Outcomes of autotransplanted teeth with complete root formation: a systematic review and meta-analysis

Advancements in tooth autotransplantation

BACKGROUND

Tooth autotransplantation (AT) involves the surgical relocation of a tooth from 1 site in the mouth to another site within the same patient. This approach is a good option in a growing patient when dental implant placements or fixed bridges are not suitable and when preserving natural teeth is a priority. Tooth AT is a complex procedure that requires specialized skills from a multidisciplinary team with careful patient and tooth selection and treatment planning.

TYPES OF STUDIES REVIEWED

The authors provided a review of the state of knowledge and research on tooth AT and presented a case scenario and barriers to adoption, with a focus on the United States.

RESULTS

Success rates for tooth AT can vary depending on several factors, including the patient's overall health, specific tooth involved, skill of the dental surgeon, and postoperative care provided. Long-term outcomes of autotransplanted teeth have been cited in the literature with impressive longitudinal follow-up spanning up to 26 years. Results of several systematic reviews showed survival rates from 75% through 98%.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

Adoption of tooth AT has grown over the years, owing to advancements in dental techniques, improved patient outcomes, and increased awareness among both dentists and patients. Increasing awareness and availability of tooth AT to replace missing teeth can provide a natural and functional alternative to traditional prosthetic options. Tooth AT helps preserve the alveolar bone in growing patients and can offer excellent esthetic and functional outcomes.

Retrospective Follow-up Assessment of Risk Variables Influencing the Outcome of Autologous Tooth Transplantation

INTRODUCTION

This retrospective study aimed to identify which patient-, donor tooth-, recipient site-, and surgical procedure-related variables may influence the outcome of tooth autotransplantation.

METHODS

The sample included 128 autotransplants performed in 122 patients. Single-visit clinical/imaging examinations were used to define the outcome as successful, survival, or failure. The association of potential indicators with the survival or failure categories was analyzed individually and adjusted for confounders through multivariate logistic regression models.

RESULTS

After a follow-up period of 1 to 30.11 years, success was achieved in 71.8% of autotransplants, whereas the survival and failure groups had rates of 14.1% each, and the grouped success/survival rate reached 85.9%. An extraoral time >15 minutes and difficult handling/placement were strong/independent risk covariates for survival and failure categories (odds ratio >1, P < .05). Additionally, unerupted/partially erupted status of the donor tooth was a significant indicator for survival, whereas deficient bone level at the recipient site, surgical extraction, poor initial stability, and lack of prophylactic antibiotics were independently linked to failure (odds ratio > 1, P < .05). The root morphology and socket status acted as modifiers of the effect of the recipient site location on the survival group (P > .05).

CONCLUSION

Based on the results of this study, unerupted/partially erupted status of the donor tooth, surgical extraction, total extraoral time >15 minutes, deficient recipient's bone level, difficult handling/placement of the autotransplant, poor initial stability, and lack of prophylactic antibiotics during the surgical procedure must be considered with caution when performing autotransplantation because of their deleterious influence on the outcome.

Survival of retained permanent canines after autotransplantation: A retrospective cohort study

INTRODUCTION

After third molars, canines are the teeth most commonly affected by displacement and impaction. Although orthodontic surgical treatment represents the standard method for realignment of canines, autotransplantation (autoTX) functions as the second-line therapy if orthodontic alignment does not succeed in treating impaction and severe displacement. This retrospective cohort study aimed to identify clinical predictors for postoperative survival and endodontic treatment needs after autoTX of severely displaced and impacted canines.

METHODS

The study cohort comprised patients who received canine autoTX in a single surgical center between 2006 and 2018. Canines with severe displacement and retention were surgically treated using a standardized protocol. Statistical analysis of survival probability was performed with the Kaplan-Meier method, and bivariate data were analyzed using logistic regression and the Pearson chi-square test. Nonparametric continuous variables were analyzed using the Mann-Whitney U test.

RESULTS

Data from 319 patients with 378 canine grafts were available for analysis after a mean follow-up of 54.7 ± 36.5 months on the patient level (range, 0.3-181.8 months). With 25 lost autotransplants, the cumulative survival rate was 93.4%. Patient age at surgery, the state of the apical foramen, endodontic treatment need, and persistence of deciduous teeth at the implantation site had a significant negative impact on autotransplant survival (P <0.05). Endodontic treatment need was significantly related to the patient's age at surgery, the state of the apical foramen, and preoperative orthodontic traction (P <0.05). Thus, these independent variables were identified as clinical predictors for the survival of both the autotransplant and the dental pulp. Gender, ischemia time, postoperative ankylosis, or site of autoTX did not influence any of the outcome variables.

CONCLUSIONS

The high survival rates of autotransplanted permanent canines make this treatment a promising option, especially in patients with severe tooth displacement, in which orthodontic treatment alone cannot provide predictable alignment, irrespective of the patient's age. Interpreting age and preoperative orthodontic traction as delaying the onset of autoTX and state of apex, time-dependent aspects seem to be of great importance for postoperative complications leading to endodontic treatment or graft loss. Therefore, early implementation of autoTX as a treatment modality for impacted, severely displaced, and vain exposed canines in daily surgical practice should be encouraged.

Computer-Guided Surgery Can Avoid Prophylactic Endodontic Treatment in Autologous Tooth Transplantation: A 5-Year Follow-Up Case Report

Autotransplantation is a successful technique to replace compromised teeth. This study presents a computer-guided surgical approach for preparing the receiving socket for a mature mandibular third molar donor tooth with a wait-and-see approach instead of prophylactic endodontic treatment. A 42-year-old woman developed root resorption of tooth 3.7. Extraction of 3.7 and autotransplantation of 3.8 was planned, following a 6-week orthodontic phase for periodontal ligament activation and teeth mobilization. Due to the different root morphology between the compromised and donor teeth and the high mandibular bone density, the receiving socket preparation was performed using guided surgery templates. Two surgical splints were designed with a surgical planning software. Tooth 3.7 was extracted, the recipient site was guided-milled, and tooth 3.8 was transplanted into the new socket in approximately one second of extra-alveolar time. The rapidity of the extra-alveolar time facilitated complete healing without resorting to root canal treatment. Five-year radiological control does not show any periapical lesion or root resorption. The surgical procedure for tooth autotransplantation is fundamental: it must be as atraumatic as possible to preserve the periodontal ligament of the tooth and the receiving socket, and the dentist must minimize the extra-alveolar time. Guided surgery is a reliable solution to combine all these aspects.

Multiple effects of dose-related GM-CSF on periodontal resorption in deep-frozen grafted teeth: A reverse study

Autologous tooth grafting is a dental restorative modality based on periodontal ligament healing.Human periodontal ligament stem cells(PDLSCs) are involved in the formation and remodeling of periodontal tissue.Based on previous findings, the proliferation and differentiation of processing cryopreserved periodontal ligament stem cells (PDLSCs) exhibit similarities to those of fresh cells. However, there is evident absorption in the transplanted frozen tooth's roots and bones, with the underlying cause remaining unknown. Granulocyte macrophage colony-stimulating factor(GM-CSF) is named for its produce granulocyte and macrophage precursors from bone marrow precursors, and it also serves as one of the regulatory factors in inflammatory and osteoclast formation. This study aimed to investigate changes in GM-CSF expression in frozen PDLSCs (fhPDLSCs) and evaluate the impact of GM-CSF on PDLSCs with respect to cellular activity and osteogenic ability. The role of GM-CSF in periodontal absorption was further speculated by comparing with IL-1β. The results revealed a significant increase in GM-CSF levels from fhPDLSCs compared to fresh cells, which exhibited an equivalent inflammatory stimulation effect as 1 ng/ml IL-1β. Cell viability also increased with increasing concentrations of GM-CSF; however, the GM-CSF from fhPDLSCs was not sufficient to significantly trigger osteoclastic factors. Considering its interaction with IL-1β and positive feedback mechanism, environments with high doses of GM-CSF derived from fhPDLSCs are more likely to activate osteoclastic responses.Therefore, for frozen tooth replantation, great attention should be paid to anti-inflammation and anti-infection.GM-CSF may serve as a potential therapeutic target for inhibiting periodontal resorption in delayed grafts.

An evaluation of 910 premolars transplanted in the anterior region-A retrospective analysis of survival, success, and complications

AIM

The aim this retrospective analysis was to evaluate the survival, success and possible complications of transplanted premolars to the anterior region subdivided in development stage and patient's age.

MATERIALS AND METHODS

The material comprised patients that underwent a tooth transplantation between April 2004 and December 2021. A total of 910 premolars were transplanted in 707 patients. Tooth mobility, oral hygiene, and periodontal parameters were clinically evaluated. Standardized radiographs were used to evaluate pulpal and periodontal healing and root formation. The cumulative survival rate was calculated using the Kaplan-Meier method.

RESULTS

The data were subdivided in three groups based on the stage of root development and patient's age. The average age at surgery was 16 years. The main indication for transplantation was trauma, followed by agenesis and other indications. Two premolars were lost during the whole observation period. The overall survival and success in the immature premolars group after an observation period of 10 years was 99.8%. The 10-year survival and success rate when fully developed premolars were transplanted in the anterior region in adolescents were 100% and 96.3%, respectively. In adults, the 10-year survival and success rate were 87.5%.

CONCLUSION

Transplantation of premolars with developing and fully developed roots to the anterior region in children, adolescents, and adults is a predictable treatment modality.

Translational approach to tooth autotransplantation: A 27-year case study

BACKGROUND

The aim of this case report was to present a translational approach to tooth autotransplantation using jiggling forces to enlarge the periodontal ligament (PDL) space before autotransplantation, with the goal of improving treatment success and long-term survival.

METHODS

A 23-year-old patient, undergoing orthodontic therapy and with an unrestorable maxillary first molar, was proposed to have a healthy and fully-erupted maxillary third molar transplanted in the socket of the first molar. Jiggling forces were applied to the third molar to enlarge the PDL space and facilitate the preservation of PDL fibers on the root surfaces during the extraction.

RESULTS

Jiggling forces induced hypermobility and widened PDL space of the third molar. The autotransplantation was successful and the patient was followed regularly over a 27-year period. At the 27-year visit, the patient showed optimal chewing function, oral plaque control, and absence of gingivitis. The transplanted molar exhibited periodontal health and absence of mobility. Probing depth of 5 mm and radiographic external root resorption was noted on a localized area of the transplanted tooth which had experienced traumatic and unintentional removal of PDL fibers during the extraction.

CONCLUSIONS

A translational approach was proposed by integrating knowledge from the fields of orthodontics, trauma from occlusion, and replantation. It validated the crucial importance of maintaining healthy PDL fibers on the root surface and demonstrated clinically the successful autotransplantation of a fully formed third molar into the socket of a first molar with a retention of 27 years.

KEY POINTS

Why is this case new information? This case provided evidence of successful autotransplantation of a molar with complete root formation. It reported the longest-term follow-up (27 years) present in the literature. Most importantly, it used a translational medicine approach to apply concepts from the fields of orthodontics and traumatic occlusion to improve the success of the autotransplantation procedure. What are the keys to the successful management of this case? Jiggling forces induced tooth hypermobility and increased the PDL space of the tooth planned for autotransplantation. In turn, they facilitated the atraumatic extraction and preservation of the PDL fibers on the transplanted tooth, improving the success of the reattachment of periodontal fibers. What are the primary limitations to success in this case? Traumatic extraction resulting in the unintended removal of PDL fibers from the tooth planned for autotransplantation, or intentional removal of PDL fibers with root planing are expected to decrease the success rate of the autotransplantation procedure. This is due to the lack of viable PDL cells necessary for reattachment.

Autogenous bone chip interspersed in PRF and PRP as an augmentative bio material in autogenous tooth transplant - A case report

INTRODUCTION

Autotransplantation technique involves extraction of tooth from the recipient site and donor tooth without damage, placing and stabilizing donor tooth within same individual. The use of autogenous bone combined with platelet rich fibrin (PRF) and platelet rich plasma (PRP) seems to be favorable to achieve stable alveolar bone. Thus we provide an innovative adjuvant method for enhancing bone formation using PRF and inter-radicular bone with PRP as autogenous graft.

PRESENTATION OF CASE

A 26 year old healthy female individual reported university teaching hospital to outpatient department of oral and maxillofacial surgery, with complain of decayed tooth. On clinical and radiographic examination it was diagnosed was chronic irreversible pulpitis with to left maxillary first molar. Looking at clinical profile, age and health status an autogenous tooth transplant was advised.

DISCUSSION

Periodontal ligament, interradicular bone autografts, PRF and PRP has potential to induce formation of alveolar bone and is recommended in cases of atrophy of alveolar process.

CONCLUSION

The solution mentioned can be hypothesized to improve - quantity and quality of bone formed, reduce the chances of ankylosis of the tooth, bone loss, sinus perforation.

Dental Auto Transplantation Success Rate Increases by Utilizing 3D Replicas

Dental autotransplantation is an effective alternative to conventional dental treatment, and it involves removing a tooth and repositioning it in a new position within the same patient. Although this procedure might pose more intraoperative challenges, it provides a great solution for replacing missing teeth or aiding difficult eruption in young patients. This prospective method is also advocated as a use of treatment for unrestorable teeth. The success rates of autotransplantation cases with and without replicas were compared in a retrospective analysis of the data. By reducing donor tooth manipulation and ensuring a proper fit and positioning in the recipient socket, replicas significantly increased success rates of the procedure. CBCT scans were used to collect data. Data exported to the Mimics system were then processed in order to achieve a model of the donor tooth. Additive manufacturing technology was used to create the replicas. Specialized biocompatible material was used. Details of the replantation site and the donor tooth requirements were described, as well as the step-by-step surgical technique. For the best results, variables, like patient selection, surgical technique, and long-term monitoring, were found to be essential. The study highlights the significance of dental professionals and biomedical engineering staff working together to develop standard operating procedures and achieve predictable outcomes in autotransplantation procedures. The results suggest that 3D printed replicas could be a useful tool for improving the effectiveness and success of dental autotransplantation.

Anterior tooth autotransplantation: a case series

Tooth autotransplantation is the technique of transplanting embedded, impacted or erupted teeth from one site into another in the same individual. It is relatively common for the anterior segment of the mouth to be affected by traumatic tooth injuries, impacted and/or congenitally missing permanent teeth. Autotransplantation of teeth into the anterior dental arch can provide unrivalled biological solutions when such issues arise in this critical aesthetic zone, particularly for adolescent patients. The combination of meticulous pre-surgical assessment, synergistic interdisciplinary collaboration and carefully performed anterior tooth autotransplantation has been demonstrated to achieve impressive outcomes, with respect to both transplant survival and clinical success. © 2023 Australian Dental Association.

Tooth autotransplantation: An umbrella review

Tooth autotransplantation is a versatile procedure with several clinical applications among patients across different age groups. The success of this procedure depends on multiple factors. Despite the wealth of studies available, no single primary study or systematic review is able to report on every factor affecting the outcomes of autotransplantation. The aims of this umbrella review were to evaluate treatment-related and patient-related outcomes of autotransplantation and to assess the pre-, peri- or post-operative factors that could affect these. An umbrella review was conducted according to the PRISMA statement. A literature search of five databases was performed up to 25 September 2022. Systematic Reviews (SR) with and without meta-analysis evaluating autotransplantation were included. Calibration among reviewers was carried out prior to study selection, data extraction and Risk of Bias (RoB) assessment. Study overlap was calculated using corrected covered area. Meta-meta-analysis (MMA) was performed for suitable SRs. The AMSTAR 2 critical appraisal tool was used to evaluate the quality of evidence. Seventeen SRs met the inclusion criteria. Only two SRs were suitable for conduct of MMA on autotransplantation of open apex teeth. The 5-year and 10-year survival rates were >95%. A narrative summary on factors that could affect autotransplantation outcomes and comparisons of autotransplantation to other treatment options were reported. Five SRs were rated as 'low quality' and 12 SRs were rated as 'critically low quality' in the AMSTAR 2 RoB assessment. In order to facilitate a more homogenous pool of data for subsequent meta-analysis, an Autotransplantation Outcome Index was also proposed to standardise the definition of outcomes. Autotransplantation of teeth with open apices have a high survival rate. Future studies should standardise the reporting of clinical and radiographic findings, as well as the definition of outcomes.

Accuracy of CAD-CAM surgically guided tooth autotransplantation using guided templates and custom-designed osteotomes in human cadaver mandibles

INTRODUCTION

A major challenge in dentistry is the replacement of teeth lost prematurely due to trauma, caries, or malformations, especially in growing patients. The aim of this study was to assess the accuracy of CAD-CAM surgically guided tooth autotransplantation in cryopreserved cadaver mandibles using guided templates and custom-designed osteotomes.

METHODS

Cryopreserved human cadaver heads were digitized and scanned using an intraoral optical scanner and a large-volume cone beam computed tomography (CBCT) device. First, virtual surgical planning was performed to create a 3D tooth replica, two surgical guides, and a custom-made osteotome for each single-rooted tooth autotransplantation procedure/case. Surgical sockets were created in the selected mandibles using guided tooling consisting of an initial guided osteotomy with implant burs and a final guided osteotomy using custom osteotomes. After tooth autotransplantation, second large-volume CBCT images of the five cadaver mandibles were obtained. The discrepancy in mm within the 3D space (apical and mesiodistal deviations) between the final position of the autotransplanted teeth and their digitally planned 3D initial position was calculated and analyzed statistically (P< .05).

RESULTS

All donor teeth were placed without incident within their newly created sockets in the real mandibles. The mean difference between the digitally planned root apex position and the final tooth position was 2.46±1.25mm. The mesiodistal deviation of the autotransplanted teeth was 1.63±0.96mm.

CONCLUSIONS

The autotransplantation of single-rooted teeth with custom-designed and 3D-printed surgical tooling provided promising results. The technique was able to create surgically prepared sockets that could accommodate transplanted teeth in mandibles.

An evaluation of 1654 premolars transplanted in the posterior region-A retrospective analysis of survival, success and complications

AIM

The aim of this retrospective analysis was to evaluate the survival, success and possible complications of transplanted premolars in the posterior region subdivided by developmental stage and patient age.

MATERIALS AND METHODS

This study included patients who underwent tooth transplantation between April 2004 and December 2021. A total of 1654 premolars were transplanted into 1243 patients. Tooth mobility, oral hygiene and periodontal parameters were clinically evaluated. Intraoral radiographs were used to evaluate pulpal and periodontal healing, and root formation. The cumulative survival rate was calculated using the Kaplan-Meier method.

RESULTS

Data were subdivided into three groups based on the stage of root development and patient age. The mean age at surgery was 14.5 years. The main indication for transplantation was agenesis, followed by trauma and other indications, such as impacted or malformed teeth. A total of 11 premolars were lost during the study period. The overall survival and success rates in the immature premolar group after an observation period of 10 years were 99.7% and 99.4%, respectively. High survival and success rates (95.7% and 95.5%, respectively) were also observed when fully developed premolars were transplanted into the posterior region of adolescents. In adults, the success rate after 10-year follow-up is 83.3%.

CONCLUSIONS

Transplantation of premolars with developing and fully developed roots is a predictable treatment modality.

Autologous Tooth Transplantation in Craniofacial Malformations

OBJECTIVE

To evaluate the applicability of transplanted teeth in young patients with craniofacial anomalies.

DESIGN

Observational study.

SETTING

Comprehensive Centre for Cleft Palate and Craniofacial Malformations.

PATIENTS/PARTICIPANTS

Patients with craniofacial anomalies who underwent tooth transplantation. Only children with complete clinical and radiological documentation and a follow-up period of at least 1.5 years were included.

INTERVENTIONS

Tooth transplantation.

MAIN OUTCOME MEASURE(S)

Retrospective evaluation of clinical records, pre- and postoperative radiographs, and operative charts. Clinical characteristics of patients, preoperative parameters and postoperative outcome parameters were collected.

RESULTS

A total of 17 patients with 23 tooth transplantations were included. The median follow-up period was 6.7 years. The pooled survival and success rates were 91%. Notably, one out of two teeth that were transplanted into the bone grafted alveolar cleft site had to be extracted, which might indicating a higher risk for this procedure. In total, two transplanted teeth had to be extracted during the follow-up period, one due to external resorption and the other one due to perio-endo lesion. One patient needed endodontic treatment due to pulp necrosis.

CONCLUSION

We consider tooth transplantation to be a reliable and suitable procedure in the dental rehabilitation of young patients with craniofacial anomalies and fitting concomitant circumstances. We encourage craniofacial teams to reconsider this option more frequently in appropriate cases.

Pulp revascularization after autotransplantation of the mandibular canines with partially resected roots. Report of five cases with follow-ups between 26 and 80 months

INTRODUCTION

Transmigrated (migrated through the midline) mandibular canines constitute a treatment challenge. Advanced transmigration can be successfully treated by autotransplantation. In developing canines, pulp revascularisation is typical after transplantation. On the contrary, the pulp of teeth with completed apex formation does not undergo revascularization. In this case, root canal treatment becomes compulsory and decreases the success of autotransplantation. The aim of this observational retrospective study was to evaluate whether partial resection of the root (performed during the autotransplantation of mature canines) would enable revascularization of the pulp after the surgery.

METHODS

Five transmigrated mandibular canines with complete apex formation before the surgery were evaluated. During the autotransplantation surgery, the resection of 2-4 mm of the root apex was performed to open the path for revascularisation of the pulp after surgery. The transplanted teeth were observed during healing after the surgery for the presence of pulp obliteration. Clinical and radiographic examinations were performed.

RESULTS

All treated canines survived the minimum observation period of two years (ranging from 26 to 80 months, mean: 55 months) without pulp healing complications. The survival was 100 percent, and the success was 80 percent. In one canine, the external cervical root resorption was diagnosed and treated one year after the surgery. At the final examination, transplanted canines presented radiographic features of pulp obliteration, normal mobility, and healthy periodontal tissues.

CONCLUSIONS

The surgical protocol proved to be successful in promoting revascularization to maintain pulp vitality, in all cases. The outcomes confirm that autotransplantation, combined with the resection of the root, constitutes as a valid treatment for mature ectopic canines.

Autotransplantation of Maxillary Third Molar with Its Attached Buccal Cortical Plate Combined with a Connective Tissue Graft

INTRODUCTION

Tooth replacement often leads to insufficient vertical volume in the recipient socket bone. The aim of this novel report is to present a successful fully guided autotransplantation of a maxillary right third molar (tooth #1) with its attached buccal plate. The procedure was combined with a palatal connective tissue graft to reconstruct a buccal hard and soft tissue defect of an irreparable maxillary right first molar (tooth #3).

METHODS

A 45-year-old man complaining of pain in tooth #3 came to the clinic. Tooth #3 was non-restorable due to an extensive caries and a vertical root fracture of the mesiobuccal root, leading to a total loss of the buccal cortical plate. Guided autotransplantation of tooth #1 was completed by using 3-dimensional surgical templates for implant burs and a 3-dimensional-printed replica. After positioning the donor tooth, the cortical plate was fixed to the recipient socket with osteosynthesis screws. A connective tissue graft was also harvested to increase the band of keratinized gingiva and the thickness of the buccal soft tissue. At 6-month follow-up, the screws were removed, showing excellent regeneration throughout the buccal area.

RESULTS

At 3-year follow-up, the transplanted tooth was asymptomatic, with a natural bone level and no signs of replacement or inflammatory root resorption.

CONCLUSIONS

The use of a donor tooth and its attached bone cortical plate combined simultaneously with a connective tissue graft appears to improve hard and soft tissues in a single procedure.

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

BACKGROUND/AIMS

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.

MATERIALS AND METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

Orthodontic management of a horizontally impacted maxillary incisor in an adolescent patient

Horizontal maxillary incisor impaction is not common, but it affects facial esthetics, phonetics, and the patient's self-esteem. Therefore, it is necessary to manage this problem as early as possible. This case report presents a patient with an unerupted maxillary left central incisor combined with anterior and left posterior crossbite, edge-to-edge overbite on the right and left anterior open bite, low smile line, and mild skeletal Class III discrepancy. The treatment consisted of 3 stages: (1) maxillary expansion and sufficient space creation for the impacted tooth; (2) surgical exposure by closed-eruption technique; and (3) induced eruption of impaction. The treatment outcome was highly favorable. Maxillary impaction erupted in the proper position with a normal clinical crown height and consonant gingival line with the adjacent teeth. Maxillary and mandibular teeth had normal and stable occlusion. The 3-year follow-up demonstrated an esthetically functional outcome after orthodontically induced tooth eruption. This treatment required a good treatment plan by the orthodontist to obtain satisfactory results.

Extraoral Root-End Resection May Promote Pulpal Revascularization in Autotransplanted Mature Teeth-A Retrospective Study

Tooth germ autotransplantation of open apices of the teeth exhibits high pulpal healing rates, whereas that of mature permanent teeth normally causes irreversible pulpal necrosis. Extraoral root-end resection (EORER) during transplantation may promote pulpal revascularization (PRV) in transplanted mature teeth and reduce endodontic treatment requirement. This study compared the primary outcomes of survival rates, PRV, and root resorption and determined relevant confounders in autotransplanted mature and immature teeth. The medical charts of consecutive patients who underwent tooth autotransplantation between January 2017 and March 2021 were evaluated. Teeth with a documented follow-up of at least 1 year were included. During the study period, 59 teeth were transplanted in 44 patients. Overall, 2 teeth were excluded owing to missing data; 57 teeth were analyzed, including 25 mature teeth additionally treated with EORER. After a mean follow-up of 21.2 ± 16.1 months, no significant differences in primary outcomes were detected. Fifty-five teeth remained in situ (96.5%), and radiological signs of root resorption were detected in 9/57 teeth (15.8%). PRV was positive in 54/57 teeth (94.7%). Surgical duration and PRV failure were significantly associated with high incidences of root resorption. Mature teeth autotransplantation with EORER yielded similar results to immature teeth autotransplantation and is a feasible treatment option. Long surgery and failed revascularization increased root resorption rates. More factors should be evaluated in larger trials with longer observation periods.

Digital technology for fabrication of removable dental prosthesis with double crowns combining fiber-reinforced composite and zirconia

PATIENTS

This clinical report describes the process for fabricating a double-crown-retained removable dental prosthesis combining a fiber-reinforced composite and zirconia using digital technology. An 83-year-old woman presented with gingival swelling around the maxillary right premolar. The swollen tooth was the abutment tooth of a cross-arch fixed partial denture. An intraoral scanner (IOS) and computer-aided design/manufacturing as digital technology were used to plan treatment with a double-crown-retained removable dental prosthesis. A metal-free prosthesis using zirconia for the primary crown and fiberglass-reinforced composite resin for the secondary crown was planned, and the patient consented to the treatment plan. After autotransplantation of a tooth as one of the abutments, the IOS was used to obtain digital scans of the prepared surface of the abutment teeth, opposing dentition, and occlusal relationships. First, primary crowns were milled using zirconia. Next, the intraoral scanner obtained a pick-up impression of the primary crowns, and secondary crowns were designed and milled from the fiber-reinforced composite. After delivery, the patient expressed satisfaction with the functionality, esthetics, and fit of the double-crown-retained removable dental prosthesis.

DISCUSSION

Digital technology offers many advantages such as efficient fabrication of double crowns, reduced material costs, improved biocompatibility, and good aesthetics of metal-free materials.

CONCLUSION

This clinical report describes the application of digital technology for the fabrication of a double-crown-retained removable dental prosthesis combining a fiber-reinforced composite and zirconia, resulting in patient satisfaction.

Tooth auto-transplantation to close an oro-sinusal communication using a 3D printed model to adapt the alveolar socket: a case report

Introduction: Tooth auto-transplantation has a high success rate therapy when limiting the extra-oral time of the graft. In this way, printing a 3D model of the germ can be a useful tool in order to prepare the receiving site. Observation: We treated a case of post extractional oro-sinusal communication closure using a 3D pattern to adapt the alveolar socket receiving the wisdom tooth auto-transplantation. Comment: Extra-oral time spent by the graft was under 15 seconds improving the chance of success. After one year follow up, the graft is vital, functional and it continued its root formation. Conclusion: 3D printing seems to be an effective technique to minimize surgical time leading to a higher rate of success for auto-transplantation therapies.

Does Root Development Status Affect the Outcome of Tooth Autotransplantation? A Systematic Review and Meta-Analysis

Background: Tooth autotransplantation is defined as the surgical repositioning of an autogenous tooth in another surgical site within the same individual. Aim: The aim of this research was to analyze the outcome of tooth transplantation using immature donor teeth compared with closed apex teeth and to compare differences between donor tooth positions on the arch. Methods: Electronic and manual literature searches were performed in different databases, including the National Library of Medicine (MEDLINE), EMBASE (OVID), Cochrane Central (CENTRAL), and the digital library of the Universitat Internacional de Catalunya (UIC University) from 1978 to March 2021. Studies were selected when they fulfilled the following criteria: only human prospective clinical studies, minimum sample size of 10 patients, minimum follow-up of 1 year, studies reporting or with at least deducible data on survival rates, immediate tooth autotransplantation with completed or incomplete root formation, and publications in the English language. A meta-analysis of random effects was developed to estimate the global effect measure of the survival rate, success rate, and root resorption involving the total sample, as well as open- and closed-apex groups. Results: Twenty-four articles were eligible for analysis. The Cohen’s kappa corresponding to this review was 0.87, and the risk assessment was considered low–moderate for the included studies. Overall survival and success rates were 95.9% and 89.4%, respectively, with a mean follow-up of 4 years and an overall mean age of 25.2 ± 12.3 years. Closed apex teeth showed a survival rate of 3.9% lower than that of open apex teeth. Higher complication rates were found for both inflammatory external root resorption and replacement root resorption in the closed-apex group, without reaching statistical significance. Conclusions: Tooth autotransplantation is a viable treatment alternative, regardless of the apical condition, with high survival and success rates after a mean follow-up of 4 years. Open-apex donor teeth could be considered the gold-standard option, showing lower complication rates when compared to closed-apex donor teeth. Future randomized controlled clinical studies are needed to examine the long-term prognosis of this technique.

Root Membrane Replantation as an Alternative Technique for the Socket Preservation

Background and Overview. Socket shield is a technique that allows the maintenance of tissue volumes. In the reported clinical case, the replantation of the buccal root fragment mistakenly extracted during a socket shield surgery is performed. We present a follow-up to 5 years with an unexpected healing.Case Description. An 88-year-old patient underwent an immediate loading implant placement associated with the replantation of the mistakenly extracted root fragment. The shaping of the fragment was performed extraorally, and the replantation was done so that the fragment protruded above the crest margin.Conclusions and Practical Implications. The 5-year follow-up shows an uneventful healing of the implant. At 48 months, postoperative CBCT exam reports images compatible with the regeneration of the bone over the portion of root that protruded over the margin. The outcome suggests clinical implications, as the opportunity to easily shape the fragment extraorally and replant sound portion of the root (not necessary the buccal) in buccal socket with bone defect.

What Are the Complications, Success and Survival Rates for Autotransplanted Teeth? An Overview of Systematic Reviews and Metanalyses

Background: Autotransplantation is the surgical repositioning of a tooth within the same patient. It can be thought of as the controlled avulsion and re-implantation of a tooth and can be a viable alternative to other dental rehabilitation options. This review aimed to evaluate the survival rate (SR), major complications such as ankylosis rate (AR) and infection-related root resorption (RR), and overall success and failure rate (FR) in autotransplanted teeth. Methods: Six databases were accessed up to January 2021 to obtain all systematic reviews and meta-analyses (SRs and MAs). Study selection: After title and abstract reading, data extraction was performed from eligible SRs. The methodological quality was calculated for the included SRs using the risk of bias in systematic reviews (ROBIS) tool. Results: Six SRs were included in this review. The overall failure rate ranged from as low as 2.0% to 10.32%. The 1-year survival was very high (97.4–98.0%). The 5-year survival rate ranged from 81 to 98.2%. Major complications of AR ranged from 1.2 to 6.2%, and RR ranged from 2.1 to 10.4%. Conclusion: The overall findings from these SR and MA are promising; however, all the SRs include only single-arm prospective or retrospective studies, the SRs are of overall low methodological quality, and for the heterogeneity of the included SRs, well-designed comparative studies with a long-term follow-up are recommended.

Comparison of Physicochemical, Mechanical, and (Micro-)Biological Properties of Sintered Scaffolds Based on Natural- and Synthetic Hydroxyapatite Supplemented with Selected Dopants

The specific combinations of materials and dopants presented in this work have not been previously described. The main goal of the presented work was to prepare and compare the different properties of newly developed composite materials manufactured by sintering. The synthetic- (SHAP) or natural- (NHAP) hydroxyapatite serves as a matrix and was doped with: (i) organic: multiwalled carbon nanotubes (MWCNT), fullerenes C60, (ii) inorganic: Cu nanowires. Research undertaken was aimed at seeking novel candidates for bone replacement biomaterials based on hydroxyapatite—the main inorganic component of bone, because bone reconstructive surgery is currently mostly carried out with the use of autografts; titanium or other non-hydroxyapatite -based materials. The physicomechanical properties of the developed biomaterials were tested by Scanning Electron Microscopy (SEM), Dielectric Spectroscopy (BSD), Nuclear Magnetic Resonance (NMR), and Differential Scanning Calorimetry (DSC), as well as microhardness using Vickers method. The results showed that despite obtaining porous sinters. The highest microhardness was achieved for composite materials based on NHAP. Based on NMR spectroscopy, residue organic substances could be observed in NHAP composites, probably due to the organic structures that make up the tooth. Microbiology investigations showed that the selected samples exhibit bacteriostatic properties against Gram-positive reference bacterial strain S. epidermidis (ATCC 12228); however, the property was much less pronounced against Gram-negative reference strain E. coli (ATCC 25922). Both NHAP and SHAP, as well as their doped derivates, displayed in good general compatibility, with the exception of Cu-nanowire doped derivates.

Finite element analysis of stress distribution in autotransplanted molars

OBJECTIVE

The biomechanical response of an autotransplanted tooth and surrounding bone to occlusal loads is not well-known. The aim of the present study was to investigate the effect of root form and occlusal morphology on stress distribution in autotransplanted teeth and surrounding bone by using finite element analysis (FEA).

METHODS

Seven FEA models representing different autotransplanted tooth situations were generated: (a) first molar, (b) third molar, (c) root canal-treated third molar, (d) root canal-treated, ankylosed, third molar, (e) crowned third molar, (f) crowned and root canal-treated third molar, (g) root canal-treated, ankylosed, and crowned third molar. Load (200 N) was applied on the occlusal surface, parallel to the long axis of the tooth. Maximum von Mises stress values on dentin and surrounding bone were calculated for each situation.

RESULTS

Differences in stress distribution were observed among models. In ankylosed model, stress was primarily observed at the coronal region of the tooth. The stress was observed more at the coronal region of the tooth in crowned models compared with the non-crowned models. The stress distribution was homogeneous with root canal-treated and crowned autotransplanted tooth.

CONCLUSIONS

The occlusal morphology and root form of the autotransplanted tooth affected the stress in surrounding bone at the transfer site and the biomechanical response of the tooth. The stress was more homogeneous in crowned tooth and primarily observed at the coronal region, which may decrease the risk for root resorption.

CLINICAL SIGNIFICANCE

Root configuration, occlusal form and root canal treatment induce significant changes on the stress distribution on teeth and bone, including characteristic stress concentration and increased stress values. Clinicians can consider crowning autotransplanted teeth for improved stress distribution within the tooth structure.

Influence of Static Navigation Technique on the Accuracy of Autotransplanted Teeth in Surgically Created Sockets

The aim of this study was to analyse and compare the position of single-rooted autotransplanted teeth using computer-aided SNT drilling and conventional freehand (FT) drilling, by comparing the planned and performed position at the coronal, apical and angular level. Materials and methods: Forty single-root upper teeth were selected and distributed into the following study groups: A. Autotransplanted tooth using the computer-aided static navigation technique (SNT) (n = 20) and B. Autotransplanted tooth using the conventional free-hand technique (FT) (n = 20). Afterwards, the teeth were embedded into two experimental models and 10 single-root upper teeth were randomly autotransplanted in each experimental model. The experimental models were submitted to a preoperative cone-beam computed tomography (CBCT) scan and a digital impression by a 3D intraoral scan, in addition to a postoperative CBCT scan, after the autotransplantation. Datasets from postoperative CBCT scans of the two study groups were uploaded to the 3D implant planning software, aligned with the autotransplantation planning, and the coronal, apical and angular deviations were measured. The results were analysed using Student’s t-test and Mann–Whitney non-parametric statistical analysis. Results: Coronal (p = 0.079) and angular (p = 0.208) statistical comparisons did not present statistically significant differences; however, statistically significant differences between the apical deviation of the SNT and FT study groups (p = 0.038) were also observed. Conclusions: The computer-aided static navigation technique does not provide higher accuracy in the positioning of single-root autotransplanted teeth compared to the conventional free-hand technique.

Impacted maxillary canine with curved apex: Three-dimensional guided protocol for autotransplantation

INTRODUCTION

Maxillary canines play a crucial role in dental and facial aspect, arch expansion, and efficient occlusion. When surgical exposure measures cannot be executed or the patient does not agree to take the treatment, autotransplantation should be considered. The aim of this case report was to describe a novel surgical technique using virtually planned three-dimensional(3D)-printed templates for guided apicoectomy and guided drilling of the recipient site for an autotransplantation of an impacted maxillary canine with a curved apex.

METHODS

A 42-year-old male complaining of pain and increased mobility in the maxillary left primary canine came to the clinic. Autotransplantation of the impacted canine was completed using altered methods from guided implant surgery to manufacture 3D-printed templates. Following a full-thickness mucoperiosteal flap elevation, the surgical template for the guided osteotomy and apicoectomy was inserted. This 3D-printed guided allowed the clinician to perform a quick and precise removal of the curved apex, providing an atraumatic extraction of the impacted canine throughout the cyst. Three further 3D surgical guides for implant burs and a 3D replica tooth were printed to modify the recipient socket. After the final position, the tooth was semi-rigid splinted to the adjacent teeth.

RESULTS

Follow-up at 2 years showed complete regeneration of the palatal defect and remodeling of the bone surrounding the maxillary canine.

CONCLUSIONS

Digitally planned procedures can facilitate the complex execution of an autotransplantation reducing the treatment chair-time and the morbidity for the patient as well as increasing the predictability of the result.

Orthodontic Extrusion vs. Surgical Extrusion to Rehabilitate Severely Damaged Teeth: A Literature Review

The need to rehabilitate severely compromised teeth is frequent in daily clinical practice. Tooth extraction and replacement with dental implant represents a common treatment choice. However, the survival rate for implants is inferior to teeth, even if severely damaged but properly treated. In order to reestablish a physiological supracrestal tissue attachment of damaged teeth and to arrange an efficient ferrule effect, three options can be considered: crown lengthening, orthodontic extrusion and surgical extrusion. Crown lengthening is considered an invasive technique that causes the removal of part of the bony support, while both orthodontic and surgical extrusion can avoid this inconvenience and can be used successfully in the treatment of severely damaged teeth. The aim of the present narrative review is to compare advantages, disadvantages, time of therapy required, contraindications and complications of both techniques.

Splint stiffness and extension effects on a simulated avulsed permanent incisor-A patient-specific finite element analysis

BACKGROUND/AIM

Splinting is an important procedure after avulsion. However, the role of splint stiffness and extension is not fully understood. The aim of this study was to evaluate the effect of splint stiffness and extensions on the mobility and stress on an injured tooth under physiological biting load.

MATERIALS AND METHODS

Three-dimensional (3D) finite element models were created from a cone beam computer tomogram of a patient with normal occlusion. An avulsion injury of the right central incisor was created with a 1000 N load application on the palatal of the injured tooth, causing increased socket width. Splints made from four materials were tested: 0.9 mm diameter wire-composite splint (WCS1), 0.4 mm diameter wire-composite splint (WCS2), 1.0 mm diameter nylon-composite splint (NCS), and a 2 mm high by 0.2 mm thick plastic strip composite splint (PSS). Three splint extensions (involving 6, 5, and 3 teeth) were evaluated. Mobility of the avulsed tooth and the maximum principal stress distributions in the adjacent teeth were calculated.

RESULTS

The injured incisor tooth mobility was not affected by the splint extensions. The NCS and PSS stabilized the avulsed incisor but allowed, respectively, 10 and 20 times more mobility under horizontal loading than the WCS1, which inhibited most mobility, while the WCS2 allowed double the mobility compared with WCS1. The NCS and PSS allowed more tooth mobility, mainly in the extrusion direction. Splints were 2-3 times more effective in limiting mobility under intrusive loads than extrusive loads. High levels of stress were found at the base of the composite attachments in the adjacent incisors.

CONCLUSION

Splinting an avulsed tooth to one or two teeth bilaterally using a nylon splint or a plastic strip is appropriate for tooth stabilization and should be recommended over the 0.4mm wire-composite splint, while the 0.9 mm orthodontic wire is too rigid and not recommended.

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.

Use of computer-aided three-dimensional prototyping to surgically assist in tooth autotransplantation

Autotransplantation is a surgical technique in which a donor tooth belonging to the same individual is repositioned into a surgically prepared socket or site of previous tooth extraction. It is beneficial in patients with teeth affected by agenesis, trauma, significant caries, and in teeth in a non-restorable condition or prognostically poor due to other pathology. It is particularly useful in paediatric patients, as properly transplanted teeth have a vital periodontium that allows for continuous growth and functional adaptation leading to preservation of the alveolar ridge. Technological advances in rapid prototyping combined with three-dimensional (3D) computed tomography (CT) have the ability to revolutionise autotransplantation. Preoperative planning for atraumatic extraction of the donor tooth and precise preparation of the recipient site with a rapid prototyped surgical template of the donor tooth considerably reduces the extra-alveolar time, and also reduces manipulation of the root sheath and periodontal ligament, and related trauma. This case series demonstrates the efficient and successful autotransplantation of various types of teeth with the use of a rapid prototyped surgical template produced from 3D CT. The use of this technology is expected to refine the surgical technique and improve treatment outcomes.

Autotransplantation of a completely developed impacted maxillary canine: A 7-year follow-up case report

BACKGROUND

Impacted maxillary canines are likely to be extracted in adult patients once orthodontic treatment is ruled out. The missing teeth are generally replaced with dental implants.

CASE DESCRIPTION

The authors report the clinical case of a 45-year-old man who was missing the maxillary left canine for 30 years. Radiographic examination revealed that the maxillary permanent left canine was palatally impacted. The tooth was transplanted into the prepared socket on the missing tooth site and secured in the desired position with a flexible wire splint. During the 7-year follow-up, the tooth remained clinically sound with no radiographic manifestation of inflammatory or root resorption.

PRACTICAL IMPLICATIONS

The prognosis for the transplanted tooth was favorable after long-term follow-up observation. This result suggests that autotransplantation of impacted maxillary canines can be a viable treatment option for some adult patients who expect to retain their natural teeth.

Mid-Term outcomes and periodontal prognostic factors Of autotransplanted third molars: A Retrospective Cohort Study

BACKGROUND

Tooth autotransplantation is a valid method for replacing non-restorable teeth. This study aimed to assess mid-term survival and success of autotransplanted third molars and the clinical periodontal parameters and factors predicting successful periodontal attachment apparatus regeneration.

METHODS

In total, 36 patients who had undergone extraction and subsequent autotransplantation of 36 third molars using virtual planning and computer-aided rapid prototyping models by an oral surgeon and endodontist were eligible. Probing pocket depth (PPD), gingival recession (REC), clinical attachment level (CAL), pulpal and periapical healing, root resorption, and radiographic bone loss (RBL) were evaluated. Additionally, a questionnaire evaluated patient-reported outcomes.

RESULTS

The mean age of the participants was 30.2 years with a mean follow-up duration of 29.42 ± 14.56 months. The overall survival and success rates were 97.2% and 91.7%, respectively. No statistically significant differences were found in success and survival rates between open and closed apex groups or between compromised and intact buccal bone groups. No signs of pulp necrosis were found in the open apex group. Progressive replacement resorption was detected in one closed apex case. The mean PPD was 2.7 ± 0.45 mm for all transplanted teeth. REC was 0.13 mm higher in transplanted teeth than in previous hopeless teeth. CAL changes were neither clinically relevant (-0.17 ± 0.66 mm) nor statistically significant. The reported patient satisfaction was high.

CONCLUSIONS

Autotransplantation of third molars is a predictable treatment method, with a 2.5-year cumulative tooth survival and success of 97.2% and 91.7%, respectively, which were not influenced by recipient site integrity or root development.

Sport and Dental Traumatology: Surgical Solutions and Prevention

Trauma is a worldwide cause of millions of deaths and severe injuries every year, all over the world. Despite the limited extension of the oral region compared to the whole body, dental and oral injuries account for a fairly high percentage of all body traumas. Among head and neck traumas, dental and facial injuries are highly correlated to sport activities, and their management can be a real challenge for practitioners of any specialty. In case of trauma directed to periodontal structures, restorative and endodontic solutions may not be sufficient to achieve a definitive and long-lasting treatment. This article aims to illustrate surgical options and appliances to prevent dental injuries that may be available to the clinicians treating dental trauma involving oral soft and hard tissues.

Autotransplantation of a mature mandibular third molar as alternative to dental implant placement: Case report

Dental autotransplantation is defined as the movement of one tooth from one position to another, within the same patient. Autotransplantation has predictable results; in fact, many studies describe a success rate of over 90%. This article describes a case report concerning the surgical management of this surgical technique. An 18-year-old patient comes for the treatment of her left first mandibular molar (3.6) involved in decay process. An accurate radiological analysis (periapical X-ray and orthopantomographic evaluation) showed an immature left mandibular third molar (3.8), suitable as donor tooth. The mandibular first molar was extracted in an atraumatic way. The intra-alveolar septum was modified with a piezoelectric device. The tooth was slightly depressed in the socket and remained in infra-occlusion. It was stabilized by sutures and a metallic splint. Then, the autotransplanted molar was fixed with a double splinting for 4 weeks. In conclusion, the autotransplantation was followed by endodontic treatment. After 36 months of follow-up, wisdom tooth showed an improvement in clinical features in agreement with radiological examination. The success of this case can be attributed to the atraumatic surgical technique and the immature stage of the transplanted element.

European Society of Endodontology position statement: Surgical extrusion, intentional replantation and tooth autotransplantation: European Society of Endodontology developed by

This European Society of Endodontology (ESE) position statement on surgical extrusion, intentional replantation and tooth autotransplantation represents the consensus of an expert committee, convened by the ESE. A narrative review in the International Endodontic Journal (Plotino et al. 2020, international Endodontic Journal, 53, 1636-52) formed the basis for the position statement. The review provided detailed information on the background, clinical procedures and the outcome of surgical extrusion, intentional replantation and tooth autotransplantation techniques. The aim of the current statement is to summarize the best available evidence on these clinical techniques to provide appropriate clinical guidance to undergraduate and postgraduate students, dental practitioners, clinical teachers and researchers. The current position statement will be updated by the ESE periodically to reflect new evidence as it becomes available to provide the most current treatment guidance for clinical practice.

Continuous archwire technique for the correction of completely transposed maxillary incisors

Tooth transposition is an uncommon disorder related to ectopic eruption; it can be classified as complete or incomplete on the basis of the position of the crowns and roots of transposed teeth. Aligning the transposed teeth to a normal sequence is always complex and challenging, especially in patients with complete transposition. The segmented archwire technique with cantilever or loops has been used in many transposition patients; however, it requires considerable laboratory work and is sometimes uncomfortable for the patient. In this case report, we present a novel orthodontic treatment for an 8-year-old boy with unilateral complete transposition of the maxillary central incisor and lateral incisor (Mx.I2.I1). During the alignment stage, the lateral incisor was moved palatally to bypass the central incisor, using a 0.012-in nickel-titanium wire continuously. Active orthodontic treatment was conducted for 44 months, and the final outcome was esthetically and functionally effective. Stable and satisfactory results were achieved within 4 years of follow-up.

Autotransplantation of Two Immature Third Molars with the Use of L-PRF

Tooth autotransplantation is a procedure which provides the extraction of an erupted or impacted tooth and its repositioning to another site in the oral cavity. This Case Report describes a successful case of two autotransplantations of open-apex mandibular third molars in place of the hopeless first mandibular molars with the use of L-PRF in a growing patient. A 15-year-old male patient was referred to the Dental Clinic for the extractions of the two hopeless mandibular first molars. Autotransplantation was considered the best treatment option for both sites 36 and 46, because the presence of two impacted mandibular third molars (38 and 48) with an incomplete root formation. Teeth 36 and 46 were extracted and replaced with teeth 38 and 48. The patient had an uneventful healing. At follow-up visits, the two autotransplanted teeth showed physiologic mobility, absence of inflammation and discomfort, and absence of infection; probing depth values were within normal range, and the vitality tests were positive. After 2 years, the teeth in position 36 and 46 showed absence of infection and mobility, and positive pulp vitality tests and the radiographic examinations exhibited closure of the root apices as well as absence of any periapical radiolucency or root resorption. Tooth autotransplantation is a good treatment option in case of tooth loss offering an alternative to traditional or implant-supported prosthesis especially for growing patients.

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.

A retrospective analysis of autotransplanted teeth including an evaluation of a novel surgical technique

OBJECTIVES

To assess survival rates and frequency of complications for immature and mature autotransplanted teeth after at least 1 year in function.

MATERIALS AND METHODS

All consecutive patients who had undergone tooth autotransplantation between 2000 and 2018 were invited to a clinical and radiographic follow-up examination. First, survival rates were calculated on the basis of a phone inquiry. A clinical follow-up examination allowed for the calculation of the success rate, i.e., absence of any potentially adverse clinical and radiographic findings of the autotransplanted teeth. Moreover, the effect of demographic, dental, and surgical variables on survival/success was analyzed statistically.

RESULTS

Thirty-eight teeth in 35 patients were transplanted during the study period. Three teeth in 3 patients were excluded due to missing records. All other patients were successfully contacted and interviewed by phone. Out of these 35 transplants, 32 were still in function, and 3 had been extracted, yielding a 91.4% survival probability after a median follow-up of 3.4 years. Of the 32 teeth qualifying for the success analysis, 20 (62.5%) showed absence of potentially adverse findings, while 3 (9.4%) required root canal treatment (RCT). Out of the 9 mature, root-end resected transplants, 4 exhibited ongoing pulp canal obliteration, all with a single root canal. Postoperative and potentially adverse findings or failures were found more frequently in the group of mature transplants (55.6%) than immature transplants (30.4%) and for molars (72.7%) than premolars (17.6%) or canines (25%). None of the potential predictors had a statistically significant effect on survival or success.

CONCLUSION

Autotransplanted teeth yielded a satisfying midterm survival rate regardless of their stage of development. An additional, extraoral root-end resection of mature transplants may lead to rates of revascularization and postoperative pulp canal obliteration higher than the data reported on unmodified mature transplants.

CLINICAL RELEVANCE

Extraoral root-end resection of mature teeth shows promising outcomes for transplants especially with a single root canal and uncomplicated root morphology.

Evidence mapping and quality assessment of systematic reviews in dental traumatology

BACKGROUND/AIMS

Evidence mapping of systematic reviews (SRs) systematically and comprehensively identifies, organizes, and summarizes the distribution of scientific evidence in a field. The aims of this study were to delineate domains in dental traumatology (DT), evaluate the existing SRs within the domains, and identify the paucity of evidence for future research.

METHODS

Domains and sub-domains of DT were established according to the methods of qualitative research. The protocol for evidence mapping was prepared as per the guidelines of GEM and PRISMA. The search strategy was formulated using words and MeSH terms in eight databases without restriction of languages and year of publication. Gray literature, protocol registries, and references of selected articles were also searched. Duplicates were removed, and the final selection of SRs was completed. Data extraction and quality analysis using the ROBIS tool and the PRISMA checklist were performed.

RESULTS

The overall search resulted in 64 SRs from 1999 to 2020 with 44 published in last six years. The highest number of SRs had been performed in the Prognostic domain (n = 19) followed by the domains of Epidemiology (n = 15), Therapeutics (n = 10), Oral Biology (n = 7), Diagnostics (n = 6), Preventive (n = 5), and Research Methods (n = 2). Within each domain, there were variabilities in the number of reviewers, a priori protocols, search limitations, risk of bias methods, and meta-analysis. Of the SRs, including 4 Cochrane reviews, 28.4% were inconclusive. A low risk of bias was found in 48.4% of the SRs. Among the registered and ongoing SRs, six were from the domain of epidemiology, two in the domain of therapeutics, five from prognostics, and one each in the domains of prevention and research methods.

CONCLUSION

The SRs in DT could be mapped in seven domains with variabilities in the methods. The majority had an a priori registered protocol and a low risk of reporting errors. Within the Epidemiology and Preventive domains, SRs were present in all the sub-domains with the majority demonstrating low-risk of bias (ROB). The domain of prognosis had SRs in most sub-domains but with a high ROB. Insufficient numbers of SRs were present in most sub-domains of the Diagnostics, Therapeutics, Research Methods and Oral Biology domains.

Survival and success of autotransplanted impacted maxillary canines during short-term follow-up: A prospective case-control study

OBJECTIVES

This prospective clinical trial aimed to examine the predictability of maxillary canine transplantation as compared to biological canine eruption. Additional objectives were to examine hard and soft tissue outcomes, including aesthetic outcome compared to outcomes with the contralateral canines.

SETTINGS AND SAMPLE POPULATION

The sample comprised 17 consecutively transplanted maxillary canines in 17 patients (mean age at surgery, 18 years; range, 11-29 years). Minimal follow-up time was 12 months post-transplantation. Clinical and radiographic parameters were recorded for the transplanted and contralateral canines, showing a natural eruption pattern.

MATERIAL AND METHODS

The Maxillary Canine Aesthetic Index (MCAI) and the Autotransplanted Maxillary Canine Radiological Index (AMCRI) were scored for all upper canines. Successful transplantation was considered as the absence of pathology during intermittent clinical and radiographic controls and a good-to-excellent outcome compared to the contralateral biological erupted canine, as defined by the MCAI and AMCRI.

RESULTS

The mean follow-up period was 28 months (±9; range, 12-40 months). The overall survival rate was 100%, and the success rate reached 68% at 1 year post-operatively. Significant predictors of success were the extra-oral time during transplantation, amount of damage to the root surface, quality of surrounding tissues and immediate post-operative oral hygiene.

CONCLUSION

Standardized measurements demonstrated clinically satisfactory outcomes with maxillary canine autotransplantation compared to outcomes with the contralateral canine during 1-3 years of follow-up. The potential predictors of success identified here should be confirmed with long-term follow-up studies.

Autotransplanted premolars with incomplete root formation in a growing patient with multiple missing teeth

A boy aged 8 years 11-months with 4 missing teeth in his mandibular arch and with a skeletal Class II pattern was treated with autotransplantation of developing premolars from his maxillary arch with the aid of temporary skeletal anchorage devices. The active treatment duration was 25 months. After treatment, he had a normal occlusion, and his profile was improved. Posttreatment records at 12 months showed stable occlusion and successfully autotransplanted premolars.