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

Effect of different splinting methods and fixation periods on root development of autotransplanted immature third molars

PURPOSE

The aim of the present study was to assess the influence of suture splinting for 1 week or rigid fixation for 4 weeks on final root length, root length increment, and mobility of autotransplanted immature third molars.

PATIENTS AND METHODS

The sample consisted of 63 patients with a total of 65 transplanted immature third molars. All transplants had reached one-half (n = 29) to three-fourths (n = 36) of their expected root length. In 24 of the transplants, postoperative fixation was carried out with a rigid acid-etch composite and wire splint for 4 weeks (rigid group), and in 41 transplants, with a suture splint for 1 week (suture group). The fixation method depended on the initial stability of the transplants. All transplants were followed up clinically and radiologically for a mean period of 3.9 years.

RESULTS

Transplants in the rigid group revealed a significantly lower final root length ( P = .002) and root length increment ( P = .001) than those in the suture group. The differences were found to be more pronounced in transplants at earlier developmental stages. No differences were found in transplant mobility.

CONCLUSIONS

The results of the present study indicate that prolonged rigid fixation of autotransplanted immature third molars has a significantly negative influence on final root length and root length increment, especially in transplants at earlier developmental stages.

Autotransplantation of immature third molars into edentulous and atrophied jaw sections

The aim of the present study was to assess the results after transplantation of 85 immature third molars. Recipient site conditions varied and different surgical techniques were used. The long-term results after preparation of a new alveolus, splitting osteotomy of the alveolar process or use of free bone autografts were compared with the results after transplantation into a fresh extraction site (control group). Transplantations into prepared sockets showed equal results to the control group (94% respectively). Transplantations in connection with free bone autografts (84%) or after splitting osteotomy of the alveolar process (63%) showed poorer success rates, the differences between the latter and the control group being statistically significant. A possible correlation to revascularization disturbances of the pulp due to an insufficiency of the recipient site or to postoperative infection is suspected. The results show that transplantation of immature third molars is a safe, useful procedure when appropriate conditions of the recipient site are present. Where the alveolus is atrophic, a splitting osteotomy should be performed only in exceptional cases and preference should be given to alternative methods such as primary bone augmentation or bone-regenerative procedures.

Root length in transplanted premolars

The objectives of the present prospective longitudinal study were to establish the survival and success rates for premolars with partly developed roots transplanted according to a set protocol, and to analyze the effect of varying pre-surgery root development on final root length. Standardized periapical radiographs of 132 consecutively transplanted premolars were obtained at predetermined intervals over a 4-year follow-up period. Survival and success rates were calculated on the basis of presence of teeth and recording of defined radiological variables, respectively. Final root length was compared to normative metric data for root morphology. From the total sample, 54 patients with 68 transplanted premolars suitable for analysis of root growth relative to initial root length were identified, and divided into subsamples according to root length pre-transplantation. Survival rates were 100% after 1, 2, and 3 years, and 98.6% 4 years post-transplantation. The success rates were 92.9%, 92.8%, 89%, and 90.5% in subsamples collected 1, 2, 3, and 4 years after transplantation, respectively. The transplants obtained on average 78% of normative root length, and by dichotomizing the transplanted teeth in subsamples with 'short' and 'long' roots pre-surgery, similar final root lengths were observed even if 'short' roots had the greatest increase. Very early transplantation (roots < 7 mm), however, tended to result in short final root length. It is concluded that the success and survival rates were comparable to results obtained in similar studies. Initial root length was a significant predictor of root length increase. Transplanting teeth with short roots is to risk short final root length.

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.

Influence of orthodontic derotation and extrusion on pulpal and periodontal condition of autotransplanted immature third molars

The aim of this study was to determine the influence of orthodontic treatment on the pulpal and periodontal condition of 91 transplanted immature third molars. In patients with atrophy of the alveolar process or unfavorable root morphology, transplants had to be placed in extreme rotated or infraoccluded positions. After 3 to 6 months, these transplants were derotated (45 degrees to 90 degrees) to a correct position in the dental arch (derotation group; n = 28) or extruded to the occlusal plane (extrusion group; n = 21). Finally, approximal spaces were closed in both groups. A sample of 42 transplanted third molars with no orthodontic treatment need served as the control group. All transplants were followed clinically and radiologically for a mean period of 4.0 years. With respect to pulpal and periodontal conditions, no significant differences were observed between the control and the extrusion group. In contrast, compared with the control group, transplants in the derotation group had a significantly poorer pulpal and periodontal condition. In the derotated transplants, a significant correlation was detected between pulp necrosis and orthodontic treatment of multi-rooted transplants. This study indicates that orthodontic extrusion and minor lateral movements of autotransplanted immature third molars, as well as rotation of single-rooted third-molar transplants, represent no additional risk to transplant survival. In contrast, rotation of multi-rooted transplants seems to initiate later severance of the vascular and nerval supply to the pulp.

Pulp revascularization of replanted immature dog teeth after treatment with minocycline and doxycycline assessed by laser Doppler flowmetry, radiography, and histology

This study investigated the effect of topical antibiotic treatment on pulp revascularization in replanted teeth. Thirty-four immature teeth were selected from three young dogs. Baseline radiographs and laser Doppler flowmetry (LDF) readings were obtained. Specimens were randomly divided into four groups: Thirty-eight teeth were extracted, kept dry for 5 min, and either (Group 1) covered with minocycline mixture (G1, n = 11), (Group 2) soaked in doxycycline (G2, n = 11), or (Group 3) soaked in saline (G3-negative control, n = 6), and replanted. Teeth in Group 4 were not extracted (positive control, n = 6). Postoperative radiographs and LDF readings were obtained for 2 months after replantation. After sacrifice, the jaws were collected and processed for light microscopy. Pre- and postreplantation LDF readings and radiographs, and histologic findings were analyzed to assess revascularization. Pulp revascularization occurred in 91% (G1), 73% (G2), and 33% (G3) of the specimens. In conclusion, minocycline facilitates pulp revascularization in replanted immature teeth after replantation.

Influence of orthodontic movement on root length of autotransplanted immature third molars

The aim of this study was to investigate the influence of orthodontic extrusion or derotation on final root length and root length increment in 75 autotransplanted immature third molars. Depending on the condition of the recipient site and the root morphology, transplants had to be placed in extreme rotated or infra-occluded position. Three to six months after transplantation, these transplants were derotated to a correct position in the dental arch (derotation group, n = 19) or extruded to the occlusal plane (extrusion group, n=18). Thirty-eight transplants with no orthodontic treatment need served as controls (control group). Transplants were followed clinically and radiologically for a mean period of 4.0 yr. No statistically significant differences were observed between the extrusion and the control groups or between the single-rooted transplants in the different groups. In contrast, multi-rooted transplants in the derotation group showed a statistically significantly shorter final root length than multi-rooted transplants in the extrusion and the control groups. However, as these differences may be considered to be of minor clinical importance (<1 mm), it can be concluded that the effect of orthodontic movement on root development of transplanted immature third molars is of only negligible clinical significance.

Twelve-year follow-up of an autogenous mandibular canine transplant

Transplantation is the transfer of tissue or an organ from 1 site to another in the same person or between different persons. A transplantation in which donor and recipient are the same individual has been termed autogenous transplantation, autoplastic transplantation, or autotransplantation. The purpose of this report was to describe a patient undergoing autotransplantation of an impacted mandibular canine to its normal position in the mandible and the 12-year follow-up. Five years after the surgical procedure, the patient presented with pulp canal obliteration in the autotransplanted tooth. Twelve years after the autotransplantation, the tooth position was stable despite pulp canal obliteration, but with no sign of inflammatory resorption or a periapical lesion. In addition, there was no sign of replacement resorption (ankylosis). The endodontic literature has shown that the prognosis of patients undergoing autotransplantation may be good under specific considerations. Therefore, the technique may be a treatment plan option for the replacement of missing teeth.

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.

Autotransplantation of immature third molars: influence of different splinting methods and fixation periods

Different data were published documenting the influence of fixation methods and periods on the outcome of autotransplantations of teeth. Besides studies reporting increased ankylosis and disturbances of pulpal revascularization following rigid or extended fixation, there are studies revealing no connection in this matter. The clinical and radiological results of 76 transplanted germs of third molars were to be assessed after a rigid fixation for 4 weeks or after a suture splinting for 7 days and compared with each other. The choice of fixation method depended on the initial stability of the transplant. After a mean observation period of 3.4 years (range 1.0-6.1 years), 92.9% of the teeth stabilized with a suture, but only 73.5% fixed with an acid-etch composite and wire splint could be classified as successful (P = 0.029). The significant increases in ankylosis (P = 0.036) and pulp necrosis (P = 0.041) were the factors for the less favorable results of the rigidly fixed teeth. Our data support the results of other experimental and clinical studies with regard to the negative influences of an extended and rigid fixation on the success of tooth transplantation. However, apart from a correlation with the method and period of fixation, we also suspect the influence of an incongruity between the transplant and recipient site.

Allo- and autotransplantation of mature teeth in monkeys: a sequential time-related histoquantitative study of periodontal and pulpal healing

Root resorption is known to be the most relevant complication determining the long-term prognosis of allotransplanted teeth, and it is initiated during the first few postoperative months. The aim of the present study was to quantitatively assess the dynamics of the periodontal ligament (PDL) and pulpal healing reactions during the first 8 weeks after allotransplantation of mature teeth. The material comprised 112 maxillary central and mandibular lateral incisors of 28 mature green Vervet monkeys, immunogenetically untested, and only matched according to the size of the grafts. Donors and recipients exchanged simultaneously both maxillary incisors and one mandibular incisor, whereas the contralateral mandibular incisors were autotransplanted as controls. At random, every second maxillary allograft was endodontically treated preoperatively. Histoquantitative analysis of the PDL and pulpal healing reactions was carried out after 1, 2, 4 and 8 weeks on serial cross-sections of the grafts in 6, 6, 6 and 8 monkeys, respectively. Necrosis zones in the PDL were prominent in both auto- and allografts after 1 week. Inflammation in the PDL dominated healing in all types of grafts 1 week after transplantation, whereas it subsided significantly after 2 weeks in autografts compared to allografts (P = 0.005). Inflammatory resorption (IR) became prominent after 4 weeks in autografts and this remained stationary. In contrast, IR initiated significantly earlier in allografts compared to autografts after 2 weeks (P = 0.007), and this type of resorption was further increasing in allografts after 4 and 8 weeks. Endodontic treatment, however, reduced IR nearly totally in the allografts with time. Replacement resorption (RR) was nearly absent in autografts. In contrast, allografts showed increasing appearance of RR with time, initiating at 4 weeks. By removing IR from the allografts by endodontic treatment, RR was unmasked significantly at 4 weeks (P = 0.02) and dominated most of the periodontal ligament (70%) after 8 weeks (P = 0.0004). Within the 8 postoperative weeks autografts showed healing with increasing amount of normal PDL reaching significantly higher levels compared to allografts already after 2 weeks (P = 0.02), with increasing differences thereafter. In most allografts, the normal PDL occupied less than 10% of the entire root surface and was located in the supra-alveolar cervical region. Downgrowth of periodontal pocket epithelium was absent or found very infrequently in all groups irrespective of type, time and treatment. In conclusion, the healing of allo- and autotransplanted mature teeth differed significantly on several aspects during the first 8 postoperative weeks. The recorded differences included a higher amount of inflammation in the PDL of allografts after 2 weeks, inflammatory resorption from the second week, and replacement resorption dominating in the eighth week, indicated that an immunologic stimulus for root resorption existed in the allogenic PDL apart from the pulp. Furthermore, specific healing reactions was found in the cervical region with almost identical gingival healing in auto- and allografts.

The esthetic outcome of autotransplanted premolars replacing maxillary incisors

Autotransplantation of developing premolars to replace maxillary incisors has been documented to provide physiologically sound results, but comprehensive studies of the esthetic outcome have not been made previously. In order to assess the applicability of this approach and to identify factors important for planning of treatment, 22 autotransplanted premolars reshaped to incisor morphology were compared to their natural, contralateral maxillary incisors by scoring of features considered important for esthetics (color, soft tissue appearance, tooth morphology, and position). The sum of scores for each feature was used to place the reshaped transplant in one of three categories - Match, Deviate, Mismatch. The 22 patients were asked to fill in a questionnaire which addressed the same features that were examined professionally, and the responses were categorized as either Satisfied, Acceptable, or Dissatisfied. Eleven of the 22 patients had received orthodontic treatment with fixed appliances following the transplantation. Most of the transplanted premolars matched the contralateral incisor, and the majority of patients were satisfied with the appearance of the transplant. Fourteen percentage of the transplants were categorized as Mismatch and 18% of patients reported dissatisfaction. The distribution in categories assessed professionally and by the patients was not significantly different. The color and gingival width of the transplanted tooth were scored as different from the natural incisor in about half of the bilateral comparisons. For those teeth categorized professionally as Mismatch and by patients as Dissatisfied, a potential for esthetic improvement could be identified, as allocation to these categories was primarily due to suboptimal positioning and restorative build-up of the transplant. Inter-disciplinary planning is important for successful esthetic results.

Autotransplantation of teeth: requirements for predictable success

The aim of this article is to summarize the biologic principles required for successful autotransplantation of teeth. Indications, armamentarium, technique and prognosis will be discussed.

Outcome of tooth transplantation: survival and success rates 17-41 years posttreatment

The literature contains no follow-up studies of transplanted teeth with mean observation times exceeding 10 years. This article describes long-term outcomes, including gingival and periodontal conditions, and the patients' attitudes about treatment and outcome. The material comprised all accessible patients in the files of the Department of Orthodontics, University of Oslo, Norway, on whom treatment had been performed at least 17 years ago (n = 28). Established clinical criteria were used to assess tooth mobility, plaque and gingival indexes, and probing pocket depth. Standardized radiography was used to evaluate the presence of pathology, pulp obliteration, and root length. Similar recordings were obtained from the in situ tooth contralateral to the initial position of the grafted tooth. Criteria for determining treatment success were established. All patients responded to questions about their treatment using visual analogue scales. The mean age at surgery was 11.5 years, and the mean observation period was 26.4 years (range, 17-41 years). Of the 33 teeth transplanted in the 28 patients, 3 teeth were lost after 9, 10, and 29 years, respectively. Therefore, the 30 teeth in the 25 patients we examined yielded a survival rate of 90%. The success rate was 79% because 2 transplants had ankylosed, and 2 others failed to fulfill the proposed criteria. The patients generally responded very favorably regarding their perception of the treatment. Their only hesitation was related to some discomfort during surgery. It was concluded that survival and success rates for teeth autotransplanted when the root is partly developed compare favorably in a long-term perspective with other treatment modalities for substituting missing teeth.

Auto-alloplastic transplantation of a primary canine after traumatic loss of a permanent central incisor

This report describes the transplantation of a primary canine after traumatic loss of a central incisor in an 8-year-old boy. The 7-month follow-up revealed normal periodontal healing with absence of infection, ankylosis or progressive resorption. The patient was then lost for control. After 16 months another trauma in the same patient resulted in an avulsion of the transplant. However, the alveolar bone was maintained in vertical and sagittal dimensions. Another primary canine was transplanted and followed for further 11 months. Again normal periodontal healing could be observed. The transplantation of a primary canine is seen as a promising method to replace a lost permanent tooth and maintain the surrounding tissues in very young patients.

Decoronation of an ankylosed tooth for preservation of alveolar bone prior to implant placement

A 12-year-old patient sustained avulsions of both permanent maxillary central incisors. Subsequently, both teeth developed replacement resorption. The left incisor was extracted alio loco. The right incisor was treated by decoronation (removal of crown and pulp, but preservation of the root substance). Comparison of both sites demonstrated complete preservation of the height and width of the alveolar bone at the decoronation site, whereas the tooth extraction site showed considerable bone loss. In addition, some vertical bone apposition was found on top of the decoronated root. Decoronation is a simple and safe surgical procedure for preservation of alveolar bone prior to implant placement. It must be considered as a treatment option for teeth affected by replacement resorption if tooth transplantation is not feasible.

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.

The problem of dentoalveolar ankylosis and subsequent replacement resorption in the growing patient

Dentoalveolar ankylosis is a serious complication following injuries of the periodontal membrane in severe dental trauma such as avulsion and intrusion. The condition is a fusion of the alveolar bone with the tooth. The consequences of this condition are progressive resorption of the root with replacement by bone (replacement resorption) and arrested growth of the alveolar process in the growing patient. This article will present an overview of dentoalveolar ankylosis and replacement resorption and its problems, treatment options and prognosis, especially focusing on the growing patient.

Autotransplantation of teeth: is there a role?

Autotransplantation of teeth, if carried out successfully, ensures that alveolar bone volume is maintained due to physiological stimulation of the periodontal ligament. Autotransplantation has been carried out for many years, but with varying success rates. As a result, it is seldom regarded as an appropriate treatment option for patients with missing teeth especially with the continued development of osseo-integrated implants. Since placement of osseo-integrated implants in growing alveolar bone is contra-indicated, transplantation of available teeth remains a suitable choice for replacing missing units in the young patient. The role of autotransplantation of teeth in several clinical situations, the clinical techniques involved and factors influencing success of the transplant are discussed. The aim of this paper is to underline the evidence based principles for successful autotransplantation and present the technique as a viable treatment option in present day orthodontic practice.

The ectopic maxillary canine: a review

This article reviews the aetiology and management of the ectopic maxillary canine. Much controversy surrounds the causes of canine palatal ectopia. The recent evidence surrounding the genetic and guidance theories are examined. The management options are detailed and the indications for each treatment modality based on the available scientific evidence are presented. Finally, the untoward sequelae of canine ectopia are discussed.

Autotransplantation of premolars. A retrospective study

The purpose of this clinical follow-up study was to evaluate the success rate of autotransplantation of human premolars. In the period between 1982 and 1994, 46 premolars in 31 patients were transplanted. A long-term success rate of 97.5% with a mean follow-up period of 3.5 years was achieved. It seems to be justified, therefore, in selected cases, to consider the possibility of autotransplantation as a good alternative to orthodontic or prosthetic treatment, including implant insertion, when closing a gap in the dental arch.

Intra-alveolar surgical uprighting of impacted teeth: a case report

Although orthodontic repositioning of impacted teeth is widely used, the treatment has its limitations. Autotransplantation or intra-alveolar surgical repositioning of teeth is an alternative therapy that may be used in selected cases of desperate impactions, when orthodontic extrusion is unsuccessful or when orthodontic treatment is rejected by the patient. A case report is presented to stress both the indications and limitations of a modified technique of intra-alveolar surgical uprighting of impacted teeth.

Autotransplantation of premolars and molars in patients with tooth aplasia

OBJECTIVES

The purpose of this study was to investigate retrospectively a group of patients who had undergone autotransplantation of teeth.

METHODS

The study group comprised 29 patients who had had a total of 31 teeth autotransplanted (22 premolars and nine molars). Seventeen premolars and one molar were moved from the upper to the lower jaw. The remaining premolars and molars were moved within the same quadrant. Twenty-three teeth were transplanted in cases of agenis, two in cases of ectopic eruption, and six after loss of the first molar. The observation period varied from 3 to 16 years (average 8 years). The patients were examined clinically, and radiographs were taken of the autotransplanted teeth. In addition, the patients were asked to complete a questionnaire.

RESULTS

By the end of the observation periods, four autotransplanted teeth had been extracted due to root fracture, caries, or external root resorption. In three of the patients who had lost their transplanted teeth and where no replacement had been inserted, the dentition had remained stable without tipping, rotations, or elongation. Most of the patients were happy with the autotransplantation and satisfied with the information that they had received in connection with the surgery.

CONCLUSION

Although not a frequent procedure, it was concluded that autotransplantation had a good prognosis after an (average) observation period of 8 years.

Influence of conventional forceps extraction and extraction with an extrusion instrument on cementoblast loss and external root resorption of replanted monkey incisors

Cementoblast loss and root resorption on the root surface was registered histologically after removal and immediate replantation of maxillary central incisors in monkeys (Cecropithecus aethiops). Incisors were removed with either a conventional extraction technique using forceps or with a special designed extrusion instrument and in both cases teeth were immediately replanted. Altogether 18 monkeys were used for the experiments in which 9 monkeys were sacrificed after 3 d and 9 animals after 8 wk. Histological analysis was made in horizontal sections perpendicular to the long axis of the tooth using either 24 measuring points or 12 sections. Histometric analysis showed extensive cementoblast loss in the periodontal ligament (PDL) and with a maximum of damage occurring on the corner surfaces of the root. Extracted teeth showed significantly more extensive cementoblast loss than extruded teeth. Root resorption was also found in the corner locations and was significantly more frequent in extracted than in extruded teeth. There was a similarity in the distribution of cementoblast loss and root resorption indicating that root resorption develops in the same areas where cementoblast loss takes place, i.e. locations that are more compressed during removal of the tooth and must have caused by mechanical damage to the PDL exerted on the root surface during tooth removal.

A clinical follow-up study of 278 autotransplanted teeth

This open study was undertaken to investigate the outcome of autotransplanted teeth over a 6-year period. The subjects were 296 patients who underwent autotransplantation in the 6-year period September 1986-August 1992 and outcome was measured by considering root formation, occlusion, endodontal and periodontal complications. 18 patients were excluded because of inadequate notes or radiographs (n = 3) or because they were lost to follow-up (n = 15). The groups were divided into open apex and closed apex, and duration of follow up was 6 months-5 years. Aplasia was the indication for operation in 158 (77 percent) of the open apex group but only 10 (14 percent) of the closed apex group, whereas caries and associated disease was the most common in the latter (n = 45, 61 percent compared with 20, 10 percent). There were 24 complete failures, 12 in each group (p <0.01). Only 7 teeth in total developed full roots, and 159 showed incomplete growth. In the open apex group 112 teeth were in occlusal contact and 4 were extracted for severe infraocclusion. In the closed apex group there were 10 cases of mild infraocclusion, none of which required treatment. There were 7 cases of pulp necrosis in the open apex group, 4 of which required extraction. Two teeth in the closed apex group were extracted for endodontic reasons. Only 1 tooth (in the closed apex group) had to be extracted for periodontal reasons. Autotransplantation is a reliable method with a good prognosis for donor teeth with both open and closed apexes. The technique is applicable whatever the aetiology of the agenesis, and is worthy of consideration should there be a suitable donor tooth.

Conservative surgical and orthodontic management of a child with central giant cell granuloma

Differential diagnosis and treatment modalities of giant cell granulomas have been a controversial matter since Jaffe first distinguished true giant cell tumours (TGCG) from central giant cell granulomas (CGCG). CGCG is a slowly growing and painless tumour usually treated by simple curettage but denotes a strong tendency to recurrence. A case report is presented to describe conservative therapy of CGCG in the maxilla of a young child: surgical enucleation of the tumour at the age of 11 years, though successful, was followed by progressive impaction of the maxillary right permanent canine. Orthodontic treatment aligned the maxillary teeth to accommodate autotransplantation of the impacted tooth. Clinical and radiographic evaluation of the patient 5 years after the initial surgical treatment showed good bony and periodontal healing around the transplanted canine and no recurrence of the CGCG. As the literature shows that distinction of the two tumours is difficult even by histological means, various clinico-pathologic factors involved in prognostic evaluation are discussed.

Autogenous transplantation of third molars in irradiated jaws--a preliminary report

Our experience with third molar autotransplants in 2 patients, into an area irradiated at an early age, is described and discussed. It is shown that such autotransplantations are possible.

Indications of autotransplantation of teeth in orthodontic problem cases

Autotransplantations of teeth have been widely used in orthodontics, mainly in cases of severe impactions, early loss of permanent teeth, or congenital aplasia. In specific clinical situations, indication of extractions or supernumerary teeth may provide donor teeth for transplantations avoiding prosthetic or implant therapy. Two cases are presented to illustrate the topic, and prognostic factors of autotransplantation are discussed.

Periodontal conditions of teeth autogenously transplanted by a two-stage technique

Inflammatory reactions of the marginal periodontal tissues and loss of attachment could partly account for the often occurring rejection of autogenously transplanted mature teeth. The periodontal conditions of transplanted teeth were investigated from 1 month up to 5 years postoperatively. The parameters plaque, bleeding on probing to the bottom of the pocket, probing pocket depth (PPD), gingival recession and probing attachment loss were analysed by multiple regression analysis. No significant difference was found between transplanted and control teeth in bleeding on probing the bottom of the pockets up to 5 years postoperatively with the exception of increased bleeding on probing of the transplanted teeth at the 1-month postsurgery examination. No significant difference of the mean probing depth between transplanted teeth and control teeth was found at the mesio- and distobuccal surfaces. The transplanted teeth at the buccal surface showed increase of the mean pocket depth during the observation period. Increased mean probing depth without progression over time was found at the transplanted teeth compared to the controls at the distolingual, lingual and mesiolingual surfaces. A small mean gingival recession at the transplants was observed. Loss of attachment was recorded at 13% of the surfaces. Totally 50% of the transplants showed loss of attachment and 5% were removed because of extensive attachment loss. On 13% of the transplanted teeth with loss of attachment, root resorption was also found.

A clinical and radiologic study of autotransplanted impacted canines

The aim of the present study was to evaluate the clinical and radiologic results of 20 autotransplantations of impacted canines performed in the Orthodontic and Pedodontic Department of the University of Geneva between 1979 and 1988. The sample, divided into two different age groups (group A: 13-20 years; group B: 20-48 years), demonstrated persistence of pulp vitality in 80% of the cases in group A, whereas routine endodontic treatment was instituted in all cases of group B. Periodontal healing was noted in 90% of the cases in group A, and in 70% of the cases in group B. The present clinical and radiologic data indicate that impacted canines can be transplanted at any age with good prognosis and are an alternative to orthodontic repositioning in selected cases of canine impaction.

Autotransplantation of a tooth using guided tissue regeneration

Autotransplantation 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.

Orthodontic closure and transplantation in the treatment of missing anterior teeth. An overview

Orthodontic closure and autotransplantation of teeth are valid treatment alternatives for young individuals with missing anterior teeth. These alternatives have, however, different indications and the choice should be based upon a comprehensive evaluation and diagnosis of the individual. Problems and limitations should be emphasized before treatment in order for the patient to have realistic expectations. The treatment plan will ultimately result from an evaluation of short- and long-term biologic and esthetic considerations. Indications, treatment principles and key factors in the treatment procedure are outlined in this overview. If transplantation is to be part of the treatment plan, the donor tooth which has the best prognosis should be selected.

Autotransplantations and loss of anterior teeth by trauma

The loss of anterior teeth by trauma has usually been corrected by orthodontic or prosthetic means. In some specific cases, however, the skeletal and dental relationship may contraindicate the use of space-closure mechanics. Autotransplantation of teeth, successfully depicted in many clinical studies, can help to reduce the severity of orthodontic cases complicated by traumatized anterior teeth. A case report is presented to stress both the indications and limitations of such treatment.

Tissue changes in immature dog teeth autotransplanted to surgically prepared sockets

Tissue reactions in teeth autotransplanted to surgically prepared sockets were investigated by means of microangiographic, enzyme histochemical, and histologic methods. The experimental material consisted of 28 immature teeth in six mongrel dogs. In each tooth, approximately three fourths of the root was formed at the time of transplantation. Ten days after transplantation, a vascularized, well-stained connective tissue was observed in the apical area of the pulp. An ingrowing tissue had reached the pulp horn in all teeth 90 days after surgery. Odontoblasts were not found in any of the transplanted teeth. External root resorption was seen in all teeth but repair usually occurred approximately parallel to the ingrowth of new tissue into the pulp cavity. In a few teeth, however, advanced inflammatory root resorption was observed in cracks in the cervical area. When compared with the results of a previous study, the ingrowth of tissue occurred at a considerably slower rate than in teeth autotransplanted to natural sockets.

Generalized "complete" calcific degeneration or pulp obliteration

Extensive calcification of the pulp is a pathologic condition that occurs as an answer to various factors (trauma, caries, periodontal disease). The increase in the amount of calcification may lead to partial or complete radiographic, but not microscopic, obliteration of the pulp chamber and root canals. Complete calcific degeneration (pulpal obliteration) may be found in two forms, generalized or localized. The generalized form which is presented in the present case report is probably part of the aging process.

Long-term clinical and radiologic evaluation of autotransplanted teeth

The purpose of the present study was to investigate the radiologic results of 40 autotransplantations (20 molars and 20 premolars) performed in the orthodontic department of the University of Geneva between 1979 and 1990. The sample demonstrated persistence of pulp vitality and continuous root development, followed, however, in most cases by replacement root resorption. The data were in accordance with previously published studies and point to an ideal developmental stage for molar and premolar transplantation to ensure pulpal and periodontal survival.

Current concepts of the biology of tooth eruption

Tooth eruption is defined as the movement of a tooth from its site of development within the jaws to its position of function within the oral cavity. We present a critical review of evidence for the mechanisms and regulation of the intraosseous and supraosseous phases of eruption, with an emphasis upon the canine premolar model studied by the authors. Analyses at different stages of premolar eruption indicate that selective fragmentation of dental follicle protein DF-95 correlates with the presence of elevated levels of follicular collagenase and stromelysin, and with the onset of premolar movement. A dramatic decrease in these metalloproteinases followed initiation of movement. A biochemical and cell biological model for regulation of tooth eruption is proposed based upon these new and existing data.

Mobility and percussion sound of healthy upper incisors and canines

In order to evaluate the correlation between mobility and percussion sound, 126 upper incisors and canines in 21 student volunteers were measured by means of the Periotest (Siemens), by evaluating the percussion sound subjectively and by analyzing its spectrum. The attenuation time and frequency of the sound were measured for each tooth. A logical mobility and percussion sound existed in accordance with the sizes of the teeth. Spearman correlation coefficients close to 1.00 were noted in individual cases between the Periotest and the three other tests describing the percussion sounds.

Autotransplantation of third molars as treatment in advanced periodontal disease

The aim of this study was to investigate the prognosis of replacing molars with advanced periodontitis by autotransplanted fully developed third molars. The patient sample consisted of 18 subjects, 24-58 years of age. The patients selected had at least 1 molar with advanced periodontal tissue destruction. After extraction of the diseased molar, autotransplantation of a third molar was immediately performed. After a splinting and healing period of 2-3 weeks, endodontic treatment was carried out. The follow-up included recordings of the clinical parameters, probing periodontal pocket depth, probing attachment level, percussion sound, and mobility. Radiographs were taken immediately after the surgical procedure, after 6 months, 1 year, and thereafter annually. The results of this study indicate that autotransplantation may be an alternative treatment procedure for molars with advanced periodontal disease.

A new method of tooth replantation and autotransplantation: aluminum oxide ceramic for extraoral retrograde root filling

After an initial clinical test phase, the new method of replantation and transplantation with the use of aluminum oxide ceramic for retrograde root filling may be viewed as possible differential indications to other methods, even to apicectomy in the molar region. Twenty-three of the twenty-five replantations and eight of the nine transplantations may be regarded as having been successful. Contraindications are cases of wide apical foramina and oval or octagonal root canal cross sections.

Cell renewal and ground substance formation in replanted cat teeth

The cellular dynamic pattern of pulpal healing 4, 10, 30, and 60 days after replantation of 47 apicoectomized cat incisors was studied after pulse labeling with 3H-thymidine and 35S-sulfate, autoradiography, and routine histology. In the control teeth the labeling index was less than 0.05%. The apical pulpal cells were capable of ground substance formation and cell proliferation already 4 days after replantation, with a labeling index of 7%, which increased up to 43% within 10 days. A gradual postoperative restitution and reorganization within the pulpal cellular compartment was seen. The maximum cell density, reached after 30 days, was reduced to on average 60% compared with the controls. The tissue reorganization was near completion within all pulpal zones after 60 days, and the labeling index was reduced to 2.5%. In some instances internal resorption in cervical pulpal areas negatively influenced the favorable healing. The present study shows that the pulpal healing in replanted teeth follows a consistent basic pattern in cellular dynamics and in histologic changes. The replanted tooth thus seems to be a suitable model for studies of healing and repair in connective tissues.

Transmission electron microscopy of supra-alveolar periodontal healing of auto- and allotransplanted teeth in monkeys

An ultrastructural study of the supra-alveolar periodontal healing of auto- and allotransplanted teeth was performed in 4 immunologically unmatched green Vervet monkeys. Eight mature incisors were either auto- or allotransplanted. Non-transplanted adjacent incisors served as controls. Prior to transplantation the teeth were endodontically treated extraorally. Eight weeks after transplantation, biopsies including part of the tooth and the adjacent supra-alveolar tissues were taken, fixed, decalcified and processed for electron microscopy. A thin electron dense layer covered the root surface of the autotransplanted teeth. Most collagen fibres inserted into this electron-dense border, as well as into the underlying cementum. A similar relationship between the fibres and root surface was found in controls. On the allotransplanted teeth a layer of electron-dense granular material covered the root surface in the supra-alveolar area. Collagen fibres inserting into the electron-dense border were frequently observed. Fibroblasts were the predominant cell type in the connective tissue adjacent to all transplanted teeth. In autotransplants 2 morphotypes of fibroblasts were observed: 1) cells with dilated endoplasmic reticulum and swollen mitochondria; and 2) cells with normal characteristics of protein synthesis and secretion. The fibroblasts of the allografts were predominantly cells with dilated endoplasmic reticulum and swollen mitochondria. The results indicated some similarities in the healing between the root surface and connective tissue in the supra-alveolar portion of the roots of auto- and allotransplanted teeth.

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.

Replacing resorbed maxillary central incisors with mandibular premolars

A case report is presented on autotransplantation of a lower premolar into the upper central incisor area. A traumatized upper central incisor lost because of external root resorption was replaced by a premolar transplant taken from a crowded mandibular arch. The transplant showed excellent adaptation and the periapical inflammation noticed a few years after the operation was treated successfully with apicectomy.

Pulp canal obliteration after Le Fort I osteotomy

A longitudinal study of 51 patients was carried out to determine the frequency of pulp canal obliteration (PCO) after Le Fort I osteotomy for the correction of dentofacial anomalies and to analyse pre- and peroperative factors influencing the development of PCO. PCO developed in 14 (2.3%) of 617 maxillary teeth followed for an average period of 28 months (range 11-59). The highest frequency of PCO was demonstrated in canines (6.0%) and premolars (4.4%). Total PCO was present in 9 teeth and partial PCO in 5 teeth. PCO was more frequent among teeth adjacent to a vertical interdental osteotomy than in teeth with no relation to a vertical osteotomy (p less than 0.0001). Change in blood supply after the operation was suggested to be responsible for PCO, although it might have been effected by the combined surgical and orthodontic treatment. Long-term follow-up, including periapical radiographs, of teeth with PCO is suggested, as pulp necrosis may develop many years after surgery.

Supra-alveolar periodontal healing of auto- and allotransplanted teeth in monkeys

Although intra-alveolar healing of allotransplanted teeth often shows pathological changes due to rejection of the tooth graft, previous clinical findings seem to indicate that the supra-alveolar part of the allografts heals differently, which is of significant prognostic value. The aim of the present study was to determine the healing of the cervical part of the periodontium of auto- and allotransplanted mature teeth in monkeys. In 4 adult, immunologically unmatched, green vervet monkeys 16 mature permanent maxillary and mandibular incisors were extracted, endodontically treated and either auto- or allotransplanted; 8 untreated neighbouring incisors served as controls. Block biopsies including part of the tooth and the adjacent vestibular tissues were obtained after a healing period of 8 weeks. The biopsies were decalcified in EDTA and embedded in Epon. In semi-thin section (1.5 microns) the morphology of the supra-alveolar periodontal tissues was analysed in the light microscope. The orientation of the connective tissue fibres close to the root surface was found to be more parallel to the root surface of allotransplants compared with autografts, while in the control teeth the fibres were generally oriented perpendicular to the root surface. Resorption of the root was seldom found in the supra-alveolar portions of any of the transplanted teeth. The junctional epithelium had migrated slightly apically onto the root surfaces of allotransplanted teeth. The gingival connective tissue adjacent to allotransplanted teeth showed a significantly increased number of lymphocytes compared with autografts and controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Dentin and osteodentin matrix formation in apicoectomized replanted incisors in cats

The reestablishment and rate of osteodentin and dentin matrix formation in 27 apicoectomized replanted and 20 control incisors in cats were studied after Procion H8-BS vital staining. In control teeth the pattern of matrix formation differed in the various pulpal zones, with a higher rate of matrix formed toward apical areas, most dominantly in maxillary incisors. Osteodentin formation could be traced after a lag period of more than 10 days after replantation. Thirty and 60 days postoperatively osteodentin matrix was found in the total pulpal length in 83% and 73% of the teeth, respectively. A common finding was a tubular osteodentin matrix in the pulpal apical third in the replanted teeth. Tubular osteodentin matrix was, however, present most incisally in some teeth 60 days postoperatively. Internal resorption corresponding to outer cervical lesions dominated the pulpal reactions in the maxillary replanted teeth after 60 days. It is concluded that under the present experimental conditions the pulp tissue possesses a high healing potential and that the osteodentin formation reflects the pulpal healing pattern after replantation traumas. The results also indicate that successful pulpal healing depends on unexposed dentinal tubules.