Immediate Dental Autotransplantation, an alternative treatment: A case
report with a 2-years follow-up.
The objective of this case report was to describe the treatment sequence
of an immediate dental autotransplantation, with the use of technology
such as the elaboration of a 3D replica made on a computer in
conjunction with cone beam computerized tomography and the use of an
piezoelectric to reduce the work time, clinical and radiographic
evaluations were carried out periodically, obtaining excellent results
such as good biointegration of the tooth with hard and soft tissues, the
aesthetic results were favorable. During the two-year follow-up there
were no biological or mechanical complications. According to this study,
immediate dental autotransplantation is an excellent treatment option.
Introduction
There are different treatment alternatives for the loss of a tooth, the
most common being prosthetic solutions such as fixed prostheses,
removable prostheses and implants,1 the latter has an
excellent survival rate of success, however the loading protocol
influences the prognosis of immediate implant
placement.2
The autotransplantation of tooth is a treatment that has been used for a
long time and is a solution to the loss of a tooth, as long as there are
favorable conditions for treatment, autotransplantation consists of the
transfer of a tooth to another area of the same patient, usually the
third molars are used,3,4 There are three types of approach related to
autotransplantation; surgical extrusion, which is defined as the most
coronal placement within the same socket, intentional reimplantation,
which is defined as the extraction of a tooth to perform endodontic
repair treatment and finally insert it into the same socket and the auto
transplant itself.5
Clinical procedures for the treatment of dental auto transplantation
have evolved, with the help of technology such as the use of tomography
and the rapid creation of prototypes such as the replica of a donor
tooth made in 3D printers, as well as the use of piezoelectric ,
reducing the time at the time of surgery and obtaining good control of
the receptor bed, consequently reducing postoperative complications,
improving the prognosis,6,7 however, there are still no established
protocols for this reason, the dentist must know the disadvantages of
auto transplantation related to the probing depth, ankylosis and root
resorption.5
The objective of this case report is to describe an alternative
treatment for tooth loss through dental autotransplantation, using a
replica of the printed donor tooth made under three- dimensional
technology with a 2-year follow-up.
Case report
A 37-year-old female patient is referred to the endodontic area, for the
evaluation of tooth 14, the medical history did not present any
impediment for a endodontic or surgical treatment, the main reason for
consultation was the mild pain that she presented during the last 6
months. The clinical examination revealed extensive destruction of the
crown due to caries on tooth 14 (Figure 1), presenting pain on
horizontal and vertical percussion, on periodontal examination she
presented physiological mobility and absence of probing depth, on
radiographic examination the deep carious lesion was observed below the
cement-enamel junction, for this reason a prosthetic solution was not
viable.
Two treatment options were proposed, the first the placement of a dental
implant immediately after extraction and the second the extraction of
tooth 14 and the auto transplant of tooth 35 after root canal treatment,
since this tooth would be extracted for orthodontic reasons (Figure 2).
The patient signed his informed consent knowing the advantages and
disadvantages of the second treatment option.
Treatment begins with planning through the use of cone beam computerized
tomography (CBCT), for the measurement and comparison of the area of the
donor tooth (tooth 35) and the receptor bed (tooth 14), the distances of
the surrounding anatomical landmarks were also analyzed. A
three-dimensional replica of the polymethylmethacrylate (PMMA) donor
tooth was made, in order to have a control during the preparation of the
receptor bed.
The execution of the treatment begins with the endodontics of tooth 35,
immediately afterwards anesthesia around tooth 14, to start the
extraction and preparation of the receptor bed, for the preparation of
the receptor bed was used the piezoelectric instrument (Woodpecker
ultrasurgery, US-II, Guangxi, China), with abundant sterile saline.
During the preparation of the receptor bed, the replica of the donor
tooth was placed, until achieved the total introduction of the replica
of the tooth (Figure 3), then the extraction of the donor tooth was
performed, an apicoectomy and an apical retropreparation were performed
due to the fact that the donor tooth presented a longer length, it was
finally sealed with Biodentine (Septodont, Saint Maur des Fosses,
France), the procedure described was carried out with the objective of
minimizing the preparation of the recipient socket. Immediately after
the total introduction of the donor tooth in the recipient bed, a
radiographic evaluation was performed (Figure 4).
The transplanted tooth was splinted with composite resin to the teeth
adjacent by buccal and palatal for 4 weeks (Figure 5), splinting was
passive to maintain the physiological mobility of the tooth, wear of
approximately 1mm was performed and it did not come into contact with
the antagonist and during the dynamic evaluation of the occlusion did
not present occlusal interferences. after the surgery, antibiotics were
prescribed every 8 hours for 5 days, after 4 weeks the splinting was
removed and a clinical and radiographic control was carried out,
observing preservation of the soft tissues and the integration of the
donor tooth and bone formation around ( osteointegration), after 2
months a clinical and radiographic control is performed again, as well
as a direct occlusal restoration.
The clinical and radiographic follow-up were at 2-months, 1-year and
2-years, during the second month of clinical control, the patient
decided not to undergo orthodontic treatment. finally the last
radiographic control was observed the good integration of the and bone
crest formation (Figure 6), clinically preservation of the soft tissues
was observed, it did not present when probing depth (Figure 7).
Discussion
This case report describes the treatment sequence of an immediate dental
autotransplant in the event of an evicted tooth, there are different
treatment alternatives and a prosthodontic treatment is not always
viable, autotransplants have presented an excellent long-term success
rate and even in autotransplanted teeth with incomplete root formation,
the different studies show low values regarding complications such as
abnormal mobility, ankylosis and root bone resorption, however these low
values influence the prognosis.1,8
Another treatment with an excellent survival rate in partial edentulous
patients is implants; however, depending on the placement and load of
the implant, it influences the prognosis,2 unlike
autotransplantation, it is defined as a single block, that is, According
to the different studies, it would have a similar classification:
immediate autotransplantation, that is, in fresh post-extraction
alveoli, and late auto-transplantation, that is, surgically created
alveoli, both with immediate loading.
Several retrospective clinical studies have shown that third molars and
premolars are donors for clinical practice, however transplanted
premolars have a higher survival rate than transplanted third molars,3,9
these results are consistent with the case report, that during 2 years
of follow-up, the transplanted premolar did not reveal any biological or
mechanical complications.
Autotransplantation is not a common treatment in general dental
practice, however it is an economically viable treatment alternative
that is less invasive and complicated than a conventional prosthetic
treatment.4
At present there is no consensus on dental autotransplantation, however
there are multiple studies with high success rates and low complication
rates, the different cases show different protocols, for this reason the
clinical protocols are not yet defined,5 all cases
show long-term treatment, however there are few studies that perform a
periodontal evaluation and there is insufficient documentation on the
occlusal evaluation of autotransplanted teeth.
The elaboration of a 3D replica of the donor tooth, through the use of
digital technology, facilitates the elaboration of the receptor bed,
with work times of approximately two minutes, I feel a less invasive
technique,6 the use of piezoelectric also reduces the
time during surgery and in some cases allows the protection and
maintenance of the periodontal fibers of the transplanted tooth, which
is necessary for long-term success.7
Conclusion
Dental autotransplantation is a viable treatment with a good prognosis
and low cost, as long as the necessary tools for the treatment are
used.
Planning through CBCT is important to reduce complications before,
during and after surgery. Occlusal evaluation and occlusal stability in
transplanted teeth is crucial for prognosis in order to avoid fractures.
Conflicts of interest
The authors declare no conflicts of interest related to this study.
Author contribution
Drs Henrry Cardenas-Sallhue and Kenyi Aronres-Huamancha contributed to
the planning and execution of the treatment and the drafting and
revision of the manuscript. All authors gave their final approval.
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