Tooth Transplantation

1
Tooth Transplantation
2
Tooth Transplantation

• a viable alternative
• endodontic treatment or extraction ?
• fixed or removable prosthetic treatment is not
  ideal treatment in adolescent

3
Why tooth transplantation is successful?
Hertwigs epithelial root sheath
4
Tooth transplantation

1. Autogenous transplantation
2. Allogeneic transplantation
3. Isogeneic transplantation
4. Xenegeneic transplantation

5
Tooth autotransplantation
6
Indication

1. Sufficient crown space and alveolar bone
2. No periapical or periodontal inflammation
3. Proximity of the transplant to the socket wall to
   assure rapid organization of the clot between the
   alveolar bone and the tooth
4. Excellent oral hygiene, low caries index

7
Tooth autotransplantation

1. Transplantation from one region to another
2. Transalveolar transplantation

Sagne S. Autotransplantation of teeth Int Dent
J. 1985 35 , 280-283
8
Transplantation from one legion to another

1. Transplant from lower 3rd molar to lower 1st
   molar
2. Transplant from upper 3rd molar to upper 1st
   molar
3. Transplant from lower premolar to upper premolar
   or upper premolar to lower premolar
4. Transplant from premolar to upper central incisor

9
Transplant from lower 3rd molar to lower 1st
molar
10
Transplant from lower3rd molar to lower 1st molar

• Most reported cases of autotransplantation
• a result of caries the first molar is frequently
  missing or removal in adolescents
• Developing third molars are usually available in
  adolescents
• In a majority of case the rate of success is well
  over 95 for an extended period of time

Andreasen et al. 1992
11
Indication for 3rd molar to 1st molar

• Appropriate candidates are adolescent patients
  ( 13 to 20 years )
• Recent lost or about to lose a permanent first
  molar
• A suitable third molar
• The roots on the donor tooth developed to the
  point of bifurcation ( should be equal to
  approximately 3 -4 mm in root length )
• A fully formed crown

12
Indication for 3rd molar to 1st molar

• A suitable third molar
• Complete enamel calcification coincides closely
  with development of the bifurcation
• The third molar should be no larger than the
  first molar it is replacing
• Slight of third molar to make it a suitable size
  is acceptable
• During instrumentation in the removal of the
  donor tooth, the vulnerable tooth buds are avoided

13
Surgical technique
1.Mobilization of the transplant

• A mucoperiosteal flap prepared by a sulcular
  incision from the mesial of second premolar to
  the distal of second molar then extending
  distolaterally and no vertical incision, assuring
  an excellent blood supply

• It is important that the flap design allow both
  adequate surgical field and blood supply

14
Surgical technique
1.Mobilization of the transplant

• The impacted third molar is carefully exposed ,
  avoiding any contact of bone-cutting instruments
  with the tooth, grasping the crown with forceps
  avoid trauma to the root sac

15
Surgical technique
1.Mobilization of the transplant

• The tooth is then luxated, elevated from its
  position and gently returned to its position or
  maintained in its socket
• Leaving the donor tooth in the socket after
  luxation will allow it to continue to receive
  nutrients and be hydrate while the host site is
  being preparation

16
Surgical technique

1. Preparation of the host site

• The first molar and interradicular bone are
  carefully removed
• Amount of cortical bone removed is critical, if
  an injudicious amount of bone is removed , there
  will not be an adequate bone support

17
Surgical technique

1. Preparation of the host site

• The required amount of bone can be estimated by
  radiograph
• Irrigate and inspected for debris before a trial
  positioning of the transplant

18
Surgical technique

1. Transplantation and stabilization

• The third molar is carried forward to new socket
• The area of resistance is relieved before seating
  the third molar

• The transplant may be stripped to seating but the
  roots of the transplantation should not be
  scraped or filed

19
Surgical technique

1. Transplantation and stabilization

• The occlusion should be carefully examined to be
  certain that the opposing teeth will not exert
  pressure on the transplant
• avoid premature contact
• Infraocclusion about 2 3 mm

20
Surgical technique

1. Transplantation and stabilization

• Mucoperiosteal flap is repositioned and suture
• The transplant is splinted in position using 0.14
  gauge stainless steel wire
• The wire ligation technique used can be figure
  eight or circumferential technique

21
Surgical technique

1. Transplantation and stabilization

• Additional stabilization of the transplant can be
  achieved by gently packing periodontal surgical
  dressing such as Coe-Pak around the transplant
  and adjacent teeth

22
Postoperative care and follow-up

• Postoperative instructions are the same as those
  given following extraction of impacted teeth
• After surgery
• 1 day the tooth has retained its new position
• periodontal pack still in good position
• swelling is within acceptable levels
• 7 days stitch off

23
Postoperative care and follow-up

• The patient should be seen at weekly intervals
• At the end of a month the transplant may still be
  slightly mobile, but splinting can be removed
• Follow-up every month within 6 months
• every 3 month within 2 years
• every year

24
Postoperative care and follow-up

• At each visit should be checked
• The stability of the transplant
• Sulcular depth
• Gingival recession
• Vitality test
• Occlusion
• Root formation, thickness of periodontal
  ligament, root resorption in radiograph
• Oral hygiene

25
Precautions

• The precaution that help ensure successful
  autogenous transplantation are the following
• Root development of donor tooth is between 1/3 to
  1/2 of the total root
• Hertwigs epithelial root sheath is not injured
  during surgery
• The host site is prepared to avoid injury to the
  epithelial root sheath
• The patient should be healthy with adequate oral
  hygiene
• Pulpy foods that might pack into the cervicular
  space should be avoided
• The patient should consider the procedure
  important, keep operative site clean and avoid
  trauma from occlusion

26
Transplantation from one legion to another

1. Transplant from lower 3rd molar to lower 1st
   molar
2. Transplant from upper 3rd molar to upper 1st
   molar
3. Transplant from lower premolar to upper premolar
   or upper premolar to lower premolar
4. Transplant from premolar to upper central incisor

27
Transplant from premolar to upper central incisor
28
Transplant from premolar to upper central incisor
29
Surgical technique
The treatment plan is to transplant a maxillary
second premolar to the maxillary central incisor
which is to be removed due to root resorption
30
Surgical technique
The maxillary central incisor is extracted
31
Surgical technique
The socket is enlarged with surgical bur The
socket is expanded palatally , then rinse with
saline
32
Surgical technique
Testing the size of socket by a glass replica of
a premolar
33
Surgical technique
Removing maxillary second premolar using gentle
luxation movement
34
Surgical technique
Repositioning of the transplant, it is placed 45?
rotate in order to achieve sufficient cervical
width
35
Surgical technique
Splint the transplant with 0.20 mm stainless
steel wire
36
Surgical technique
Complete treatment, after grinding and restore
with crown
37
Summary
Although it is not possible to perform tooth
autotransplantation in all patients with
nonrestorable molars, it may be a viable
alternative in some instance
38
Reference
Bowden David E. J. et al Autotransplantation of
premolar teeth to replace missing maxillary
central incisor, British Journal of
orthodontics, Vol. 17, 1990 Munksgaard Text
book and color atlas of traumatic injuries to
the teeth, 1994 Plainfield S. et al A viable
alternative Tooth transplantation, Journal of
Prosthodontics, Vol. 50, 1983 Robison J. Peter
and Grossman I. Louis Tooth Transplantation,
Clinical transplantation in dental
specialties Smith J. J. et al Successful
Autotransplantation, Journal of Endodontics,
Vol.13, 2, 1987