Combined application of artificial bone powders and concentrated growth factor membranes on the autotransplantation of mature third molars: A 5-year retrospective case series.

AIM: This study aimed to observe the efficacy and outcomes of the combined application of artificial bone powder and concentrated growth factor (CGF) membranes for tooth transplantation in cases with wide recipient sockets and small donor teeth. MATERIAL AND METHODS: A total of 36 teeth from 36 patients with wide recipient sockets and small donor teeth were enrolled. Autogenous tooth transplantation was performed using bone powders and CGF membranes. After transplantation, the visual analog scale (VAS) score, Landry Wound Healing Index, probing depth (PD), mobility, and gray value of the alveolar bone around the transplanted teeth were measured, and a patient satisfaction questionnaire was administered. All patients underwent clinical and radiographic examinations during follow-up. RESULTS: The VAS score of 16 (44.4%) cases after 1 week was 0, and 26 (72.2%) patients showed excellent gingival healing after 2-4 weeks. The PD of a few cases was deeper than 3 mm during the first month; however, returned to normal after 3 months. Although the majority of the transplanted teeth possessed mobility greater than grade I during the first month, the mobility gradually improved within 3 months. The gray value of the alveolar bone around the transplanted teeth, 1 year postoperatively showed no difference with pre-operation (p > .05). During the mean follow-up period of 42.7 months (range 20-72 months), 33 of the 36 transplanted teeth remained in situ without clinical or radiographic complications, with an overall success rate of 91.7%. CONCLUSIONS: Although the PD and mobility of the transplanted teeth were not ideal during the early stages of healing, most of the transplanted teeth had good clinical outcomes. In cases with large recipient sites accompanied by small donor teeth, autotransplantation of teeth using artificial bone powder combined with CGF membranes is a viable option and can lead to optimistic results with favorable success rates.

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.

Accuracy assessment between computer-guided surgery planning and actual tooth position during tooth autotransplantation.

BACKGROUND/AIM: This study aims to evaluate the precision and efficacy of utilizing computer-aided design (CAD) in combination with three-dimensional printing technology for tooth transplantation. MATERIAL AND METHODS: This study analysed 50 transplanted teeth from 48 patients who underwent tooth transplantation surgery with the aid of CAD and positional guides. A consistent coordinate system was established using preoperative and postoperative cone-beam computed tomography images. Linear displacements and angular deviations were calculated by identifying key regions in both virtual designs and actual transplanted teeth. Additionally, an analysis was conducted to explore potential factors influencing these deviations. RESULTS: The mean cervical deviation, apical deviation, and angular deviation among the 50 transplanted teeth were 1.16 ± 0.57 mm, 1.80 ± 0.94 mm, and 6.82 ± 3.14°, respectively. Cervical deviation was significantly smaller than apical deviation. No significant difference in deviation was observed among different recipient socket locations, holding true for both single-root, and multi-root teeth. However, a significant difference was noted in apical deviation between single-root and multi-root teeth. Our analysis identified a correlation between apical deviation and root length, leading to the development of a prediction model: Apical deviation = 0.1390 × (root length) + 0.2791. CONCLUSIONS: The postoperative position of the donor teeth shows discrepancies compared to preoperative simulation when utilizing CAD and 3D printed templates during autotransplantation procedures. Continual refinement of preoperative design is a crucial endeavour.

Midterm outcomes of autogenous mature third molars transplantation into surgically created sockets: A retrospective cohort study.

BACKGROUND/AIMS: The purpose of this study was to observe the outcome of mature third molars transplantation into surgically created sockets with the assistance of computer designed three dimensional (3-D) printed replicas and compare its outcome with the conventional fresh socket autotransplantation. MATERIAL AND METHODS: This study included total of 96 mature third molars autotransplanted in 96 cases with the guidance of computer designed 3-D printed replicas. Forty-eight teeth autotransplanted into surgically created sockets were enrolled into the surgically created socket group and 48 teeth conventionally autotransplanted into fresh sockets were enrolled into the fresh socket group. In the surgically created socket group, mature third molars were autotransplanted into surgically prepared sockets at the site of previously missed or extracted molars in the alveolar bone and in the fresh socket group, autotransplantation of mature third molars were performed in fresh sockets of extracted diseased molars simultaneously. After transplantation, the visual analogue scale (VAS) score, Landry Wound Healing Index (LWHI), mobility and probing depth (PD) of the transplanted teeth were measured and the patient satisfaction questionnaire were held in both group. All patients underwent clinical and radiographic examinations during the follow-up. RESULTS: During the mean follow-up period of 47.63 ± 16.78 months (range 18-78 months), 92 out of 96 teeth remained in situ without clinical or radiographic complications with overall success rate of 95.83%. No statistically significant differences were found in success and survival rates between the two group. The average extra-oral time of the donor teeth were 60.76 ± 22.41 s and mean positioning trials of the donor teeth were 2.43 ± 1.19. The VAS score at Day 1 in the surgically created socket group was higher than the fresh socket group (p < .05). LWHI scores in the surgically created group were lower than the fresh socket group during the first 2 weeks (p < .05). The degree of mobility of the transplanted teeth in both group showed no statistically significant difference during the first 3 months. PD in the surgically created group were higher than the fresh socket group in the first month but there were no statistically significant difference after 1 month. Twenty-six out of 48 cases in the surgically created group needed crown restoration while only 10 cases went through crown restoration in the fresh socket group. Most patients in both group were satisfied with the treatment. CONCLUSIONS: Autogenous mature third molars transplantation into surgically created sockets is as effective as conventional fresh socket transplantation. This technique is worth recommending in carefully selected cases and optimistic results can be achieved.

Prognostic factors, outcomes, and complications for dental autotransplantation: an umbrella review.

BACKGROUND: Dental autotransplantation (DAT) is a biological way of replacing missing or compromised teeth for patients. The techniques often necessitate a multi-disciplinary approach. The prognosis and success of the procedure may be impacted by variable factors in varying degrees. OBJECTIVE: Evaluating outcomes and complications of DAT, including prognostic factors using an umbrella review. SEARCH METHODS: Six databases were searched for all relevant systematic reviews published up to 30 June 2022. No restrictions were applied to language or publication date. SELECTION CRITERIA: Systematic reviews and meta-analyses of DAT studies. DATA COLLECTION AND ANALYSIS: Identification, screening, eligibility, and quality assessment using the AMSTAR 2 tool were performed independently by two authors (M.C. and S.A.). Two studies (20%) scored moderate, six studies (60%) scored low, and two studies (20%) scored critically low. Data were analysed using a random effects meta-analysis, and meta-regression was performed to investigate the effect of open and closed apices on the dependent variables. The results were summarised as relative risk ratios. RESULTS: A total of 310 studies were eligible for inclusion, of which 20 studies were selected for full-text evaluation. Ten systematic reviews were included, 9 of which had a meta-analysis. Overall findings suggest that DAT offers favourable success and survival rates. Meta-regression results indicate that a closed apex increased the proportion of ankylosis and resorption, reduced survival but had no effect on success during the observational period. LIMITATIONS: A varying degree of heterogeneity and bias was present in all systematic reviews. The samples of donor teeth included in the systematic reviews also varied morphologically. CONCLUSIONS: DAT is a technique-sensitive procedure requiring a multidisciplinary team, vigilant case assessment and thorough consideration of the respective prognostic factors involved. Despite methodological limitations reported across studies, DAT shows favourable success and survival rates, with a distinctive advantage of bone induction and soft tissue thickness preservation, and should, therefore, be considered as a viable treatment modality. Standardisation of clinical guidelines and practice are highly recommended. REGISTRATION: CRD42020202484.

Tooth auto-transplantation: A bibliometric analysis of the top 100 most-cited articles.

BACKGROUND/AIM: Tooth auto-transplantation has recently gained high clinical acceptance. The aim of this study was to identify the top 100 most-cited articles regarding tooth auto-transplantation, to analyse multiple citations and publication metrics and to outline the historical scientific advancements in this field. MATERIALS AND METHODS: An advanced search of the Clarivate Analytics' Web of Science 'Core Collection' and Elsevier's Scopus databases utilising specific keywords related to tooth auto-transplantation between 1971 and 2021 was performed. The retrieved articles were ranked in descending order based on their Web of Science citation counts and further cross-matched with citation data from Scopus. The extracted data included citation counts, citation density, level of evidence, year of publication, contributing authors names and institutes, corresponding author's address, journal of publication, journal local citations index, cumulative growth index, keywords and keywords Plus. Data analysis was performed using descriptive statistics and graphical mapping. RESULTS: A total of 1290 articles were retrieved. The top 100 most-cited articles received a total of 4899 (Web of Science) and 5250 (Scopus) citations. Among these, cohort studies (29%) and case series (18%) were the most common study designs. Scandinavian countries produced major contributions in defining the top 100 most-cited articles and ranked within the top 5 countries based on the number of publications and citations per year. The greatest contributing authors were Schwartz O (n = 12), Andreasen JO (n = 8) and Paulsen HU (n = 6), and they were affiliated with Copenhagen, Denmark. The top contributing journals were American Journal of Orthodontics and Dentofacial Orthopedics, International Journal of Oral and Maxillofacial Surgery, Oral Surgery Oral Medicine Oral Pathology Oral Radiology, European Journal of Orthodontics, Dental Traumatology and Journal of Oral and Maxillofacial Surgery. CONCLUSION: This bibliometric analysis revealed a large geographical scientific interest and broad development in the field of tooth auto-transplantation spanning multiple dental disciplines.

OUTCOMES OF AUTOTRANSPLANTED THIRD MOLARS WITH COMPLETE ROOT FORMATION: A SYSTEMIC REVIEW AND META-ANALYSIS.

OBJECTIVES: Clear evidence is lacking regarding the outcomes of autogenous tooth transplantation (ATT) of third molars with complete root formation. The current review aims to explore the long-term survival and complication rates. METHODS: A comprehensive search was performed in December 2022 of the PubMed, Scopus, Embase, EBSCO, Ovid, Science Direct, and Web of Science databases. The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered at the International Prospective Register of Systematic Reviews (CRD42022337659). The pooled survival, root resorption, and ankyloses rates were calculated. Subgroup analyses were performed to explore the effects of sample size and 3D techniques. RESULTS: Twelve studies from 5 countries fulfilled the eligibility, with 759 third molars transplanted in 723 patients. Five studies reported 100% survival at 1-year follow-up. After excluding these 5 studies, the pooled survival rate was 93.62% at 1 year. The survival rate of 1 large sample study was significantly higher than that of small ones at 5 years. The complications of studies using 3D techniques were: root resorption 2.06% (95% CI: 0.22, 7.50) and ankyloses 2.81% (95% CI: 0.16, 12.22), compared to those without 3D techniques: root resorption 10.18% (95% CI: 4.50, 17.80) and ankyloses 6.49% (95% CI: 3.45, 10.96). CONCLUSIONS: ATT of third molars with complete root formation is a reliable alternative for replacement of a missing tooth and has a promising survival rate. The use of 3D techniques can reduce complication rates and improve long-term survival.

Efficacy of autogenous tooth roots for a combined vertical and horizontal alveolar ridge augmentation and staged implant placement. A prospective controlled clinical study.

OBJECTIVES: To assess and compare the efficacy and safety of autogenous tooth roots (TRs) and autogenous bone blocks (ABs) for combined vertical and horizontal alveolar ridge augmentation and two-stage implant placement. MATERIALS AND METHODS: A total of 28 patients in need of implant therapy and vertical ridge augmentation were allocated to parallel groups receiving either healthy autogenous tooth roots (e.g., retained wisdom teeth) (n = 14, n = 15 defects) or cortical autogenous bone blocks harvested from the retromolar area (n = 14, n = 17 defects). After 26 weeks of submerged healing, the clinical reduction in ridge height (RH) deficiency was defined as the primary outcome. RESULTS: Both surgical procedures were associated with a similar mean reduction in RH deficiency values, amounting to 4.48 ± 2.42 mm (median: 4.25; 95% CI: 3.08-5.88) in the TR group and 4.46 ± 3.31 mm (median: 3.00; 95% CI: 2.54-6.38) in the AB group (p = .60, Mann-Whitney U-test). In all patients investigated, the reduction in RH deficiency values allowed for an adequate implant placement at the respective sites. The frequency of complications (e.g., soft tissue dehiscences) was low (TR: n = 4; AB: n = 0). CONCLUSIONS: Up to staged-implant placement, both TR and AB grafts appeared to be associated with comparable efficacy and safety for combined vertical and horizontal alveolar ridge augmentation.

Autogenous dentin block versus bone block for horizontal alveolar ridge augmentation and staged implant placement: A randomized controlled clinical trial including histologic assessment.

OBJECTIVES: This study aimed to compare the dentin block (D-group) harvested from impacted wisdom teeth with autogenous ramus bone block (A-group) for horizontal alveolar ridge augmentation. MATERIALS AND METHODS: Forty-two patients with anterior missing teeth and horizontal ridge defect were randomly assigned to two groups (n = 21 per group) to receive either dentin block group or autogenous bone block. Six months after the augmentation, dental implants were placed in all patients, and a core biopsy was performed for histological evaluation in addition to clinical and radiographic evaluation using cone beam computed tomography. The primary outcome was the mean overall clinical ridge width gain (CRWG) after 6 months of augmentation. Secondary outcomes were the overall radiographic ridge width gain (RRWG) after 6 months of augmentation and descriptive histological analysis with histomorphometric assessment of bone fraction %. RESULTS: All sites healed uneventfully, and the mean overall CRWG 6 months after augmentation was 3.52 ± 0.56 mm and 2.24 ± 0.86 mm in the D and A groups, respectively, with statistically significant difference between them (P ≤ .001). The overall mean RRWG was 3.61 ± 0.61 mm and 3.41 ± 1.15 mm in D and A groups, respectively, without any statistically significant difference between them (p = .062). The histomorphometric analysis of the bone area fraction was 42.6% and 41.3% in D and A groups, respectively, without any statistically significant difference between the two values (p = .89, Student's t-test). Histological evaluation in the D-group revealed new bone formation, viable cells, and matrix formation on the dentin block periphery, in addition to well-organized woven bone that suggests dentin block remodeling and supports new bone deposition. CONCLUSION: The present clinical study revealed that dentin block may serve as an alternative graft to support horizontal alveolar ridge augmentation. Dentin blocks showed less resorption than autogenous bone blocks.

Present status and future directions: Surgical extrusion, intentional replantation and tooth autotransplantation.

Surgical extrusion, intentional replantation and tooth autotransplantation procedures are important treatment options that clinicians may consider performing in their day-to-day clinical practice. Despite compromised teeth are generally considered for extraction, clinicians must be aware that these cases could be suitable for management by these alternative predictable treatment options. Surgical extrusion, intentional replantation or tooth autotransplantation have similar treatment protocols which includes atraumatic tooth extraction, visualisation of the root portion and replantation. Surgical extrusion is defined as the 'procedure in which the remaining tooth structure is repositioned at a more coronal/supragingival position in the same socket in which the tooth was located originally'. Intentional replantation is defined as the 'deliberate extraction of a tooth and after evaluation of root surfaces, endodontic manipulation and repair, placement of the tooth back into its original position'. Tooth autotransplantation is defined as the 'transplantation of an unerupted or erupted tooth in the same individual, from one site to another extraction site or a new surgically prepared socket'. The same team previously published a narrative review (International Endodontic Journal. 2020, 53, 1636) and European Society of Endodontology position statement (International Endodontic Journal. 2020, 54, 655) on this topic in International Endodontic Journal. The aim of the current updated review was to provide the reader a complete overview and background on these procedures, to established clear clinical protocols and step-by-step for technically perform these therapies in their clinical practice and to establish future directions on the topics. The clinicians must periodically update their knowledge about these three procedures to achieve success.