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

Clinical application of CAD/CAM technology in 3D printed dental model used for removable splints fabrication in the treatment of traumatized anterior permanent teeth in children

OBJECTIVES

To evaluate the effectiveness of computer-aided design (CAD)/computer-aided manufacturing (CAM) in designing and manufacturing 3D-printed dental models used to make thermoplastic removable splints for children with traumatized anterior permanent teeth.

METHODS

A total of 28 patients with dental trauma (subluxation, extrusive luxation, and lateral luxation) were divided into experimental (14 patients) and control groups (14 patients). The experimental group was treated with the removable splint made using a new 3D printed dental model designed with CAD/CAM technology, while the control group received a wire-composite splint. Follow-up was performed at week 2 and 1, 2, 3, 6, 12, 18, and 24 months post-treatment, and every year after that. The traumatized teeth were evaluated according to clinical symptoms, tooth color, mobility, position, percussion pain, abnormal percussion sounds indicating ankylosis or other pathosis, swelling, fistula of gums, vitality test, and radiographic examination.

RESULTS

No significant difference was found in gender and age between the two groups. The experimental group had 23 traumatic teeth, and the control group had 24 traumatic teeth. Traumatic teeth in the two groups most commonly involved open apex teeth (>90 %). The average follow-up time for the experimental and control group was 35.47±14.23 and 32.92±14.79 months (P > 0.05), respectively. The pulp survival rate and periodontal healing rate in the experimental group (86.96 %, 91.30 %) were higher compared to the control group (62.50 %, 75.00 %) (all P > 0.05).

CONCLUSION

A removable splint made by a 3D printed dental model designed with CAD/CAM technology achieved an equivalent treatment effect to a wire-composite splint.

CLINICAL SIGNIFICANCE

A 3D-printed dental model designed with CAD/CAM technology can be used to fabricate removable splints, which in turn can decrease iatrogenic injuries frequently encountered during the traditional model production process. For example, taking the impression directly from the patient's mouth can cause displacement of a traumatized tooth or even exfoliation. The removable splints produced using a new 3D-printed dental model can meet clinical treatment requirements of traumatized teeth, especially for children and adolescents with occlusal trauma in mixed dentition.

Comparison of two composite resin materials for splinting of dental luxation injuries: A double blind randomized controlled trial

BACKGROUND/AIM

Luxation is a common traumatic dental injury treated with a wire composite (WC) splint. However, bulk-fill flowable composite and conventional packable composite have not been compared for retaining these splints. Therefore, the objectives of this randomized controlled trial were (1) to compare retention of WC splints, and (2) to compare adhesive point dimension, application and removal time, and effect on tooth mobility between the two WC splints.

MATERIALS AND METHODS

In this parallel group, non-inferiority double blind randomized controlled trial, a total of 90 patients, aged 16-50 years participated. They were randomly allocated into two groups, the packable composite group (PC) n = 45 and the bulk-fill flowable composite group (BF-FC) n = 45 by lottery method. Following measurements were taken at the splint application appointment. Horizontal tooth mobility measured via Periotest, splint application time, and frontal images of splinted teeth to measure the percentage composite adhesive point area. After 2 weeks, splints were visually inspected for retention, whereas mobility and removal times were also recorded. Statistically, comparisons were made using independent samples sample T-test, Fisher's exact test, and Mann-Whitney U at p ≤ .05.

RESULTS

A total of 88 patients with 156 luxated teeth completed the trial, as two patients were lost to follow-up. Two patients in the PC group reported with completely de-bonded splints while none de-bonded in the BF-FC group. Both groups were similar in terms of splint retention (p = .352), reduction of mobility (p = .426), and splint removal times (p = .372). The BF-FC group performed significantly better in adhesive point dimension percentages (p < .001) and splint application time (p < .001).

CONCLUSION

Both groups were comparable in most parameters of the study. However, for BF-FC group application time and adhesive point dimension were significantly less.

Autotransplantation of teeth with incomplete root formation: systematic review and meta-analysis

OBJECTIVES

To determine the survival of intentional autotransplantation of developing teeth.

MATERIAL AND METHODS

An electronic search was carried out in the MEDLINE database, Web of Science, and Cochrane Library. The criteria used are the ones described in the PRISMA Declaration. The following MeSH terms were used: ("tooth" [MeSH Terms] OR "tooth" [All Fields]) AND ("transplantation, autologous" [MeSH Terms] OR ("transplantation" [All Fields] AND "autologous" [All Fields]) OR "autologous transplantation" [All Fields] OR "autotransplantation" [All Fields]) AND ("humans" [MeSH Terms]. Randomised clinical trials and prospective and retrospective clinical studies were included.

RESULTS

The meta-analytic study of overall survival included a total of 14 studies, yielding an overall survival rate of 97.9%. In studies with 1-year follow-ups, survival was 98%. The resulting 2-year follow-up rate was 97%, while the 5- and 10-year survival rates were 95.9% and 96.9%, respectively.

CONCLUSIONS

The autotransplantation technique performed in a single-phase and on teeth that have not completed their development is a predictable technique, with a described survival rate at a 2-year follow-up of more than 97%.

CLINICAL RELEVANCE

The technique of dental autotransplantation is considered an important resource for the resolution and rehabilitation of tooth loss in patients, especially in those who are still in a growth period. Moreover, this technique has a low complication rate and a 10-year survival rate of 96.9%. It should therefore be considered a safe and reliable procedure.

Autotransplantation of the Third Molar: A Therapeutic Alternative to the Rehabilitation of a Missing Tooth: A Scoping Review

INTRODUCTION

Tooth autotransplantation is the repositioning of an erupted, partially erupted, or non-erupted autologous tooth from one site to another within the same individual. Several factors influence the success rate of the autotransplant, such as the stage of root development, the morphology of the tooth, the surgical procedure selected, the extraoral time, the shape of the recipient socket, the vascularity of the recipient bed, and the vitality of the cells of the periodontal ligament. The aim of this scoping review was to provide the most up-to-date information and data on the clinical principles of the third-molar autograft and thus provide clinical considerations for its success.

MATERIALS AND METHODS

This review was conducted based on PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews). The research was conducted by searching for keywords in three databases-PubMed, Scopus and Google Scholar-by two independent reviewers following the PRISMA protocol, from which 599 records were identified.

CONCLUSIONS

Third-molar autotransplantation is a valid solution to replace missing teeth. The key to the success of this technique is the surgical procedure, which must be as atraumatic as possible to preserve the periodontal ligament of the tooth to be transplanted. The success rate is also linked to the stage of development of the root, with a worse prognosis in the case of a complete root.

Guided tooth autotransplantation in edentulous areas post-orthodontic treatment

OBJECTIVE

Tooth autotransplantation with a complete root formation to replace one or more lost teeth is indicated as a cost-effective alternative to implants. The aim of this case report was to describe a successfully guided autotransplantation of a maxillary third molar with fully formed roots into a surgically created socket after orthodontic space opening.

CLINICAL CONSIDERATIONS

A guided autotransplantation of the maxillary left third molar into the missing maxillary left first molar site was chosen. After virtually orientating donor tooth to confirm its optimum fit, it was deemed necessary to open 4 mm the mesiodistal space. Following the orthodontic movement, a 3-dimensional (3D)-guiding template and a milled surgical guide were manufactured to allow the donor tooth to be transplanted exactly in the planned position. The 2-year follow-up periapical radiograph showed a continuous periodontal space with no signs of apical periodontitis or root resorption.

CONCLUSIONS

Virtual planning and 3D-printed tooth replica combined with guided surgery can simplify the autotransplantation technique for both the clinician and the patient, particularly when the socket has been completely created during surgery.

CLINICAL SIGNIFICANCE

Virtual digital planning, which can accurately calculate the exact space to open orthodontically before an autotransplantation, could prove essential to enhancing the precision of 3D placement of the donor tooth in the recipient site.

Effect of Root Canal Therapy on the Success Rate of Teeth with Complete Roots in Autogenous Tooth Transplantation

BACKGROUND

Autogenous tooth transplantation is a reliable method for repairing missing teeth. Although it recently became a recognized and feasible treatment method in dentistry, the long-term efficacy of root canal therapy (RCT) has not been well confirmed. This study is aimed at determining whether RCT has a good effect on the success rate of teeth with complete roots in autogenous tooth transplantation.

MATERIALS AND METHODS

Data were collected from the Korea University Guro Hospital. Data of patients who underwent autogenous tooth transplantation within 9 years were collected. We selected 29 teeth with complete roots as the research subjects in our study. None of the patients had any systemic diseases. All cases in this study were obtained with patient permission.

RESULTS

According to the tooth vitality test, the autogenous teeth tested negative in dental pulp test and function. Nine of the 29 teeth with autogenous tooth transplantation were treated with RCT and survived throughout the observation period. However, 20 autogenous teeth were not treated with RCT, and eight of them did not survive. All statistical analyses were performed using IBM SPSS 20.0. The null hypothesis was rejected (p < 0.05).

CONCLUSION

For complete root teeth, the success rate after autogenous tooth transplantation after RCT is higher than that of teeth not treated with RCT.

Photoelastic stress analysis of different types of anterior teeth splints

BACKGROUND/AIMS

Traumatic dental injuries are highly prevalent and are considered an important health problem. The aim of this study was to evaluate the in vitro stress distribution around simulated traumatized teeth subjected to different types of splints by photoelastic analysis.

MATERIALS AND METHODS

For each group, five models of maxillary and mandibular arches were made in photoelastic resin using prefabricated teeth models, which were fixed and adjusted in a semi-adjustable articulator. All splints were bonded with composite resin on the labial surfaces of the maxillary central incisors, the lateral incisors and the canine teeth, simulating trauma to the 11. The groups were divided according to the type of splint: control-without splint; rigid-brackets and 0.021 × 0.025 inch stainless steel wire; semi-rigid-brackets and 0.016 × 0.016 inch cobalt-chromium wire; fiber-fiberglass ribbon; and flexible-nylon thread. The groups were submitted to an occlusal force in a special device attached to a universal test machine in balanced, protrusive, and lateral occlusions. Then, the incisal edge of the 11 was ground to simulate infra-occlusion, and the tests were performed again. Five points were analyzed around tooth 11 with a polariscope, and the data were submitted to ANOVA and Tukey tests at a 5% level of significance.

RESULTS

When centric occlusion was analyzed by comparing normal occlusion to infra-occlusion, all groups showed high stress values in infra-occlusion with statistical differences-except for the control group. When lateral occlusion was analyzed, the nylon splint showed lower statistical differences compared with the control, fiberglass, and rigid splint groups, which did not differ between each other. The semi-rigid splint did not differ from any group.

CONCLUSIONS

Fiberglass and semi-rigid splints showed better stress distribution around the traumatized tooth under occlusal loads. The nylon splint showed characteristics of non-stress distribution.

The use of 3D additive manufacturing technology in autogenous dental transplantation

Background

In medicine and dentistry, 3D technology allows the virtual planning and printing of surgical replicas of anatomical structures that can facilitate certain transplant procedures. In dentistry, 3D technology is useful in autogenous tooth transplantation.

Case presentation

We present a clinical case of an ectopic mandibular second premolar, describing the preoperative planning with dental replicas and the autotransplantation surgery. 3D prints of the surgical replica of the tooth to be transplanted was made using an Objet30 Prime® Printer, PolyJet. Clinical controls performed at 3, 6 and 12 months indicated the satisfactory evolution of the transplanted tooth.

Conclusion

3D additive manufacturing technology allows the preparation of a new recipient socket with the aid of a surgical replica of the tooth to be transplanted, thus minimizing handling and extraoral time.

Autotransplantation of third molars: a literature review and preliminary protocols

Tooth autotransplantation (the movement of a tooth from one site to another in the same person) is a technique with a history dating back many centuries. However, the use of third molars as donor teeth is perhaps less well-recognised and less documented. A review of the current literature was undertaken with particular attention to the use of the third molar as the donor tooth. The selection process, surgical procedure and follow-up pathways were summarised in the review. Appropriate patient selection was found to be a key factor in the success of the technique. Other prognostic factors were also discussed. The findings from the available literature suggest that autotransplantation is a viable and cost-effective technique. However, the literature relating to the use of third molars as donor teeth for autotransplantation is limited and there are currently no evidence-based guidelines or protocols relating to the technique. This paper discusses the literature and protocols the authors implement for autotransplantation of wisdom teeth.

Best Splinting Methods in Case of Dental Injury-A Literature Review

The objective of this manuscript was to review the literature on dental trauma splints and discuss materials used for splinting injured teeth in terms of their properties and conditions that are required for optimal stabilization. A literature search was conducted in the PubMed database with the keywords: "trauma splints", "dental trauma" and "traumatic dental injuries". The search was limited to English language publications. 42 publications fulfilled the inclusion criteria and were in accordance with the current recommendations. Optimal splinting of the teeth after trauma is one of the main predictors for pulpal and periodontal healing. The splints stabilize and protect the teeth, creating favorable conditions for the regeneration of the supporting tissues. Their application and removal should be easy and fast without any additional irritating of the surrounding tissues. The materials used to stabilize the injured teeth should keep the tooth in the original position, allowing for its physiological mobility.

Alternative treatment plan for congenitally missing teeth in an adolescent patient: A case report

BACKGROUND AND OVERVIEW

Mandibular second premolars are the second most commonly missing teeth, and there are various treatment alternatives to restore the space of the missing teeth. However, in growing patients, implants are contraindicated because they prevent growth of bone.

CASE DESCRIPTION

In this case report, the authors describe a 13-year-old girl with Class II malocclusion with congenitally missing mandibular second premolars. Autotransplantation of 2 maxillary premolars to the missing teeth site was performed considering the presence of crowding in the maxillary anterior segment. The teeth were fixed with a semirigid splint for 3 months. The patient had an acceptable occlusion at the end of the orthodontic treatment, which lasted 20 months.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

The autotransplanted right premolar showed normal physiological adaptation, whereas the tooth on the left side was ankylosed. The short-term results show that autotransplantation, which requires high technical sensitivity, may provide a biological and economical alternative to tooth replacement.

Establishment of experimental models to evaluate the effectiveness of dental trauma splints

The purpose was to describe a novel simple experimental model of injured teeth for developing dental trauma splints (DTS), and to test various splints by combining use of this model and the Periotest^® device. Rubber O-rings and spring washers were used to simulate and modify injured tooth mobility. Splinting effects were assessed among three kinds of DTS, including a composite splint and two wire-composite splints (1: rectangular orthodontic wire 0.533×0.635 mm, 2: cobalt-chromium alloy wire Φ0.9 mm). The Periotest values were measured three times for each tooth before and after splint insertion. The splinting effect was defined as the change in tooth mobility. Splinting effects significantly increased in the order wire-composite splint 1<wire-composite splint 2<composite splint (p<0.05). This model system could evaluate the effects of DTS including the differences among various splint methods, which showed reasonable reproducibility of dental trauma situations depending on severity in clinical usage.

Posttraumatic displacement management: lateral luxation and alveolar bone fracture in young permanent teeth with 5 years of follow-up

Dental trauma is an important public health problem due to high prevalence and associated limitations. The external impact accounting for trauma may result in different injury types to teeth and supporting structures. This paper describes a clinical case of tooth trauma in an 8-year-old patient exhibiting the displacement of three permanent teeth with open root apexes. Although the traumatic impact resulted in two injury types to teeth and supporting tissues (lateral luxation and alveolar bone fracture), the therapeutic approach was the same in both situations. The bone and teeth were repositioned by digital pressure, stabilized by semirigid splint, and followed up at every week. After six weeks, the splint was removed. At that moment, the clinical and radiographic findings indicated normal soft/hard tissues and absence of pulp/periodontal pathologies. At the fifth year of follow-up, the treatment success of the case was confirmed, although it has been observed that all lower incisors exhibited pulp obliteration as a consequence of the dental trauma.

Autotransplantation of mesiodens for missing maxillary lateral incisor with cone-beam CT-fabricated model and orthodontics

AIM

Autotransplantation is a viable treatment option for a missing tooth when there is a suitable donor, especially in adolescents with remaining facial growth. This report presents the aesthetic restoration of a missing maxillary lateral incisor through orthodontic treatment and autotransplantation of a mesiodens using a CBCT-fabricated rapid-prototyping model.

SUMMARY

A 14-year-old male patient with a congenitally missing maxillary lateral incisor was referred from the Department of Orthodontics. The teeth were moved orthodontically to regain space for the missing lateral incisor and to close the space of the mesiodens after transplantation. A replica of the donor tooth was fabricated from a cone-beam computed tomography scan through a rapid-prototyping machine before autotransplantation surgery. The model was used to create a socket for the graft tooth, thereby shortening the extra-oral time and minimizing the damage to the root surface. After transplantation and orthodontic tooth movement, the mesiodens was finally restored with an aesthetic laminate restoration. Over 3 years, the aesthetics remained excellent, and the transplant functioned normally without any signs or symptoms of root resorption.

KEY LEARNING POINT

Missing anterior teeth may be replaced through a combination of orthodontics, autotransplantation with a rapid-prototyping model and prosthodontic restoration, in growing patients.

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.

Root and periodontal tissue development after allogenic tooth transplantation between rat littermates

OBJECTIVE

The study was designed to investigate the development of roots and periodontal tissues after allogenic tooth transplantation between rat littermates by micro-computed tomography (micro-CT) and histology.

MATERIALS AND METHODS

The upper right second molars in 2-week-old rats were extracted and immediately transplanted into the upper right first molar socket of rat littermates under anesthesia. The upper left second molars in 2-week-old recipient rats were used as a control. The rats were fixed and tissues analyzed at 0, 4, 8, or 12 weeks after transplantation. Root development of seven rats in each group was analyzed quantitatively using micro-CT. Periodontal tissue formation was examined qualitatively by histologic methods.

RESULTS

Roots developed after allogenic transplantation, but they were significantly shorter than control roots. The number of roots varied from one to four in transplanted teeth, while it was consistently four in control teeth. Periodontal tissue formation in transplanted teeth was equivalent to that of the control teeth.

CONCLUSION

Allogenic transplantation between rat littermates permits root development and periodontal tissue formation.

Autotransplantation of premolars

Autotransplantation is a reliable treatment option for the replacement of missing teeth; however, there is a wide variation in reported survival rates. The purpose of this study was to evaluate the success and survival rate of premolar autotransplantation and to underline the importance of autotransplantation in the treatment of missing teeth. We present the treatment and follow-up of 63 premolar autotransplants in 44 patients. After transplantation under local anaesthesia, radiological and clinical follow-up showed a survival rate of 100%, ie all premolars were still functional. We conclude that autotransplantation of premolars is a reliable treatment method especially for agenesis. It is not difficult to perform and is aesthetically superior and more cost-effective than other treatments, especially when orthodontic alignment is necessary.

Immediate autotransplantation of mandibular third molar in China

OBJECTIVE

Tooth autotransplantation is a useful surgical method to replace a nonrestorable tooth. We reported our experiences in the replacement of mandibular nonrestorable molars by immediate autotransplantation in a Chinese population.

STUDY DESIGN

Thirty-five mandibular third molars with open or closed apices from 34 patients were autotransplanted into the same or contralateral fresh recipient sites immediately after the extraction of the nonrestorable mandibular molars. Root canal treatment was routinely performed in the closed-apical molars within 1 month after surgery. Clinical and radiographic examination of the transplanted donor molars was done after surgery.

RESULTS

Two teeth were been extracted for progressive root resorption. The remaining 33 autotransplanted teeth were asymptomatic and functioning after a mean follow-up period of 5.2 years. No infection, ankylosis, loss of the transplants, or root resorption was noted in the remaining autotransplanted teeth.

CONCLUSION

Immediate autotransplantation of the mandibular third molar is a reasonable and alternative treatment to replace a nonrestorable tooth in China.

Treatment of a horizontal open bite with an invisible multiloop appliance in a girl with tooth trauma

This case report presents the treatment of a girl with a Class II horizontal open bite and severe crowding with an invisible appliance. She had been in a severe traffic accident at 5 years 10 months of age. Her teeth, especially the mandibular right lateral incisor, canine, and first premolar had ankylosed, and their roots were severely resorbed and fused to the alveolar bone. Orthodontic treatment started at the age of 12 years. The mandibular left first premolar and both maxillary first premolars were extracted to reduce overjet and crowding. The left first premolar was extracted and transplanted to the extracted position of the right first premolar. Because the patient wanted an invisible appliance, we selected the Fujita lingual bracket system for her treatment. During the final stage of treatment, a multiloop mushroom archwire was placed to correct the open bite in the maxillary arch with vertical elastics. Six years after retention, her occlusion remained stable, and the transplanted premolar was functioning normally.

Autogenous transplantation of teeth with complete root formation: two case reports

AIM

Autotransplantation is an alternative treatment for replacing lost teeth when suitable donor teeth are available. This paper presents two cases of successful autogenous tooth transplantation.

SUMMARY

Two third molars with complete root development were autogenously transplanted from their original sockets into new recipient sites on the same side of the mouth, one in the maxilla and one in the mandible. In both cases, the third molars were transplanted immediately after the first molar extractions. To provide better adaptation of the donor teeth, the recipient alveolar sites were remodelled using surgical burs. Semi-rigid splints were maintained for 45 and 15 days, respectively. Root canal treatment commenced one a week after transplantation and the canals were medicated with a calcium hydroxide paste before they were filled. Clinical and radiographic findings after 5 and 3 years of follow-up, respectively, are discussed in relation to the literature.

KEY LEARNING POINTS

Autogenous transplantation of teeth with complete root formation may be considered as a viable treatment option to conventional prosthetic and implant rehabilitation for both therapeutic and economic reasons. Careful surgical and endodontic procedure, together with careful case selection may lead to satisfactory aesthetic and functional outcomes.