Tooth autotransplantation with adjunctive application of enamel matrix derivatives using a digital workflow: A prospective case series.

OBJECTIVES: Digital protocols and bioactive materials may reduce complications and improve tooth autotransplantation (ATT) success and survival rates. This prospective study assesses the performance of a fully digital autotransplantation protocol of close-apex molars with the adjunctive application of Enamel Matrix Derivatives (EMD). METHODS: Twelve adult patients with 13 hopeless molar teeth were replaced with autotransplantation of closed apex third molars. Outcomes, including success and survival rates, clinical, endodontic, radiographic, patient-reported outcome measures (PROMs), and digital image assessments, were conducted over a two-year follow-up period. RESULTS: Survival and success rates were 100% and 91.2%, respectively, with no progressive inflammatory or replacement root resorption (ankylosis) except for one tooth presenting radiographic furcation involvement. A significant probing depth reduction of 2.4 ± 2.58 mm and CAL gains of 2.8 ± 3.03 mm were observed in transplanted teeth compared to the hopeless receptor teeth. Radiographic bone levels remained stable throughout the study period (-0.37 ± 0.66 mm), and digital image assessments showed minimal alveolar ridge width changes (-0.32 to -0.7 mm) and gingival margin changes (-0.95 to -1.27 mm) from baseline to last visit. PROMs indicated very high patient satisfaction. CONCLUSION: The use of a digital ATT protocol with adjunctive use of EMD in closed-apex third molars demonstrated promising short-term high success and survival rates. Additionally, this type of therapy adequately preserves the dimensions of the alveolar ridge in the receptor site. CLINICAL SIGNIFICANCE: This is the first prospective clinical study examining the effect of a digital tooth autotransplantation protocol combined with the application of EMD. It demonstrates that this approach is an effective treatment for replacing hopeless teeth and also validates the digital assessment of ATT alveolar ridge preservation at the recipient site.

Effect of 3D printed replicas on the duration of third molar autotransplantation surgery: A controlled clinical trial.

BACKGROUND/AIM: This study aimed to develop a protocol that combines cone-beam computed tomography (CBCT), software, and 3D printing to design 3D replicas for tooth autotransplantation. The goal was to evaluate the impact of this approach on the extraoral time of the donor teeth and the total surgical time, thereby enhancing surgical efficiency and outcomes. MATERIALS AND METHODS: A non-randomized trial (protocol 10.1186/ISRCTN13563091) was conducted at Riga Stradins University, enrolling 46 patients (13-22 years old) who required molar extraction and possessed a non-erupted third molar. The patients were sequentially assigned to a 3D replica group (24 patients) or a control group (22 patients). The primary outcome measured was the extra-alveolar time of the donor tooth, and the secondary outcome was the total duration of surgery. Both were assessed using a sample size capable of detecting a 10-min difference. A generalized linear model adjusted for various factors was used to test for significant time differences (p < .05) between the groups. RESULTS: Forty-six patients were included in this analysis. The effect of using 3D replicas was not statistically significant and was associated with a decrease in the extraoral time of the donor tooth in seconds (ß = -9.35, 95% CI [-40.86, 22.16]). For the total surgical time in minutes, the use of 3D replicas had a statistically significant impact, reducing the operation duration in minutes (ß = -13.42, 95% CI [-24.50, -2.34]). No early complications were observed in either group, with all teeth present at 3-4 weeks post-surgery. CONCLUSIONS: The integration of 3D printing technology can enhance the efficiency of autotransplantation surgeries, primarily by reducing surgical time.

Autotrasplante Digital: Reporte de Caso Clínico / Digital Autotransplantation: Clinical Case Report

El trasplante dentario autólogo se define como el po-sicionamiento de una pieza dentaria autóloga en un alvéolo post extracción o en un lecho formado qui-rúrgicamente. Actualmente, siguiendo los criterios de selección adecuados y una técnica quirúrgica mi-nuciosa, resulta una alternativa terapéutica ideal en ciertos pacientes. La gran variabilidad de implantes dentales y alternativas de injertos óseos han resuelto el problema de sustituir una pieza dentaria perdida. En los pacientes en crecimiento o con potencial de crecimiento residual del proceso alveolar, se pone en evidencia el inconveniente que puede representar la colocación de implantes, lo que hace necesario ree-valuar la conservación de dientes y la utilización de técnicas quirúrgicas clásicas. Las tasas de éxito de los autotrasplantes autólogos han aumentado con el tiempo, alcanzando cifras mayores al 90%. En el pre-sente artículo se reporta un caso clínico de autotras-plante dentario con planificación digital y una réplica tridimensional de la pieza a trasplantar (AU)

Autologous tooth transplantation is defined as the positioning of an autologous tooth in a post-extraction socket or in a surgically formed bed. Currently, following the appropriate selection criteria and a meticulous surgical technique, it is an ideal therapeutic alternative in certain patients. The great variability of dental implants and bone graft alternatives have solved the problem of replacing a lost tooth. In growing patients or with potential for residual growth of the alveolar process, the inconvenience that implant placement can represent is evident, which makes it necessary to reevaluate tooth conservation and the use of classic surgical techniques. The success rates of autologous autologous transplants have increased over time, reaching figures greater than 90%. This article reports a clinical case of dental autotransplantation with digital planning and a three-dimensional replica of the piece to be transplanted (AU)

Autotransplantation of teeth as an alternative to dental implantation.

Autotransplantation of teeth is a considerable option for tooth replacement in adults who are to undergo orthodontic treatment. Being compared with dental implantation, this procedure is more preferable as a grafted tooth functions as a normal one. In this case report, we describe successful autotransplantation of the third molar with complete root formation. To provide better adaptation of the donor tooth, we used its preoperatively printed replica. The donor tooth was immediately placed to the recipient site and splinted for 28 days. Endodontic treatment was initiated 2 weeks after transplantation. Clinical and radiographic findings at 6 and 12 months of follow-up are compared with the results described in the literature.

Technology at the service of surgery in a new technique of autotransplantation by guided surgery: a case report.

BACKGROUND: The aim of this case report was to use a surgical technique for autotransplantation of tooth using virtually planned 3D printed surgical templates for guided osteotomy preparation of the recipient of donor tooth. CASE PRESENTATION: An 18-year-old male patient received autotransplantation of the right mandibular third molar to replace an included right second molar. This procedure was based on guided implant surgery methods by superimposition of DICOM files and 3D data sets of the jaws. In order to design a 3D-printed template with the aid of a fully digital workflow; the third molar was conserved in PRGF during the surgical procedure and the tooth socket was prepared with a template and the help of a 3D-printed donor tooth copy in order to prevent iatrogenic damage to the donor tooth. This template and replica were manufactured using 3D-printing techniques. The transplanted tooth was placed in infra-occlusion and fixed with a suture splint and root canal therapy was performed 15 days later. The intervention was be accomplished by performing preplanned virtual transplantations with guided osteotomies to ensure accurate donor tooth placement in the new recipient site. The 24 months follow-up showed physiological clinical and radiologic results compatible with healing periradicular tissues. CONCLUSIONS: This approach enables the planning and production of a 3D printed surgical template using the latest diagnostic methods and techniques of guided implant surgery. These accurate virtually predesigned surgical templates and printed analogues of the donor tooth could facilitate autotransplantation, ensuring an atraumatic surgical protocol.

Virtual Simulation of Autotransplantation Using 3-dimensional Printing Prototyping Model and Computer-assisted Design Program.

This case report describes an innovative virtual simulation method using a computer-aided rapid prototyping (CARP) model and a computer-aided design (CAD) program for autotransplantation of an immature third molar.A compromised left mandibular second molar (#18) was extracted and replaced by autotransplantation using an immature left mandibular third molar (#17). In order to minimize the surgical time and injury to the donor tooth, a virtual 3-dimensional (3D) rehearsal surgery was planned. Cone-beam computed tomographic images were taken to fabricate the 3D printing CARP model of the donor tooth and tentative extraction socket. Subsequently, both CARP models were scanned with an intraoral scanner (CEREC Omnicam; Dentsply Sirona, Bensheim, Germany) followed by superimposition and virtual simulation of osteotomy preparation of the recipient alveolus using the CAD analysis program. During the surgery, the extraction socket was precisely prepared according to the predetermined location and dimensions via virtual simulation rehearsal surgery using CAD analysis. The donor tooth was atraumatically transplanted into the prepared socket. The follow-up examination revealed that the root developed with a normal periodontal ligament and lamina dura.Virtual simulation using a 3D printing CARP model and a CAD program could be clinically useful in autotransplantation of an immature third molar by ensuring an atraumatic and predictable surgery.

Dental autologous transplantation: technique optimization of immediate step by step for clinical practice

Dental transplantation is a treatment used to replace a missing tooth with another tooth. It is autogenous when it comes from the same individual. The aim of this article is to discuss the surgical protocol and present a case study to optimize the technique for the general dental practitioner. The first molars are the first permanent teeth to erupt during infancy, they are teeth most commonly lost among the permanent dentition. The third molars are best suited for this treatment, the treatment should be undertaken as soon as possible, as the patient ages there is decrease in the mesenchymal cells. Whenever possible, the pericoronal bag should be preserved in the removal of the tooth germ or tooth formed. We present a case where the tooth was placed in the receiver socket, taking into account the anatomical orientation of its faces, in infra-occlusion. The contention was made by silk and point "X" on the occlusal graft and fixed to the adjacent teeth with light-cured resin. Transplantation is an excellent alternative for treating the loss of one molar, especially in young patients.

Outcome of Autotransplantation of Mature Third Molars Using 3-dimensional-printed Guiding Templates and Donor Tooth Replicas.

Autotransplantation exhibits a number of advantages compared with other treatment options (ie, dental implants or fixed partial prostheses), such as greater resistance to occlusal loading, maintenance of the periodontal ligament and surrounding bone, and the potential for better esthetics. The aim of this study was to determine clinical outcomes for autotransplanted teeth with complete root formation using 3-dimensional-printed guiding templates and tooth replicas. Twenty-seven third molars with completely formed roots were autotransplanted. Each donor tooth and recipient site were examined clinically and radiographically (periapical radiographs). A selective cone-beam computed tomographic scan was taken of each donor tooth and recipient site. The images of the selected donor teeth were segmented and saved as stereolithography files. Similar to virtual planning of dental implants, correct angulation, rotation, and accurate positioning of the donor teeth were predefined using the stereolithography files. According to the virtually defined positions and dimensions of the donor teeth, 3-dimensional guiding templates and donor tooth replicas were printed. All autotransplantations were performed according to 1 treatment protocol and surgical technique. In 22 of the 24 transplanted teeth, no inflammation occurred during the healing period. At 2 years, no pathologic radiolucency or tooth resorption was observed in the 22 donor teeth. The autotransplanted teeth fulfilled the success criteria in 22 cases for a 91.7% success rate. Digital planning could potentially provide an accurate alternative to current autotransplantation techniques.

Autotransplantation of Third Molars With Platelet-Rich Plasma for Immediate Replacement of Extracted Non-Restorable Teeth: A Case Series.

PURPOSE: The aim of this study was to examine the use of platelet-rich plasma (PRP) for autotransplantation of third molars as a successful technique to provide immediate tooth structure for space maintenance and masticatory function when premature loss of a permanent tooth occurs and other dental restorative options are not indicated. MATERIALS AND METHODS: This study included 10 healthy patients 10 to 17 years of age with at least 1 immature third molar (one to two thirds of root formation) used to replace extracted non-restorable teeth. Eleven third molars were transplanted and adapted to sockets of the extracted teeth with the adjunct of PRP. Transplanted teeth were stabilized to the adjacent teeth using orthodontic wires and dental composite for 1 month. Patients were followed for 1 year. Function, tooth vitality, root development, and periodontal health were recorded. RESULTS: All 10 patients had functioning asymptomatic transplanted teeth, with physiologic tooth mobility after splint removal at 1 month and after 1 year. All 10 patients had positive tooth vitality (by cold test) at 3, 6, and 12 months; all transplants showed positive root development (average growth, 2.01 mm) confirmed and measured using periapical radiographs. No patients required root canal therapy at any point in the study. Periodontal assessments were performed at the scheduled follow-up appointments with circumferential periodontal probing. Periodontal health was maintained because probing depths were shallower than 4 mm during the 1-year follow-up. CONCLUSION: Autotransplantation of immature third molars with PRP shows excellent results and should be considered a viable option for premature loss of permanent molars. PRP might have other advantages, such as root promotion and neurosensory development.

Replacing Heavily Damaged Teeth by Third Molar Autotransplantation With the Use of Cone-Beam Computed Tomography and Rapid Prototyping.

This article describes the autotransplantation of third molars to replace heavily damaged premolars and molars. Specifically, this article reports on the use of preoperative cone-beam computed tomographic planning and 3-dimensional (3D) printed replicas of donor teeth to prepare artificial tooth sockets. In the present case, an 18-year-old patient underwent autotransplantation of 3 third molars to replace 1 premolar and 2 molars that were heavily damaged after trauma. Approximately 1 year after the traumatic incident, autotransplantation with the help of 3D planning and rapid prototyping was performed. The right maxillary third molar replaced the right maxillary first premolar. The 2 mandibular wisdom teeth replaced the left mandibular first and second molars. During the surgical procedure, artificial tooth sockets were prepared with the help of 3D printed donor tooth copies to prevent iatrogenic damage to the actual donor teeth. These replicas of the donor teeth were designed based on the preoperative cone-beam computed tomogram and manufactured with the help of 3D printing techniques. The use of a replica of the donor tooth resulted in a predictable and straightforward procedure, with extra-alveolar times shorter than 2 minutes for all transplantations. The transplanted teeth were placed in infraocclusion and fixed with a suture splint. Postoperative follow-up showed physiologic integration of the transplanted teeth and a successful outcome for all transplants. In conclusion, this technique facilitates a straightforward and predictable procedure for autotransplantation of third molars. The use of printed analogues of the donor teeth decreases the risk of iatrogenic damage and the extra-alveolar time of the transplanted tooth is minimized. This facilitates a successful outcome.

Autotrasplante de un tercer molar inmaduro: reporte de un caso / Autotransplantation of an immature third molar: a case report

El autotrasplante se refiere a la transferencia quirúrgica de un dientede una posición a otra en el mismo individuo dentro de los alveolosde dientes extraídos o sitios preparados quirúrgicamente. El autotrasplante de un diente inmaduro puede ser una opción para reemplazarmolares con caries extensas en pacientes jóvenes como una alternativaal reemplazo de dientes con prótesis fi ja o implanto-soportada. Es unprocedimiento clínico con un índice de éxito de 98 por ciento cuando los dientes son trasplantados traumáticamente y el tiempo extraoral se mantiene al mínimo. El estado de desarrollo del diente determina ampliamente el potencial de reparación pulpar después del autotrasplante. Para obtener una pulpa vital en un diente autotrasplantado el foramen apical no debe medir menos de1 mm de diámetro. El área receptora debe ser 1-2 mm más grande y profunda que las medidas de las raíces donadoras parapreservar las células del ligamento periodontal, un óptimo contacto entreambas estructuras puede mejorar el suministro sanguíneo y los nivelesde nutrición de las células del ligamento periodontal, el cual puedeincrementar el éxito del autotrasplante. En este artículo se presenta un caso exitoso de autotrasplante de tercer molar inmaduro.

Autotransplantation refers to the surgical transfer of a tooth fromone position to another in the same individual onto extracted toothsockets or surgical prepared recipient sites. Autotransplantation of animmature teeth can be an option to replace extensive decayed molarsin young patients as an alternative to immediately replacing teeth withfi xed or implant-supported prosthesis. Autotransplantation is a clinicalprocedure with a success rate of 98% when teeth are transplantedatraumatically and when the extraoral time is keep to a minimum.The developmental stage of the tooth highly determines the potentialof pulpal repair after transplantation. To obtain a vital pulp in anautotransplanted tooth, the apical foramen should not be smaller than1 mm in diameter. The recipient area must be 1-2 mm larger and deeperthan the measurements of the donor roots to preserve the periodontalligament cells, an optimal contact between both structures can improvethe blood supply and the level of nutrition to the periodontal ligamentcells, which can increase the success of autotransplantation. In thispaper, we report one case of successful autotransplantation of animmature third molar.

Autotransplantation of third molars with completely formed roots into surgically created sockets and fresh extraction sockets: a 10-year comparative study.

The aim of this study was to analyze and compare the long-term clinical outcomes of mature third molar autotransplantation in surgically created sockets and fresh extraction sockets with regard to survival and functional success rates. A total of 65 third molars with completely formed roots were autotransplanted in 60 patients (average age 33.1 years). Thirty-six of the teeth were autotransplanted into surgically created sockets with or without guided bone regeneration (GBR; delayed autotransplantation), while 29 were autotransplanted into fresh extraction sockets (immediate autotransplantation; control group). All patients underwent annual clinical and radiographic examinations (average follow-up 9.9 years, range 7-13 years). The survival rates for the control, GBR, and no GBR groups were 93.1%, 95.2%, and 80.0%, respectively, with no significant differences among the groups. There were no statistically significant differences among the groups with regard to the frequency of inflammatory root resorption or root ankylosis. Age did not influence the clinical outcomes. These results suggest that the autotransplantation of third molars with completely formed roots is effective in both surgically created and fresh extraction sockets and provides a high long-term success rate if cases are selected and treated appropriately.

Impacted third molar transplantation on the malpracticed extraction socket.

Autotransplantation with or without endodontic therapy is regarded as an alternative treatment option for the replacement of missing teeth. A primary responsibility of a maxillofacial surgeon is to reverse any malpractice to promote successful outcomes and improve the patient's quality of life. This paper presents a malpractice case of incorrect extraction of the lower second molar instead of the impacted third molar. A simple technique of transplanting the impacted third molar to the site of the extracted second molar is introduced by a maxillofacial specialist in Ghana. By making an intentional root socket and fixation without using additional appliances, a novel second molar was achieved with complete recovery. This patient was followed after transplant for a four-year period with the best satisfaction. FUNDING: A grant of the Korean Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea. (HI15C0689).

A New Method Using Autogenous Impacted Third Molars for Sinus Augmentation to Enhance Implant Treatment: Case Series with Preliminary Results of an Open, Prospective Longitudinal Study.

PURPOSE: This prospective longitudinal study reports on the results in patients given autologous tooth material for augmentation in a sinus elevation procedure. MATERIALS AND METHODS: Six patients with inadequate bone supply for augmentation in the maxillary posterior tooth region and at least one impacted maxillary third molar underwent sinus elevation surgery with lateral access using the particulate tooth material. One of the patients received four implants during the same session, while the other patients had a total of 15 implants placed after a healing phase of an average 5.5 months. Drill cylinders collected from the implant bed during the procedure were subjected to histologic/immunohistochemical evaluation. RESULTS: All six patients showed normal and unobtrusive postoperative healing, having undergone prosthetic restoration up to 5 years before. The average peri-implant probing pocket depth after a period of up to 5 years ranged between 1.86 mm (mesial and lingual) and 2.07 mm (distal and buccal). No bleeding could be triggered with any of the peri-implant probes. The average peri-implant bone resorption measured during the first year was up to 0.63 mm, with the lowest being 0 mm and the maximum 2.9 mm. Peri-implant bone remained stable for the follow-up time of up to 5 years. Histologically, six biopsy specimens collected from five patients showed osteoconductive osteogenesis with encapsulation of tooth enamel and dentin portions and partial resorption of the tooth components. Cementum shares were no longer discernible. Immunohistochemical assessment showed intense new vessel formation that could be observed in the area of loose stroma of reorganized tissue in the augmented area. CONCLUSION: Within the limits of these preliminary results and with adequate consideration of the small number of patients included, the use of autogenous crushed tooth material from impacted third molars may represent an alternative augmentation material for use in sinus elevation procedures.

Vertical Bone Growth after Autotransplantation of Mature Third Molars: 2 Case Reports with Long-term Follow-up.

Tooth autotransplantation is a viable treatment option for tooth replacement when a suitable donor tooth is available. These case reports described significant vertical bone growth after autotransplantation of a mature third molar. The left mandible third molars (n = 2) were transplanted to the missing tooth in the left mandible. The patient follow-up period was 10 years after transplantation. Clinical examination revealed no mobility of the transplanted tooth. Radiographic examination indicated that bone regeneration occurred around the transplanted tooth. Vertical bone growth was observed in the cervical area of the root surface and the recipient bone. In autotransplantation of mature teeth, long-term follow-up results indicate that vertical bone growth can be expected if viability of the periodontal ligament cells is maintained.

Immediate autotransplantation of third molars: an experience of 57 cases.

OBJECTIVE: We present our experience of success with immediate third molar transplants in young individuals while secondarily assessing factors predicting failure. STUDY DESIGN: A total of 57 cases of third molar transplant with both open and closed apices were studied in individuals aged 15 to 25 years. Factors influencing prognosis were analyzed by univariate and multivariate analysis. RESULTS: The replaced teeth included 17 maxillary molars (29.8%) and 40 mandibular molars (70.2%). After a follow-up of 19.9 ± 2.8 months, 49 cases (86%) were successful; 7 (12.3%) cases failed owing to root resorption, and 1 (1.7%) failed owing to infection. Pulp revascularization was seen in all successful cases with open apices. Proximal grinding of donor tooth was significantly associated with failure (odds ratio, 12.5; P = .025). CONCLUSIONS: Autogenous third molar transplant is an excellent and viable treatment modality. By using proper case selection and minimizing damage to the donor tooth root, high success rates can be achieved.

Optimizing third molar autotransplantation: applications of reverse-engineered surgical templates and rapid prototyping of three-dimensional teeth.

The success of autogenous tooth transplantation depends on the vitality of the periodontal ligament attached to the donor tooth, and its viability decreases when it is exposed extraorally. This report describes the case of a 16-year-old patient in whom a rapid prototyped tooth model was performed using cone-beam technology and a surgical template guide for autotransplantation as an effective technique for a critical time-based procedure.

Risk factors affecting third molar autotransplantation during 5 and 10 years.

The aim of this study was to investigate risk factors affecting 5- and 10-year survival in autotransplantation of third molars with complete root formation at dental clinics. Participating dentists were requested to provide information on transplantations performed between 1 January 1990 and 31 December 2009. After data screening and elimination, 183 teeth in 171 men aged 20-72 years (mean, 44.8 years) and 205 teeth in 189 women aged 20-74 years (mean, 42.0 years) were included in the study. A single-factor analysis using the log-rank test revealed that the following factors had a significant influence (p<0.05) on 5-year survival in transplanted teeth in men: recipient site in the maxilla and fewer than 25 present teeth; those for 10-year survival, on the other hand, were recipient site tooth extraction due to periodontal disease, recipient site in the maxilla, fewer than 25 present teeth, and Eichner index Group B1 to C. Cox regression analysis revealed that the odds ratio for 5-year survival for recipient site in the maxilla was 2.873 (95% CI, 1.073-7.695), while that for 10-year survival was 3.713 (95% CI, 1.601-8.609) for recipient site extraction due to periodontal disease, 2.190 (95% CI, 1.021-4.700) for recipient site in the maxilla, and 3.110 (95% CI, 1.470-6.581) for fewer than 25 present teeth. In women, the log-rank test indicated experience of less than 10-year in performing treatment as a significant factor (p <0.05) in 5-year survival. These results suggest that medium-term survival in transplanted teeth is influenced by operational risk factors in women, while long-term survival in transplanted teeth is influenced by individual oral status in men.

Evaluating success of autotransplantation of embedded/impacted third molars harvested using piezosurgery: a pilot study.

OBJECTIVE: To evaluate the success of autogenous transplantation of embedded/impacted third molars harvested using piezosurgery. MATERIALS AND METHODS: This prospective pilot study enrolled 20 healthy patients with non-restorable first/second molars and a caries-free retrievable embedded/impacted third molar. Piezosurgery was used for removing inter-radicular bone at the recipient socket as well as for bone removal around the donor teeth. RESULTS: After an average follow-up of 16.4 months (SD = 1.9), 18 cases were successful with formation of periodontal ligament around the teeth. One tooth was lost due to infection at 1 month. One patient was lost to follow-up. There was no root resorption or ankylosis in any of the cases. In six donor teeth with complete root formation, root canal treatment was carried out. All the remaining teeth responded positively with vitality testing. CONCLUSION: Piezosurgery is an effective device if embedded/impacted third molars are to be harvested for successful autogenous transplantation.