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Background: Tooth autotransplantation is defined as the surgical repositioning of an autogenous tooth in another surgical site within the same individual. Aim: The aim of this research was to analyze the outcome of tooth transplantation using immature donor teeth compared with closed apex teeth and to compare differences between donor tooth positions on the arch. Methods: Electronic and manual literature searches were performed in different databases, including the National Library of Medicine (MEDLINE), EMBASE (OVID), Cochrane Central (CENTRAL), and the digital library of the Universitat Internacional de Catalunya (UIC University) from 1978 to March 2021. Studies were selected when they fulfilled the following criteria: only human prospective clinical studies, minimum sample size of 10 patients, minimum follow-up of 1 year, studies reporting or with at least deducible data on survival rates, immediate tooth autotransplantation with completed or incomplete root formation, and publications in the English language. A meta-analysis of random effects was developed to estimate the global effect measure of the survival rate, success rate, and root resorption involving the total sample, as well as open- and closed-apex groups. Results: Twenty-four articles were eligible for analysis. The Cohen's kappa corresponding to this review was 0.87, and the risk assessment was considered low-moderate for the included studies. Overall survival and success rates were 95.9% and 89.4%, respectively, with a mean follow-up of 4 years and an overall mean age of 25.2 ± 12.3 years. Closed apex teeth showed a survival rate of 3.9% lower than that of open apex teeth. Higher complication rates were found for both inflammatory external root resorption and replacement root resorption in the closed-apex group, without reaching statistical significance. Conclusions: Tooth autotransplantation is a viable treatment alternative, regardless of the apical condition, with high survival and success rates after a mean follow-up of 4 years. Open-apex donor teeth could be considered the gold-standard option, showing lower complication rates when compared to closed-apex donor teeth. Future randomized controlled clinical studies are needed to examine the long-term prognosis of this technique.
ABSTRACT
INTRODUCTION: Outcome predictors for the restoration of endodontically treated teeth mainly include cavity wall integrity and the presence of a 1.5-2 mm ferrule. However, in some clinical situations, the aforementioned predictors cannot be achieved. Three different techniques have been proposed to obtain an adequate ferrule respecting the supracrestal tissue attachment: surgical crown lengthening, orthodontic forced eruption, and surgical extrusion. There are little published prospective data evaluating periodontal changes after surgical extrusion. Therefore, the aims of this study were to report the outcome of surgical extrusion in single-rooted teeth, to digitally evaluate soft tissue volumetric changes after surgical extrusion, and to observe patient satisfaction regarding the treatment after a minimum of 1 year. METHODS: This prospective clinical study was performed between 2017 and 2020. Thirteen patients referred for surgical extrusion met the following inclusion criteria: nonsmokers; systemically healthy with at least 1 straight, single-rooted tooth with an insufficient ferrule; a favorable tooth crown-to-root ratio, and no periodontal pathology. Preoperative clinical variables included patient age, sex and phenotype, tooth number, tooth mobility, crown-to-root ratio, gingival index (GI), probing pocket depths at 6 sites, bleeding on probing (BOP), and mesial and distal interproximal papillae volume. Surgical extrusion was performed by a single operator who completed the root canal treatment/retreatment and restored the teeth with a crown. One year later, all patients were controlled, and the following variables were recorded: tooth mobility, crown-to-root ratio, GI, pocket depth, BOP, interproximal papillae aspect, soft tissue rebound, periapical healing, marginal bone loss, and patient-reported outcome measures of the treatment. All variables were analyzed using a descriptive method (mean, %). The Wilcoxon test was used to evaluate pre- and postoperative clinical parameters at a significance level of .05. RESULTS: At a mean follow-up period of 18.8 months, no teeth were extracted. Compared with preoperative GI and BOP, a significant reduction was observed at 1 year after surgery. Likewise, no significant differences in probing depths were shown, and only 1 tooth presented a type 2 mobility. The mean soft tissue rebound was -0.46 ± 0.69 mm. Overall, no significant interproximal papillae height loss was observed.Apical lesions were completely healed after surgery. The tooth crown-to-root ratio was favorable in all cases before extrusion, whereas in 3 cases it was appropriate (1 = 1), and only 1 case presented >25% of marginal bone loss during the follow-up period. The reported success rate was 92.3%, and patients were generally satisfied with the outcome. CONCLUSIONS: Surgical extrusion of single-rooted teeth was successful with minimal or no soft tissue loss, and patients were satisfied with the surgical procedure and the esthetic result.
Subject(s)
Orthodontic Extrusion , Tooth, Nonvital , Humans , Periodontal Index , Prospective Studies , Tooth CrownABSTRACT
BACKGROUND: Tooth autotransplantation is a valid method for replacing non-restorable teeth. This study aimed to assess mid-term survival and success of autotransplanted third molars and the clinical periodontal parameters and factors predicting successful periodontal attachment apparatus regeneration. METHODS: In total, 36 patients who had undergone extraction and subsequent autotransplantation of 36 third molars using virtual planning and computer-aided rapid prototyping models by an oral surgeon and endodontist were eligible. Probing pocket depth (PPD), gingival recession (REC), clinical attachment level (CAL), pulpal and periapical healing, root resorption, and radiographic bone loss (RBL) were evaluated. Additionally, a questionnaire evaluated patient-reported outcomes. RESULTS: The mean age of the participants was 30.2 years with a mean follow-up duration of 29.42 ± 14.56 months. The overall survival and success rates were 97.2% and 91.7%, respectively. No statistically significant differences were found in success and survival rates between open and closed apex groups or between compromised and intact buccal bone groups. No signs of pulp necrosis were found in the open apex group. Progressive replacement resorption was detected in one closed apex case. The mean PPD was 2.7 ± 0.45 mm for all transplanted teeth. REC was 0.13 mm higher in transplanted teeth than in previous hopeless teeth. CAL changes were neither clinically relevant (-0.17 ± 0.66 mm) nor statistically significant. The reported patient satisfaction was high. CONCLUSIONS: Autotransplantation of third molars is a predictable treatment method, with a 2.5-year cumulative tooth survival and success of 97.2% and 91.7%, respectively, which were not influenced by recipient site integrity or root development.
Subject(s)
Molar, Third , Tooth Extraction , Adult , Humans , Molar, Third/diagnostic imaging , Molar, Third/surgery , Prognosis , Retrospective Studies , Transplantation, Autologous , Treatment OutcomeABSTRACT
INTRODUCTION: Digital technology has been progressively introduced into tooth autotransplantation to enhance both treatment planning and surgery. The aim of this report was to describe a novel protocol for fully guided tooth autotransplantation. METHODS: This report includes 10 consecutive patients treated with a complete virtual planning and a multidrilling axis surgical guide in combination with the computer-aided rapid prototyping model. RESULTS: All transplanted teeth fulfilled the criteria for success over a mean follow-up duration of 13.1 months. No signs of progressive root resorption or pain were found during follow-up. One case required minimal adjustment of the surgical stent to allow correct seating, whereas a second case could not be performed fully guided because of limited mouth opening. CONCLUSIONS: Our protocol for fully guided tooth autotransplantation is a viable option that involves minimal bone preparation in a short surgical time. Future research should focus on further investigation of the benefits of this novel protocol in a larger sample.
Subject(s)
Surgery, Computer-Assisted , Tooth , Cone-Beam Computed Tomography , Humans , Stents , Transplantation, AutologousABSTRACT
El surco de desarrollo es una malformación anatómica que predispone al diente a un defecto periodontal. El diagnóstico supone un reto en casos de necrosis pulpar. Se han sugerido diferentes alternativas terapéuticas para su manipulación. En el presente caso, se describe el tratamiento de un surco de desarrollo en un incisivo lateral superior con un defecto periodontal severo. Se optó por un abordaje combinado en el que se realizó el reimplante intencional, posterior a la endodoncia, con el objetivo de tratar el surco fuera de la cavidad oral. Después de un año de control, se observó curación radiográfica y periodontal, por lo que se puede concluir que el reimplante intencional es un tratamiento predecible para el manejo de esta entidad
The palatogingival groove is an anatomic malformation that predisposes the involved tooth to a periodontal defect. The diagnosis may be challenging in case of pulp necrosis. Different treatment alternatives have been suggested for the treatment of this entity. In this case report, we describe the treatment of a palatogingival groove in a lateral upper incisor with a severe periodontal defect. A combined treatment approach, involving both root canal treatment and intentional replantation was perfomed, with the aim of the manipulation of the palatogingival groove out of the oral cavity. After one year follow-up, radiographic and periodontal healing can be observed, for this reason, it can be concluded that intentional replantation offers a predictable procedure for the management of this entity
