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.

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.

Survey of patients and parents on the autotransplantation of developing premolars to replace traumatised maxillary incisors.

BACKGROUND/AIM: There is a little research on the experiences and opinions of patients who have had autotransplantation of a tooth. The aim of the study was to assess the satisfaction of patients who underwent the autotransplantation of a developing premolar to replace a traumatised maxillary central incisor. MATERIALS AND METHODS: Eighty patients (with a mean age of 10.7-years) and 32 parents were surveyed with 13 and 7 questions, respectively, to determine their opinions about the surgery, post-operative period, orthodontic and restorative treatment they had received. RESULTS: Patients and their parents were very satisfied with the outcomes of the autotransplantation treatment. The majority of patients and all parents declared that they would choose this treatment again if needed. Patients who already had aesthetic restoration of the transplanted toothscored significantly better in position, similarity to other teeth, alignment and aesthetics, when compared to patients before restoration of the premolar to the shape of incisor. Patients after orthodontic treatment considered the alignment of the transplanted tooth between the adjacent teeth as better when compared to patients before or during their orthodontic treatment. CONCLUSIONS: Autotransplantation of developing premolars to replace traumatized maxillary central incisors proved to be a well-accepted treatment option. A delay of restoration of the transplanted premolars to the shape of the maxillary incisors did not have a negative impact on the satisfaction with the treatment.

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.

Periodontal ligament preloading and rapid prototyping of the donor tooth in the autotransplantation of premolars with complete root formation.

This case report describes the successful orthodontic treatment of an 11-year-old girl with skeletal Class II malocclusion and congenitally missing mandibular second premolars. To resolve her upper lip protrusion and restore the missing mandibular premolars, extraction of the maxillary first premolars and subsequent autotransplantation of the extracted premolars onto the site of the missing mandibular second premolars were performed. To ensure the success of the autotransplantation and subsequent orthodontic treatment, an orthodontic force was preapplied on the donor teeth, and the recipient sockets were prepared with the aid of replica teeth. Thereafter, comprehensive orthodontic treatment was performed to close the extraction space in the maxilla and align the mandibular dentition, including the transplants. The patient achieved a functional occlusion with an improved facial profile. Results of the orthodontic treatment and autotransplantation were stable during the 5-year follow-up. On the basis of this report, a management protocol for a biomechanically enhanced autotransplantation procedure was suggested. This approach would enable an effective treatment procedure, thereby increasing the usefulness of autotransplantation.

Patient with asymmetric multiple hypodontia treated with autotransplantation of 2 premolars.

Tooth autotransplantation is performed in patients with congenitally missing teeth and those with traumatic tooth loss. We report a course of edgewise treatment of a girl with multiple congenitally missing teeth and residual features of ectodermal dysplasia, who was treated with autotransplantation of 2 premolars with developing roots. She was 8 years old at the beginning of the treatment. No signs of inflammation, root resorption, or pulp symptoms were observed during the 2.5 years of edgewise treatment after autotransplantation. Cervical external root resorption was detected 31 months postoperatively in 1 transplanted tooth (maxillary first premolar), and the same problem occurred in the other transplanted tooth (mandibular second premolar) 2 years later. Root canal treatment was immediately undertaken and resulted in inhibition of further pathology. Consequently, the survival of both transplanted teeth was achieved. The orthodontic treatment that included intervals related to diagnosis and treatment of root resorption of the transplanted premolars is described in detail.

Autotransplantation of premolars and space closure in a patient with inflamed sinuses.

Congenital absence of permanent teeth can be treated by means of dental implants and prosthetics. Tooth autotransplantation is an alternative in growing patients because continued eruption of the transplanted tooth and associated alveolar bone growth can be expected. This clinical report presents tooth autotransplantation in a 10-year-old boy with chronic maxillary rhinosinusitis, diagnosed by the department of otorhinolaryngology. The patient's mandibular second premolars were transplanted to a congenitally edentulous maxillary premolar region. There was insufficient alveolar bone during transplantation because of pneumatization, but normal root development with vertical alveolar bone growth was observed during a 3-year follow-up. Healing of the transplant in the right side without closing of the apex and without signs of obliteration after 4 years is exceptional.

The evaluation of the transport medium for extracted premolars prior to cryopreservation: a systematic literature review.

Prior to cryopreservation, a tooth is transported from a contaminated oral environment to the tooth bank. Our objective was to identify all studies reporting or investigating a transport protocol prior to the cryopreservation of teeth, in terms of decontamination of the subjects. The systematic literature search (1970-2017) was based on MEDLINE via PubMed, Web of Science and the Cochrane Library. The reference lists of the included studies and the Science Citation Index were used for hand searching (snowballing). Only studies reporting the transport conditions of the transplant were included. Language restrictions for English, Dutch or French were applied. The search led to 14 eligible studies. Almost all studies were laboratory studies, so the methodological quality of evidence was low. The majority of the included studies was performed by only five different research groups and the number of subjects varied between 1 and 120 teeth. In general, the teeth were stored in a tissue culture medium supplemented with fetal calf serum and/or different combinations of antibiotics and/or antimycotics. The teeth were transported cooled (4 °C) or at room temperature, for a period of time not exceeding 24 h. Only three studies reported the irrigation of the teeth with phosphate buffered saline prior to the transport. The optimisation of the decontamination during transport was investigated in three studies (from 1971, 1980 and 1982). It was concluded that the literature on this topic is scarce, and the decontamination protocol for teeth, prior to cryopreservation has not been validated recently.

Tooth autotransplantation as a pillar for 3D regeneration of the alveolar process after severe traumatic injury: A case report.

In dental traumatology, the loss of teeth and the supporting alveolar bone in children compromise the proper development of maxillofacial structures and also limit the solutions that can be offered. In this case report, multidisciplinary management is described of a child with a significant loss of alveolar bone and associated teeth due to a traffic accident at 8 years of age. The management involved staged teeth autotransplantation into surgically prepared sites with bone expanders, orthodontic treatment and dental implants. The 3D regeneration of the alveolar process was successfully stimulated by teeth autotransplantation. At the 4-year follow-up visit, evaluation of the autotransplanted teeth and the implants indicated a successful outcome for the patient.

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

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

Histomorphometric Analysis of Contaminated Autogenous Tooth Graft Materials After Various Sterilization.

PURPOSE: The purpose of this study was to evaluate histomorphometrically contaminated autogenous tooth graft materials, which were resterilized. MATERIALS AND METHODS: The intentional defects (diameter: 8 mm, depth: 4 mm) were formed around implant fixture on the iliac crest of 6 mongrel dogs. Autogenous tooth graft materials were made by extracted premolars. After the contamination of the tooth materials, graft procedure was performed; no contaminated group (control group), contaminated groups (nonsterilization group [group 1], ethylene oxide [EO] gas group [group 2], and autoclave group [group 3]). The bone-to-implant contact (BIC) and the new bone formation rate (NBFR) were evaluated after sacrifice. RESULTS: The BIC and NBFR of groups 1 and 3 were significantly lower than the control group after 4 weeks. The BIC and NBRF of group 3 were significantly lower than the control group after 8 weeks. However, the BIC and NBRF of group 2 was not significantly different comparing with the control group after 4 and 8 weeks. CONCLUSION: Sterilization using EO gas may be more favorable than high-pressure sterilization in cases the reuse of contaminated autogenous tooth graft materials.

Management of severely impacted mandibular canines and congenitally missing mandibular premolars with protraction of autotransplanted maxillary premolar.

Transmigrated mandibular canines increase the treatment complexity in terms of both anchorage and biomechanical planning. Additionally, a Class II malocclusion with a deep overbite and associated dental anomalies such as hypodontia can further increase the treatment complexity and the overall treatment time. This case report describes the successful interdisciplinary treatment of a patient, aged 12.5 years, with transmigrated and severely impacted mandibular canines and congenitally missing mandibular second premolars. The transmigrated mandibular right canine was extracted, and a maxillary second premolar was autotransplanted to the missing mandibular right second premolar site with the aid of a stereolithographic donor tooth replica fabricated with 3-dimensional cone-beam computed tomography and a rapid prototyping technique. Furthermore, the autotransplanted tooth was protracted by 4 to 5 mm to close the space caused by the extraction of the mandibular right canine. The impacted mandibular left canine was orthodontically guided into its normal position in the arch. Good esthetic outcome and functional occlusion were achieved.

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

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

Premolar transplantation to replace a missing central incisor.

During childhood, the anterior maxilla is susceptible to injury, and the loss of incisors is one of the most serious injuries. In many cases, autotransplantation is the best alternative for children who lose an incisor during the growth phase. This case report describes the treatment of a boy who had a traumatic injury when he was 8 years old that resulted in avulsion of the maxillary right central incisor. When he sought treatment at age 10, the space was lost as was bone in the incisor region. Because he lacked space in the mandibular arch for proper tooth alignment, extractions were planned. One extracted premolar was transplanted into the space of the missing maxillary incisor area. The posttreatment results were good, and follow-up records 7 and 9 years after treatment showed healthy periodontal support and cortical bone gain in the transplanted tooth's buccal area.

Nasomaxillary hypoplasia with a congenitally missing tooth treated with LeFort II osteotomy, autotransplantation, and nickel-titanium alloy wire.

INTRODUCTION: In some skeletal Class III adult patients with nasomaxillary hypoplasia, the LeFort I osteotomy provides insufficient correction. This case report describes a 20-year-old woman with a combination of nasomaxillary hypoplasia and a protrusive mandible with a congenitally missing mandibular second premolar. METHODS: We performed a LeFort II osteotomy for maxillary advancement. Autotransplantation of a tooth was also performed; the donor tooth was used to replace the missing permanent tooth. To increase the chance of success, we applied light continuous force with an improved superelastic nickel-titanium alloy wire technique before extraction and after transplantation. RESULTS: The patient's profile and malocclusion were corrected, and the autotransplanted tooth functioned well. The postero-occlusal relationships were improved, and ideal overbite and overjet relationships were achieved. CONCLUSIONS: The methods used in this case represent a remarkable treatment.

Comprehensive treatment approach for bilateral cleft lip and palate in an adult with premaxillary osteotomy, tooth autotransplantation, and 2-jaw surgery.

We report the successful treatment of a woman aged 25 years 3 months with bilateral cleft lip and palate. She had a protruded premaxilla, collapsed posterior segments, wide alveolar defects with oronasal fistulae, a congenital missing tooth, and severe facial asymmetry with a transverse occlusal cant. The comprehensive treatment approach included (1) premaxillary osteotomy combined with alveolar bone grafting to reposition the premaxilla and minimize the wide alveolar defects, (2) autotransplantation of a tooth with complete root formation to the grafted bone region to restore the missing tooth without a prosthesis such as a dental implant or bridge, and (3) 2-jaw surgery to improve facial asymmetry. The premaxillary osteotomy was managed orthodontically, in combination with bone grafting. The results suggest that surgical orthodontic treatment with tooth autotransplantation might be useful to improve the occlusion and facial esthetics without prosthetics.

The prospective study of autotransplanted severely impacted developing premolars: periodontal status and the long-term outcome.

AIMS: To determine the periodontal status and long-term outcomes of the surgical treatment of severely impacted developing premolars. MATERIALS AND METHODS: Nine impacted and adversely angulated second premolars (four maxillary and five mandibular) were autotransplanted from their initial position to the ideal position within the arches (trans-alveolar autotransplantation). The mean age of patients at the time of the surgery was 13 years and 9 months (from 11 years and 5 months to 17 years) and the mean observation period was 5 years (from 2 to 8 years and 6 months). Naturally erupted, contralateral premolars in the same patients were used for comparison. RESULTS: The survival and success were 100%. Autotransplanted premolars did not differ statistically from their controls, except for having a wider zone of keratinized gingiva (mean difference 0.625 mm), increased probing depths (from 0.04 to 0.49 mm depending on the probing location), pulp canal obliteration and a slightly higher crown-to-root ratio (C/R = 0.71 for transplanted teeth and C/R = 0.6 for control teeth respectively). CONCLUSIONS: Trans-alveolar transplantation of severely impacted and adversely angulated developing premolars is a viable treatment option and an attractive alternative to other treatment modalities.

Orthodontic treatment combined with tooth transplantation for an adult patient with a missing mandibular first molar: long-term follow-up.

A Japanese woman, age 29 years 8 months, had a missing mandibular left first molar, bimaxillary dentoalveolar protrusion, and crowding. She had a skeletal Class II relationship and a long face with a steep mandible. She had previously undergone root canal treatment for the mandibular right second premolar, and the mandibular left third molar was impacted. The maxillary left first premolar was extracted for autotransplantation to the mandibular left first molar region. After confirmation of a favorable prognosis for the transplanted tooth, the maxillary right first premolar, the mandibular right second premolar, and the impacted mandibular left third molar were extracted for orthodontic treatment. The active orthodontic treatment period was 32 months. The patient returned for follow-up records 12 years 7 months after the active treatment, and her facial profile and occlusion were well maintained. At 13 years 9 months after transplantation, no abnormalities were observed with the transplanted tooth in the radiographic and clinical evaluations.

Premolar transplantation in a patient with solitary median maxillary central incisor syndrome.

This case report describes the orthodontic treatment of an 11-year-old girl with solitary median maxillary central incisor syndrome, a presumed microform of holoprosencephaly. Because both second premolars were missing in the maxilla, deciduous molar extraction and orthodontic space opening were performed, moving the solitary median maxillary central incisor electively off-center. A mandibular second premolar was transplanted to replace the missing incisor. The resulting spaces could be orthodontically closed in both arches. Prosthodontic reshaping of the transplanted tooth after debonding completed the dental treatment.

Orthodontic retraction of autotransplanted premolar to replace ankylosed maxillary incisor with replacement resorption.

This case report describes the successful treatment of an adult with lip protrusion and a previously traumatized maxillary central incisor that had experienced replacement root resorption. An extracted premolar was transplanted into the incisor space and retracted orthodontically. Autotransplantation was successful with complete root formation and, combined with orthodontic treatment, provided a satisfying esthetic outcome.