Endodontic Congress

Dr. Mile Churlinov

Guided Tooth Autotransplantation

Tooth loss usually occurs after periodontal pathology, vertical root fractures, carious destruction and trauma. Autotransplantation of teeth is a technique that includes surgical creation of an artificial socket or utilising freshly extracted tooth socket and reposition an autogenous erupted or unerupted tooth to reestablish the primary role of dentition in terms of function, speech and aesthetics (1,2)

While preserving donor tooth “PDL” seems to be the key factor for success (4,5) some researchers found that immature teeth have a better prognosis in autotransplantation as they could promote revascularization easily than mature teeth (3), several case report studies have also reported high- success rates for autotransplantation of mature teeth (6–8) and 98.0% and 90.5% at 1 and 5 years, according to systematic reviews (6). Previous researchers found out that having a printed donor tooth (3D replica) prior extraction could optimise the total time of the procedure and most importantly it would decrease the donor tooth extraoral time (9). With digital planning and the CBCT, freshly extracted sockets are not a limitation anymore if the whole procedure is planned well and the procedure performed fast (12). Anssari Moin et al. described a method of computer- assisted template-guided autotransplantation with custom 3D designed/ printed surgical tooling (13) and few years later Abella et al. went even further with a custom designed osteotome and a fully exposed buccal wall of the donor tooth (14).
In this presentation the author will demonstrate how to plan and perform autotransplantation in different clinical situations by the use of modern technology and still be supported by the literature.

Accidental tooth loss is more frequent in younger persons than adults. Treatment of a missing tooth/teeth with an implant in adults is an excellent and predictable method of choice, but contraindicated in growing individuals as it does not provide further growth of the alveolar ridge vertically as natural dentition tends to. Follow-up studies of cases with missing incisors in growing patients have shown that in long-term perspective, prosthetic rehabilitation was the least desired treatment option compared to orthodontic space closure and autotransplantation.
Performing a successful implant procedure in a compromised recipient socket with a significant bone loss and/ or sinus lift in adults is a very challenging task even for the most experienced clinicians. Having an available fresh socket or bone height/ width makes the procedure fast and predictable. On the other hand if there is a soft and hard tissue deficiency, autotransplantation could be advantageous to implants mainly because of the “PDL ” osteoinductive potential and optimal biologic interactions with soft tissue.

1. H. Apfel.: Autoplasty of enucleated prefunctional third molars. Journal of oral surgery, vol. 8, no. 4, 1950, pp. 289-296.
2. B. Bjercke.: Autotransplantation in premolars. Trans. Int. Conf. Oral Surg., vol. 2, no. 2, 1967, pp. 380-382. PubMed
3. Andreasen, J. O., Reinholdt, J., Riis, I., Dybdahl, R., Soder, P .O. & Otteskog, P.: Periodontal and pulpal healing of monkey incisors preserved in tissue culture before replantation. Int. J. Oral Surg, 1978: 7: 104-
112.
4. Andreasen, J. O .: The effect of extra-alveolar period and storage media upon periodontal and pulpal healing after replantation of mature permanent incisors in monkeys. Int. J. Oral Surg, 1981: 10: 43-53.
5. Andreasen, J. O. & Kristerson, L.: The effect of limited drying or removal of the periodontal ligament upon periodontal healing after replantation of mature permanent incisors in monkeys. Acta Odontol. Scand. 1981: 39: 1-13.
6. Bae JH, Choi YH, Cho BH, Kim YK, Kim SG.: Autotransplantation of teeth with complete root formation: a case series. J Endod. 2010;36 (8):1422-1426.
7. Sugai T, Yoshizawa M, Kobayashi T, et al.: Clinical study on prognostic factors for autotransplantation of teeth with complete root formation. Int J Oral Maxillofac Surg. 2010;39(12):1193-1203.
8. Yu HJ, Jia P, Lv Z, Qiu LX.: Autotransplantation of third molars with completely formed roots into surgically created sockets and fresh extraction sockets: a 10-year comparative study. Int J Oral Maxillofac Surg.
2017;46(4):531-538.
9. Lee SJ, Jung IY, Lee CY, Choi SY, Kum KY.: Clinical application of computer-aided rapid prototyping for tooth transplantation. Dent Traumatol. 2001;17(3):114-119.
10. Chung WC, Tu YK, Lin YH, Lu HK.: Outcomes of autotransplanted teeth with complete root formation: a systematic review and meta- analysis. J Clin Periodontol. 2014;41(4):412-423.
11. Bauss O, Engelke W, Fenske C, Schilke R, Schwestka-Polly R. Autotransplantation of immature third molars into edentulous and atrophied jaw sections. Int J Oral Maxillofac Surg. 2004 Sep;33(6):558-63. doi: 10.1016/j.ijom.2003.10.008. PMID: 15308255.
12. Tsukiboshi, M.: Autotransplantation of teeth: requirements for predictable success. Dental Traumatology, 2002:18, 157– 180.
13. Anssari Moin, D., Verweij, J.P., Waars, H., van Merkesteyn, R. & Wismeijer, D.: Accuracy of computed- assisted tem-plate guided autotransplantation of teeth with custom three- dimensional designed/printed surgical tooling: a cadaveric study. Journal of Oral and Maxillofacial Surgery, 2017: 75, e1–e7.
14. Abella Sans F, Ribas March F, Zubizarreta-Macho Á, Boschini L, Roig Cayón M, Durán-Sindreu Terol F.: Guided autotransplant of a first premolar to replace a maxillary ankylosed incisor using a custom-designed
osteotome. J Am Dent Assoc. 2022 Mar;153(3):265-272. doi: 10.1016/j.adaj.2021.08.010. Epub 2021 Dec 18. PMID: 34930574.