replica of the donor tooth was used to prepare a precisely fitting new alveolus at the recipient site before extracting the donor tooth. Procedure time, extra-alveolar time, and number of attempts needed to achieve a good fit of the donor tooth in the new alveolus were recorded. For each transplantation procedure, the surgical time was shorter than 30minutes. An immediate good fit of the donor tooth in the new alveolus was achieved with an extra-alveolar time shorter than 1minute for all transplantations. These results show that the extra-alveolar time is very short when the surgical guide is used; therefore, the chance of iatrogenic damage to the donor tooth is minimized. The use of a replica of the donor tooth makes the autotransplantation procedure easier for the surgeon and facilitates optimal placement of the transplant.

Autotransplantation of premolars to the maxillary incisor region: a long-term follow-up of 12–22 years

To investigate the long-term outcome of treatment of missing maxillary incisor teeth by transplantation of premolars, with special reference to aesthetics and patient satisfaction. Twenty subjects who had undergone transplantation of premolars to the maxillary incisor area were recalled for follow-up varying between 12 and 22 years post-surgery. Twelve subjects presented for examination, including radiography and three subjects participated only by answering questions. Three reference groups-general practitioners, orthodontists, and lay people-evaluated the aesthetic results from photographs. Patient satisfaction was evaluated by interviews and OHIP-14. The mean age at transplantation was 12.3 years: 1 subject had been 20 years old and 11 were in the range of 9-14 years. Twelve to 22 years after autotransplantation, 5 subjects could not be reached: of the 15 who could be contacted, the survival rate was 15 out of 15. In the 12 subjects who presented for clinical examination, 11 out of the 12 transplants were assessed as successful. Nine transplants were restored with crowns and five had been recontoured with composite build-ups. In one patient, no restorative treatment had been undertaken. The subjects were satisfied with the aesthetic result. Autotransplantation of premolars is an appropriate method for treatment of missing maxillary anterior teeth. Subjects with a transplanted tooth to the maxillary anterior region perceive their oral health as good long term.

Mandibular premolar autotransplantation in cleft patients as part of the cleft treatment protocol

Mandibular premolar autotransplantation in cleft patients as part of the cleft treatment protocol

Metal tooth‐like surgical templates for tooth autotransplantation in adolescents

The aim of this study was to suggest a way to fabricate surgical templates to assist the surgeon in preparing the recipient socket when performing premolar autotransplantation. Premolars used previously for extractions of periodontal ligament (PDL) fibroblasts were used in this study as archetype of models for tooth transplantation. Eighty-four mandibular and maxillary first and second extracted premolars were reviewed. All teeth were extracted for orthodontic reasons. From these teeth, eight teeth were selected to serve as archetype of models in which all the other teeth were at equal size or smaller in maximum 2mm in M-D or B-L dimension. These teeth were sent to dental technician to perform identical archetype stainless steel templates. During autotransplantation immediately following donor tooth extraction, the appropriate template is chosen out of the toothlike stainless steel surgical templates and the donor tooth is then immediately replaced in its socket. This enables the surgeon to prepare the recipient site without manipulating the donor tooth and thus preventing damage to the PDL cells of the donor tooth. Only after the recipient site had been prepared to the appropriate size and shape according to the template, the donor tooth is removed from its socket, immediately placed at the recipient site and splinted as recommended. The advantage of the presented metal tooth-like surgical templates described in this study is that a set of stents has been produced by replicating different common shape adolescent premolars that reflect the biological variation in size and shape of these teeth.

Survival Rate in Autotransplanted Premolars with Complete Root Formation: A Retrospective Clinical Survey

The purpose of this study was to analyze the survival rate in autotransplanted premolars with complete root formation in dental clinics. Participating dentists were requested to provide information on transplantations they had undertaken between 1 January 1990 and 31 December 2010. Data on a total of 708 teeth from 637 patients were collected. Data for other tooth types and for teeth with incomplete root formation were eliminated. In this study, data on 40 teeth in 35 patients were analyzed. Participants consisted of 17 men and 18 women ranging from 24 to 79 years in age (mean age, 43.7 years). The cumulative survival rate was 100% at the 5-year mark and 72.7% at 10 years, as calculated by the Kaplan-Meier method. Single-factor analysis revealed that "transplanted to the molar regions" was a significant risk factor (p<0.05) influencing the survival of transplanted teeth. However, a Cox regression analysis showed no significance. The results of this study suggest that, in cases where there is a suitable donor tooth and the oral condition is good, premolar autotransplantation is a viable treatment option, even when there is complete root formation in the donor teeth.

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.

Regional odontodysplasia: Orthodontic treatment and transplantation of premolars

Regional odontodysplasia is a rare and unique dental anomaly involving both dentitions, but mostly the teeth of 1 quadrant. This report describes the combined surgical and orthodontic treatment of a boy with regional odontodysplasia. The mandibular right central and lateral incisors and the canine (as well as the deciduous predecessors) were affected. In a 2-step procedure, the maxillary right and left second premolars were autotransplanted to the affected area. The extraction sites in the maxilla were closed, and a good functional occlusion was established.

Retrospective long‐term evaluation of autotransplantation of premolars to the central incisor region

This retrospective case-series study aimed to examine the long-term outcomes of autogenously transplanted premolars. Twelve patients in whom donor premolars were used to replace maxillary central incisors lost by trauma were clinically and radiologically monitored. Standardized clinical and radiographic records were systematically obtained during the follow-up period of 14 years, to determine the influence of specific clinical criteria on the overall success rate of transplantation. The success rate of premolar autotransplantation in the maxillary central incisor area was 80% after 14 years follow-up. The highest success rate occurred in those teeth transplanted with two-thirds of full root development. Complete pulp obliteration was positively related to autotransplant viability, followed by root formation in the bony crypt. Autotransplantation of donor teeth, at the stage of ½ to ¾ of their expected root length, can provide a successful treatment solution for over 14 years.

Management of a 9-year-old boy experiencing severe dental injury - a 21-year follow-up of three autotransplants: a case report

The replacement of missing anterior teeth is a particular challenge in children and adolescents. This report describes the management of a 9-year-old boy suffering a severe dental injury. The treatment included three autotransplantations and orthodontic space closure to replace four maxillary teeth. A follow-up period of 21 years demonstrated a successful outcome. Autotransplantation of premolars in growing individuals is a predictable method for replacement of missing teeth and for re-establishment of the alveolar process after traumatic bone loss. This case report shows that a multidisciplinary approach is essential for the management and outcome of severe dental injuries in children.

Autotransplantation of two maxillary premolars in a free vascularized fibula reconstructed mandible

A 10-year-old female patient with a fibula transplant in her left hemimandible due to ameloblastoma treatment was referred for combined orthodontic and surgical planning and treatment to observe and prevent expected asymmetric facial development and malocclusion, because the premolars and molars on the left side of the mandible were missing. The patient had an Angle Class II malocclusion and arch length discrepancy in the upper jaw. The two second premolars in the maxilla were transplanted into the neomandible to create occlusion on the left side and retention for orthodontic treatment. Clinical and radiological examination 3 months postoperatively showed good integration of both premolars without pocket formation. After 4 months, active orthodontic treatment with fixed appliances was started to create sufficient arch space in the upper jaw for both canines to erupt and to extrude and for the transplanted premolars in the lower jaw to rotate and align into the planned positions. This case report demonstrates that autotransplantation of premolars into a fibula transplant can be a successful dental rehabilitation procedure.