Australian Dental Journal 2023; 68: 202–215

doi: 10.1111/adj.12966

Anterior tooth autotransplantation: a case series

DC-V Ong,*,† P Goh,* G Dance†
*University of Queensland, Brisbane, Queensland, Australia.
†Private Practice, Townsville, Australia.

ABSTRACT
Tooth autotransplantation is the technique of transplanting embedded, impacted or erupted teeth from one site into
another in the same individual. It is relatively common for the anterior segment of the mouth to be affected by traumatic
tooth injuries, impacted and/or congenitally missing permanent teeth. Autotransplantation of teeth into the anterior den-
tal arch can provide unrivalled biological solutions when such issues arise in this critical aesthetic zone, particularly for
adolescent patients. The combination of meticulous pre-surgical assessment, synergistic interdisciplinary collaboration
and carefully performed anterior tooth autotransplantation has been demonstrated to achieve impressive outcomes, with
respect to both transplant survival and clinical success. © 2023 Australian Dental Association.
Keywords: Adolescent patient, anterior tooth autotransplantation, critical aesthetic zone, interdisciplinary, trauma.
Abbreviations and acronyms: 3D = three-dimensional; 3DCT = three-dimensional computed tomography; CAD/CAM = computer-
aided design/computer-aided manufacturing; CBCT = cone beam computed tomography; STL = stereolithography; TADs = temporary
anchorage devices.
(Accepted for publication 17 June 2023.)

mouth are associated with significant clinical

INTRODUCTION
dilemmas. According to a recent systematic review,12
The transfer of a tooth within the same individual is dental trauma is experienced by approximately 17.5%
known as tooth autotransplantation.1 This technique of the adolescent patient population, with a higher
can be implemented to relocate a suitable donor tooth prevalence in young males. Dental trauma may vary
to a recipient site where its functional and/or aesthetic in severity, ranging from simple enamel fracture
properties can provide greater value.2 Autotransplan- through to more problematic intrusive luxation and
tation can be utilized for both anterior and posterior avulsion. Should significant dental trauma in an ado-
tooth replacement.3 lescent patient result in a declining (e.g. due to resorp-
Unfortunately, teeth in the anterior segment or tion, ankylosis, unrestorable root fracture, etc.) or
“aesthetic zone” of the mouth may be congenitally missing anterior tooth (e.g. avulsion), the continuation
missing, impacted, or experience decline due to previ- of physiologic alveolar bone growth and adjacent
ous traumatic injury. With respect to the latter, it has tooth eruption will truncate the range of immediately
been reported that the majority of traumatic dental available restorative options.
injuries in children occur before the age of 16,4–7 with Unfortunately, the unplanned loss of a permanent
loss of permanent teeth occurring in 7%–8% of these anterior tooth in an adolescent patient is commonly
cases.8,9 associated with a subsequent deterioration in the hori-
The “aesthetic zone” refers to the hard and soft tis- zontal and vertical alveolar bone volume.13–15 Should
sues which become visible when the person makes a implantology be the desired long-term restorative
broad smile.10 An individual’s smile makes a key con- option, any significant loss of bone volume will
tribution to overall facial aesthetics, and also plays an require bone augmentation prior to the eventual
important role in non-verbal communication, through implant placement. Additional surgical procedures
the conveyance of emotions such as happiness, fear, may also be required to achieve satisfactory soft tissue
sadness and surprise.11 augmentation at the implant site, which further
For adolescent patients, severely compromised and/ increases the biological, financial and opportunity
or missing anterior teeth in the aesthetic zone of the costs of treatment.16,17
202 © 2023 The Authors. Australian Dental Journal published by John Wiley & Sons Australia, Ltd on behalf of Australian Dental Association.
This is an open access article under the terms of the Creative Commons Attribution License, which permits use,
distribution and reproduction in any medium, provided the original work is properly cited.

This problematic scenario highlights the unrivalled
benefits of successful tooth autotransplantation into the
anterior segment of the mouth for adolescent patients.
Autotransplantation with successful periodontal liga-
ment preservation represents a unique opportunity with
an aesthetic advantage, due to its inherent potential for
physiologic tooth eruption, bone induction and re-
establishment of a normal alveolar process, which in
turn contributes to soft tissue preservation.17,18 In the
anterior maxilla, an immature premolar may be used as
a donor tooth to replace a severely compromised or
missing maxillary incisor.19–23
Despite its many advantages, tooth autotransplanta-
tion is undoubtedly a highly technique-sensitive proce-
dure. Appropriate individual case selection and
surgical skill are the critical determinants for auto-
transplantation success, with interdisciplinary collabo-
ration also required to achieve optimal functional and
aesthetic outcomes.3 Although the evidence-base is rel-
atively limited compared to other treatment modali-
ties, a systematic review reported transplanted teeth
to have a survival rate of 81% at a minimum of
6 years follow-up.24 A recent study has reported the
survival and success rates to be 93% and 80% respec-
tively, for transplanted premolars into the anterior
maxilla following dental trauma.25
Survival has been defined as the transplanted tooth
still being present in situ, with or without meeting
specific success criteria,26 with no presenting indica-
tion for extraction.27 Although there is no current
consensus regarding the definition of success for a
transplanted tooth,28 it has been suggested that a suc-
cessful transplant should satisfy the following criteria:
normal clinical and radiographic findings; no evidence
of ankylosis; no progressive resorption or infection; a
crown-to-root ratio close to normal; normal mobility
and gingival contour; and normal gingival pocket
depth.26,27 In addition, the perceived aesthetic out-
come of anterior tooth transplantation should also be
included as a parameter of success, as the aesthetic
presentation of tooth replacement in this region may
be considered as being even more important to the
individual patient.28
The treatment option of autotransplantation does
warrant serious consideration when the long-term
prognosis of an anterior tooth is questionable, where
suitable donor teeth at the ideal stage of root develop-
ment are present, and when restorative implant place-
ment is not yet possible due to expected future facial
growth and dentoalveolar change.3
Every patient who experiences significant anterior
tooth trauma must accept some degree of compromise
and additional ongoing cost. Therefore, a favourable
outcome for a transplanted tooth would be a scenario
when the tooth survives for several decades, functions
normally and has a reasonably aesthetic appearance.
© 2023 The Authors. Australian Dental Journal published by John Wiley & Sons Australia, Ltd on behalf of Australian Dental Association.
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Anterior tooth autotransplantation
Should these criteria not be satisfied for some reason,
anterior tooth autotransplantation may be viewed as a
long-term temporary option during the growth period
to preserve the alveolar ridge, whilst keeping future
restorative options open for the adolescent patient.3,21
The available treatment options for missing or fail-
ing anterior teeth in the aesthetic zone are directly
influenced by many variables. The age, growth poten-
tial, occlusal relationships, oral hygiene, periodontal
status, caries and/or dental pathology, and a patient’s
motivation and compliance are all important and rele-
vant factors. For adolescent patients with a poor
prognosis of one or more anterior teeth, the primary
objective is to preserve hard and soft tissues for as
long as possible, ideally into adulthood.29
This case series aims to demonstrate the impressive
biocompatibility of tooth autotransplantation. A combi-
nation of comprehensive treatment planning, gentle sur-
gical management of critical tissues and synergistic
interdisciplinary collaboration can successfully address
the clinical dilemmas faced by growing patients with sig-
nificantly compromised anterior teeth, especially when
limited alternative treatment options are available.
CASE SERIES
Case 1: Diagnosis
An 11-year-old patient presented with a Class II divi-
sion 2 malocclusion, a deep anterior overbite and
moderate to severe maxillary and mandibular arch
crowding. The maxillary right permanent central inci-
sor had a history of significant trauma, had undergone
previous endodontic treatment and was deemed to be
significantly compromised due to residual apical
inflammation (Figs 1a and 1b). The maxillary left
permanent central incisor had a small incisal edge
fracture and was asymptomatic. The panoramic radio-
graph (Fig. 1c) demonstrated a lack of space for
the erupting maxillary and mandibular permanent
canine teeth and favourable root stage development
of the mandibular first premolars to consider
autotransplantation.
Surgical and post-transplantation management
Given the features of the malocclusion and skeletal
profile, the removal of the maxillary and mandibular
first premolar teeth was considered justifiable to
resolve the intra-arch crowding. An interdisciplinary
discussion between the orthodontist, restorative den-
tist and oral and maxillofacial surgeon took place. All
relevant treatment options for the compromised 11
were discussed in significant detail with the patient
and family (Table 1). The treatment option of extract-
ing the 11, 14, 24, 34 and 44 with subsequent
203
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DC-V Ong et al

(a) (b) (c)

(d) (e) (f) (g) (h)

(i) (j) (k) (l) (m)

(n) (o) (p) (q) (r)

Fig. 1 (a and b) The 11 had previously sustained significant trauma, with the endodontic treatment deemed to be unsuccessful. (c) The pre-treatment pan-
oramic radiograph demonstrates a lack of space for the erupting maxillary and mandibular permanent canine teeth and favourable root stage development
of the mandibular first premolars to consider autotransplantation. (d–g) Intra-operative photographs demonstrate extraction of the 11 and subsequent auto-
transplantation of the donor 34 tooth into the 11 recipient extraction site. (h) Maxillary arch fixed orthodontic appliances were placed 2 years post-
transplantation to improve the position of the transplanted tooth and align the maxillary arch. No orthodontic treatment of the mandibular arch was
desired. (i–k) A series of periapical radiographs throughout orthodontic treatment demonstrate a normal appearance of the periodontal structures, with addi-
tional root development and pulpal obliteration observed post-transplantation. (l and m) Following removal of fixed appliances, the transplanted tooth and
the 21 were restored with composite resin to improve the dental aesthetics. (n–p) Upon review at 7 years post-transplantation, the composite resin restora-
tion on the transplanted tooth was intact and had maintained normal function, along with pleasing aesthetics. (q and r) The periapical radiograph demon-
strated a slight increase in root length of the transplanted tooth compared to the previous films, along with pulpal obliteration. The periodontium and
apical tissues appeared healthy, with no clinical signs of ankylosis. There was no radiographic evidence of replacement resorption or any other periapical
or periodontal pathology.

autotransplantation of either the developing 34 or 44
into the 11 recipient site under a single general anaes-
thetic was chosen by the family.
The patient was given 600 mg of Penicillin through
an intravenous drip. A laryngeal mask was used to
administer the general anaesthetic. The patient was
aged 11 years and 2 months when the donor 34 was
carefully removed and transplanted to the 11 recipient
site (Fig. 1d–g). The recipient site was prepared
conventionally3 as three-dimensional donor tooth tem-
plates for autotransplantation were not being rou-
tinely used at that point in time.
The patient was instructed to take 500 mg of
Amoxicillinâ tablets three times daily for five days.
Standard post-extraction hygiene measures were recom-
mended, including the use of a chlorhexidine mouth
rinse and gentle brushing until the retention suture was
due to be removed. The silk suture was removed after
14 days and satisfactory gingival health and primary
stability of the transplanted 34 were noted. The trans-
planted tooth was intentionally placed into a position of
204 © 2023 The Authors. Australian Dental Journal published by John Wiley & Sons Australia, Ltd on behalf of Australian Dental Association.
slight infraocclusion in the recipient site to avoid occlu-
sal interference, with an expectation that the tooth
would eventually erupt into functional occlusion. No
signs of infection were evident. The surgeon instructed
that no hard or sticky foods be chewed on the tooth and
to avoid contact sports for at least 3 months. Although
the transplanted tooth could have been restored with
composite resin 6 months post-transplantation, the
patient and family were satisfied to leave this tooth
unrestored until the completion of the planned future
orthodontic treatment. Upon review at 11 months post-
transplantation, the tooth was noted to have erupted
clinically and had light functional occlusal contact with
the mandibular incisors. Maxillary arch fixed orthodon-
tic appliances were placed 2 years post-transplantation
to improve the position of the transplanted tooth and
align the maxillary arch. The patient and family
declined the option for concurrent placement of man-
dibular fixed orthodontic appliances (Fig. 1h).
The process of pulpal obliteration is generally
reflective of ongoing tooth vitality and therefore does
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Anterior tooth autotransplantation

Table 1. Relevant treatment options for case 1

Treatment Endodontic re-treatment for the compromised 11 and reassessment
option 1
Advantages If successful, there is some potential for maintaining the compromised 11 in the short to medium term
If successful, this would delay the need for prosthetic replacement for the compromised 11, which in turn, maintains
alveolar bone volume in this area
Disadvantages Additional cost of the endodontic re-treatment with an uncertain prognosis and longevity of the compromised 11
Treatment Extraction of the compromised 11 and prosthetic replacement
option 2
Advantages Removes the compromised 11 and eliminates the risk of ongoing endodontic infection
Disadvantages Post-extraction bone atrophy will result in loss of alveolar bone volume
Restorative implant placement must be delayed until the cessation of facial growth
A removable partial denture or bonded bridge will be required to satisfy the functional and aesthetic requirements until the
cessation of facial growth
Treatment Extraction of the compromised 11 and 14, 24, 34, 44 with autotransplantation (i.e. recycling) of the 34 into the 11 site
option 3 (Chosen treatment option)
Advantages If successful, this would provide a biologically compatible and long-term replacement for the compromised 11
In the event of failure of the transplant, traditional treatment alternatives still remain viable
Disadvantages Success is directly dependent upon the surgeon’s skill and careful post-transplantation management of the transplanted 34
The transplanted 34 will require additional restorative procedures to resemble the morphology of a maxillary central incisor
Treatment Extraction of the compromised 11 and 24, 34, 44 with subsequent unilateral orthodontic space closure
option 4
Advantages If successful, this would provide a biologically compatible and long-term replacement for the compromised 11
Disadvantages More complicated and longer duration orthodontic treatment involving the use of temporary anchorage devices (TADs)30
would be required to achieve asymmetric orthodontic intra-arch space closure
The mesialised 12, 13 and 14 will require additional restorative procedures to resemble the morphology of maxillary central
incisor, lateral incisor and canine teeth respectively

not indicate a need for endodontic treatment. A series
of periapical radiographs demonstrate the normal
appearance of the lamina dura, intact periodontal lig-
ament and additional root development of the trans-
planted 34 (Fig. 1i–k). The duration of active
orthodontic treatment was 18 months. Composite
resin was placed on the transplanted 34 (to resemble
a maxillary permanent central incisor) and to restore
the enamel fracture on the 21, thus achieving satisfac-
tory anterior smile aesthetics (Figs 1l and 1m).
The patient was reviewed again 7 years post-
transplantation, aged 18 years at the time of this
review. The composite resin restoration on the trans-
planted tooth remained intact and maintained normal
function and pleasing aesthetics (Fig. 1n–p). The
transplanted tooth remained asymptomatic, with no
signs of ankylosis or periapical pathology (Figs 1q
and 1r).
Case 2: Diagnosis
An 8-year-old patient was referred for an orthodontic
consultation 5 days after the traumatic avulsion of the
maxillary left permanent central incisor (Fig. 2a). A
lateral cephalograph (Fig. 2b) demonstrated a signifi-
cant Class II division 1 malocclusion and it was deter-
mined that removal of the maxillary first premolars
would facilitate the anterior overjet reduction. The
panoramic radiograph revealed that the 14, 24 were
not at the ideal root developmental stage to consider
immediate autotransplantation, therefore the patient
was scheduled for review in another 12 months
(Fig. 2c). Three-dimensional computed tomography
© 2023 The Authors. Australian Dental Journal published by John Wiley & Sons Australia, Ltd on behalf of Australian Dental Association.
(3DCT) data were obtained at the next review
appointment (Fig. 2d), which confirmed further root
development of the 24 and the atrophic alveolar bone
change in the avulsed 21 region (Fig. 2e). Due to these
atrophic changes, a vertical ridge split osteotomy was
recommended to provide alveolar bone augmentation
in the 21 region.
Surgical and post-transplantation management
After considering all reasonable and relevant treat-
ment options (Table 2), the patient and family decided
to proceed with the option of transplanting the devel-
oping 24 into the 21 edentulous site. A specialist oral
and maxillofacial surgeon performed the vertical split
ridge augmentation, subsequently transplanted the
immature 24 into the 21 site, and also removed
the 54, 64 and 14 under a single general anaesthetic.
The patient was aged 9 years and 5 months at the
time of the surgery. Due to the more challenging pro-
cedures, the transplanted 24 demonstrated significant
immediate post-surgical mobility. Appropriate physio-
logic stabilization was provided with both a silk
suture and a flexible nickel-titanium orthodontic wire
splint for a total of 22 months (Fig. 2f).
The patient was reviewed periodically following the
autotransplantation procedure. Periapical radiographs
were taken at 4 and 22 months post-transplantation
demonstrated the presence of pulpal obliteration and
favourable root development (Figs 2g and 2h). Clini-
cally, the transplanted tooth was periodontally sound,
had grade one mobility, an absence of ankylosis and
demonstrated no signs or symptoms of periapical
205
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DC-V Ong et al

(a) (b) (c) (d) (e)

(f) (g) (h) (i) (j)

(k) (l) (m) (n)

(o) (p)

Fig. 2 (a) Clinical photograph taken 5 days following the traumatic avulsion of the 21. (b) Cephalometric analysis revealed a Class II division 1 maloc-
clusion, with significant proclination of the maxillary anterior teeth. Effective management of this malocclusion would ideally involve bilateral extraction
of maxillary premolar teeth to reduce the overjet, with the potential for autotransplantation of one of the extracted premolars to provide a biological
replacement of the avulsed 21. (c) The panoramic radiograph demonstrated that the 14 and 24 were not at the ideal stage for autotransplantation into the
21 site, due to their lack of root development. (d and e) Upon review 1.5 years later, a three-dimensional computed tomography (3DCT) was obtained,
which demonstrated further root development of the 24 and atrophic changes to the alveolar ridge in the 21 site. Autotransplantation of the 24 into the
missing 21 site (prepared with a vertical ridge split osteotomy to increase the buccolingual dimension of the alveolar ridge) was recommended at this time
to limit any further alveolar ridge resorption. (f) The donor 24 was transplanted into the 21 site and a flexible nickel titanium wire splint was placed to
provide primary stability. (g and h) Post-transplantation periapical radiographs were obtained, which demonstrated pulpal obliteration and additional root
development of the 24. No signs of ankylosis, periodontal, or periapical pathology were noted (i and j) Photographs taken 44 months post-
autotransplantation demonstrated a satisfactory composite build-up of the transplanted tooth and progression into the permanent dentition. Residual space
in the maxillary arch remained. (k) Comprehensive fixed appliance orthodontic treatment was provided to correct the Class II division 1 malocclusion, and
close all of the residual space in the maxillary arch. (l) A subsequent periapical radiograph during the active orthodontic treatment demonstrated continued
root development of the transplanted 24, with an absence of any radiographic pathology. The transplanted tooth responded normally to orthodontic forces
and had maintained periodontal and apical health. (m–p) Clinical photographs taken 6.5 years after post-transplantation demonstrated successful aesthetic,
functional and biological integration of the transplanted 24 in the maxillary left central incisor position.

pathology. It was decided to delay any active ortho-
dontic treatment until the remaining primary teeth
had exfoliated. At 22 months post-transplantation,
the patient requested to have the tooth restored to
improve its cosmetic appearance. A conservative com-
posite resin restoration was subsequently provided by
a general dentist, which immediately improved the
anterior smile aesthetics, with the restored trans-
planted tooth demonstrating satisfactory aesthetics
and function almost 2 years later, 44 months post-
transplantation (Figs 2i and 2j).
Comprehensive orthodontic treatment commenced at
44 months post-transplantation to address the Class II
division 1 malocclusion (Fig. 2k). A periapical radio-
graph was obtained 5.5 years post-transplantation
(Fig. 2l), with the asymptomatic transplanted tooth
demonstrating no signs of ankylosis or periapical
206 © 2023 The Authors. Australian Dental Journal published by John Wiley & Sons Australia, Ltd on behalf of Australian Dental Association.
pathology. The comprehensive orthodontic treatment
duration was 26 months. The patient was reviewed
again 6.5 years post-transplantation, aged 16 years at
the time of this review (Fig. 2m–p). The composite resin
restoration on the transplanted tooth had recently been
modified by the restorative dentist to improve the mor-
phological symmetry with the contralateral maxillary
right central incisor. The transplanted tooth had main-
tained normal function and although a slight discoloura-
tion was noted, the functional and anterior aesthetic
outcome was pleasing.
Case 3: Diagnosis
A 12-year-old patient presented for assessment of the
compromised maxillary left permanent central incisor
(Figs 3a and 3b). The 21 was traumatized in a fall
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Anterior tooth autotransplantation

Table 2. Relevant treatment options for case 2

Treatment Prosthetic replacement for the missing 21
option 1
Advantages Provides an immediate cosmetic and functional solution for the missing 21
Disadvantages A removable partial denture is the only viable option due to the pre-existing malocclusion and continuation of alveolar
bone growth
Atrophic changes in the alveolar bone will occur in the missing 21 site, thus requiring a future bone graft prior to implant
placement
Restorative implant placement must be delayed until the cessation of facial growth (and ideal implant placement and
function will not be possible without correction of the significantly increased overjet)
Treatment Extraction of the 14, 24 with autotransplantation (i.e. recycling) of the 24 into the missing 21 site (Chosen treatment
option 2 option)
Advantages If successful, this would provide a biologically compatible and long-term replacement for the missing 21
Orthodontic treatment can be performed post-transplantation to correct the Class II division 1 malocclusion
In the event of failure of the transplant, traditional treatment alternatives remain available
Disadvantages Success is directly dependent upon the surgeon’s skill and careful post-transplantation management of the transplanted 24
The transplanted 24 will require additional restorative procedures to resemble the morphology of a maxillary central incisor
Treatment Extraction of the 14 (i.e. to balance the missing 21) with subsequent asymmetric orthodontic space closure in the maxillary
option 3 arch
Advantages If successful, this would provide a biologically compatible and long-term replacement for the missing 21, with the 22
relocated into the 21 position and all posterior teeth in the second quadrant moved mesially
Disadvantages More complicated and longer duration orthodontic treatment involving the use of temporary anchorage devices (TADs)30
would be required to achieve asymmetric orthodontic intra-arch space closure
The mesialised 22, 23 and 24 will require additional restorative procedures to resemble the morphology of a maxillary
central incisor, lateral incisor and canine tooth, respectively
Treatment Extraction of the 11 (i.e. to balance the missing 21) with subsequent symmetrical orthodontic space closure in the maxillary
option 4 arch
Advantages If successful, this would provide a biologically compatible and long-term replacement for the missing 21, with the 22
relocated into the 21 position and all the posterior teeth in the maxillary arch moved mesially
Disadvantages Requires removal of the otherwise healthy 11 for dental symmetry, which may not be justifiable
More complicated and longer duration orthodontic treatment will ensue, as all posterior teeth in the maxillary arch will
require significant mesial movement
The mesialised 12, 22, 13, 23 and 14, 24 will require additional restorative procedures to resemble the morphology of
maxillary central incisors, lateral incisors and canine teeth respectively16

onto concrete 4 years previously, had undergone sub-
sequent endodontic therapy and had a large composite
resin restoration (Figs 3c and 3d). A lateral cephalo-
graph (Fig. 3e) demonstrated a significant Class II
division 1 malocclusion. Cone beam computed tomog-
raphy (CBCT) was obtained (Fig. 3f), with a radiolu-
cency noted in the apical region, in addition to mild
apical resorption and thinning of the labial plate.
These radiographic features were consistent with
inflammatory pathology. The long-term endodontic
prognosis was confirmed to be poor, which necessi-
tated the consideration of alternative treatment
options.
Surgical and post-transplantation management
Given the presence of the significant Class II division
1 malocclusion with an anterior overjet of 6 mm, it
was determined that removal of the maxillary second
premolars could be utilized to facilitate the required
overjet reduction. The CBCT data revealed that the
25 had a single root and an open apex measuring
3.3 mm in diameter (Fig. 3g). At this root develop-
mental stage, it was decided to consider autotrans-
plantation of the 25 into the 21 recipient site in the
near future. The patient underwent surgery 5 months
later, aged 12 years and 10 months. A rapid
© 2023 The Authors. Australian Dental Journal published by John Wiley & Sons Australia, Ltd on behalf of Australian Dental Association.
prototype biomodel was printed using the CBCT
data, with this replica tooth used to facilitate the
autotransplantation of the 25 into the 21 recipient
site.
To fabricate the rapid prototype biomodel, the pro-
spective donor 25 tooth was selected and isolated
from the other images through manipulation of the
3D data. The 3D data pertaining to the 25 tooth was
then transferred as a stereolithography (STL) file. The
3D printer read the information as a G-code file,
which is the standard language for most 3D printers.
The STL file was subsequently converted to a G-code
file for the 3D printer, which permitted the successful
printing of the customized tooth biomodel (Fig. 3h).
The autotransplantation procedure of the 25 into the
21 recipient site (and concurrent removal of the con-
tralateral 15 for symmetry) was performed by an oral
and maxillofacial surgeon under a general anaesthetic,
with the patient aged 12 years and 10 months.
The patient was reviewed 11 days and 28 days
post-transplantation. A flexible wire splint, which per-
mitted physiologic mobility (Fig. 3i), remained in situ
from the time of surgery. Composite resin bite stops
were placed on the occlusal surfaces of 16 and 26 to
ensure that the transplanted tooth was not subject to
antagonistic occlusal contact immediately post-
transplantation (Fig. 3j).
207
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DC-V Ong et al

(a) (b) (c) (d) (e)

(f) (g) (h)

(i) (j) (k) (l) (m)

(n) (o) (p) (q) (r) (s)

Fig. 3 (a and b) The 21 had sustained significant trauma 4 years previously, with endodontic treatment and a composite resin restoration provided shortly
thereafter. (c and d) The panoramic radiograph and periapical radiograph demonstrated the extent of compromise associated with the 21, which included a
significant loss of coronal tooth structure and ongoing endodontic complications. (e) Cephalometric analysis revealed a Class II division 1 malocclusion
with an increased anterior overjet. It was determined that removal of the maxillary second premolars to reduce the overjet would provide effective and pre-
dictable resolution of the malocclusion, with the possibility of transplanting one of these premolars to replace the significantly compromised incisor. (f and
g) Cone Beam Computed Tomography (CBCT) assessment revealed the poor restorative and endodontic prognosis for the 21 and favourable stage of root
development for autotransplantation of the 25. (h) The CBCT data was used to 3D print a tooth template biomodel of the donor 25 to facilitate precise
surgical preparation of the 21 recipient site and to minimize the extra-alveolar time of the donor tooth during the autotransplantation procedure, with the
primary objective to avoid undesirable damage to the periodontal apparatus. (i and j) A flexible wire splint was bonded to stabilize the transplanted tooth,
whilst maintaining physiologic mobility, and compomer was placed on the maxillary first permanent molars to avoid occlusal contact onto the transplant.
(k) Prosthodontic wax-up of the planned composite restoration for the transplanted tooth revealed the potential for significant aesthetic improvement. (l)
Conventional fixed orthodontic brackets were placed, with the nickel-titanium archwire in the maxillary arch carefully adjusted to avoid any active ortho-
dontic force on the transplanted tooth. (m) A periapical radiograph taken 3 months post-transplantation revealed no evidence of periodontal or periapical
pathology. (n) A minimal preparation composite resin restoration was performed on the transplanted 25 at 5 months post-transplantation, to ensure that the
transplant attained the morphology of a maxillary central incisor. (o) A subsequent periapical radiograph taken at 11 months post-transplantation revealed
pulpal obliteration and additional root development, which indicate the vitality of the transplanted tooth. (p) The transplanted tooth demonstrated no signs
of ankylosis and responded normally to orthodontic force. (q and r) The comprehensive orthodontic treatment duration was 23 months. Although the trans-
planted tooth is mildly discoloured, the overall anterior smile aesthetics are satisfactory, with normal function successfully restored. (s) A periapical radio-
graph was subsequently obtained at 29 months post-transplantation, which demonstrated a favourable outcome for this adolescent patient.

The wire splint was removed at 12 weeks post-
transplantation and the transplanted tooth demonstrated
good primary stability. A study model was obtained to
facilitate the planned composite resin build-up of the
transplant (Fig. 3k). Conventional fixed orthodontic
brackets were placed at 3 months post-transplantation,
with the nickel-titanium archwire in the maxillary arch
carefully adjusted to avoid any active orthodontic force
on the transplanted tooth (Fig. 3l).
A periapical radiograph was taken at 3 months post-
transplantation, which demonstrated no periapical
pathology or inflammatory resorption (Fig. 3m). The
prosthodontist waxed up the proposed crown morphol-
ogy of the planned minimal preparation composite
resin restoration for the transplanted tooth, which was
placed at 5 months post-transplantation (Fig. 3n).
208 © 2023 The Authors. Australian Dental Journal published by John Wiley & Sons Australia, Ltd on behalf of Australian Dental Association.
Another periapical radiograph was taken 11 months
post-transplantation (Fig. 3o), which demonstrated the
presence of pulpal obliteration and continued root
development. Clinically, the transplanted tooth was
periodontally sound, had no significant mobility,
showed no evidence of ankylosis and demonstrated no
signs or symptoms of periapical pathology (Fig. 3p).
The comprehensive orthodontic treatment was com-
pleted after 23 months of active treatment. Although
the transplanted tooth was mildly discoloured
(Fig. 3q), the overall anterior smile aesthetics was
pleasing (Fig. 3r), and normal function had been suc-
cessfully restored. A periapical radiograph was subse-
quently obtained at 29 months post-transplantation,
which demonstrated a favourable outcome for this
adolescent patient.
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Anterior tooth autotransplantation

Case 4: Diagnosis Although all clinical procedures are associated with

potential risks and costs, the benefits which would be
A 13-year-old patient presented with a Class II divi-
provided from successful autotransplantation of the
sion 2 malocclusion and it was noted that the maxil-
23 were considered to justify this surgical
lary left primary lateral incisor and maxillary left
intervention.
primary canine had not yet exfoliated naturally
(Fig. 4a,b). The panoramic radiograph revealed that
the 18, 22, 28, 31, 38, 47 and 48 were congenitally Surgical and post-transplantation management
absent and that the 23 was horizontally impacted
Space was opened orthodontically to prevent damage
(Fig. 4c). The lateral cephalograph (Fig. 4d) confirmed
to the 62 during the surgical repositioning of the 23,
the severely ectopic position of the 23 and the
as the over-retained 63 was assumed to be signifi-
extreme difficulties that would be associated with tra-
cantly narrower than the impacted 23 (Fig. 4e). The
ditional orthodontic canine disimpaction for this case.
patient was referred to a specialist oral and maxillofa-
Due to the low predictability of successful alignment
cial surgeon and had the surgical repositioning (i.e.
of the 23 through surgical exposure of the 23 and
autotransplantation) procedure performed under a
subsequent orthodontic traction, a decision was made
general anaesthetic at the age of 13 years and
to attempt surgical repositioning of the 23 using an
10 months, along with the removal of the over-
autotransplantation technique. Given that the 22 was
retained 63 (Figs 4f and 4g). Orthodontic treatment
congenitally missing, future prosthodontic treatment
continued as planned and the 23 was bonded with an
would almost certainly be required in the second
orthodontic bracket at 4 months post-transplantation
quadrant. If the 23 could be successfully repositioned
(Fig. 4h).
and maintained in its cornerstone position for the
Subsequent consultation with a prosthodontist
long term, this would represent the ideal treatment
determined that additional space was required to
outcome for such a challenging clinical scenario.

(a) (b) (c) (d)

(e) (f) (g) (h)

(i) (j) (k) (l)

(m) (n) (o) (p) (q)

Fig. 4 (a–d) A pre-treatment Class II division 2 malocclusion was noted, with congenital absence of the 22, 31 and 47. The maxillary and mandibular
third molars were also absent and the 23 was horizontally impacted. The 62 and 63 were over-retained. (e) Space was opened orthodontically to facilitate
surgical repositioning (i.e. autotransplantation) of the horizontally impacted 23, as this tooth was significantly wider in the mesiodistal dimension com-
pared to the over-retained 63. (f and g) The 63 was subsequently extracted and the 23 was successfully surgically repositioned into a vertical orientation
in the maxillary arch. (h) The 23 was bonded with a conventional orthodontic bracket at 4 months post-transplantation. (i) The comprehensive orthodontic
treatment duration was 30 months. (j and k) The over-retained 62 and 71 were subsequently restored with composite resin to improve their morphological
dimensions. (l) A panoramic radiograph taken 3 weeks post-treatment demonstrates the successful disimpaction of the 23, with no endodontic treatment of
this tooth required. (m and n) A review performed 17 years post-transplantation demonstrated the ongoing success of the surgically repositioned 23. The
23 remained asymptomatic and showed evidence of normal physiologic eruption, particularly in comparison to the adjacent 24. (o and p) Radiographic
assessment revealed pulpal obliteration and no signs of periapical pathology. (q) Clinical examination demonstrated physiologic mobility and normal peri-
odontal probing depth.
© 2023 The Authors. Australian Dental Journal published by John Wiley & Sons Australia, Ltd on behalf of Australian Dental Association. 209

DC-V Ong et al
permit restoration of the diminutive 62 and 71 to
larger mesiodistal dimensions. The objectives of these
build-ups were to improve the anterior smile aes-
thetics and to more predictably hold sufficient space
for the eventual definitive prosthodontic rehabilitation
in the missing 22 and 31 sites. The orthodontic appli-
ances were removed after an active treatment duration
of 30 months (Fig. 4i) and the composite build-ups
for the 62 and 71 were performed 3 weeks later
(Fig. 4j and 4k). A panoramic radiograph was also
obtained following the placement of the restorations
(Fig. 4l). The transplanted 23 did not undergo any
form of endodontic treatment.
The patient presented again 17 years post-
transplantation; aged 31 years old. The 23 was
slightly more yellow in colour (Figs 4m and 4n) and
had undergone pulpal chamber obliteration (Figs 4o
and 4p). The transplanted 23 had remained asymp-
tomatic, showed no evidence of ankylosis and demon-
strated normal periodontal health and mobility
(Fig. 4q). The 62 and 71 remained in situ along with
their original composite restorations and although
these restorations remained functional, significant dis-
colouration and deterioration of the margins had
occurred.
DISCUSSION
Autotransplantation of teeth may be considered a via-
ble treatment option for the replacement of missing
teeth, or teeth with a poor prognosis,3,33,34 with suc-
cessfully transplanted teeth able to restore normal
function.35 Transplanted teeth retain a vital periodon-
tium, and therefore remain compatible with ongoing
alveolar growth.36,37 Healthy transplanted teeth can
avoid the effects of progressive infraocclusion and can
regenerate38 and/or effectively maintain alveolar bone
by erupting and functioning in situ.17 Autotransplan-
tation also aids in the preservation of the natural gin-
gival morphology, which in turn, can improve the
overall aesthetic outcome.39 The autotransplantation
of immature teeth has numerous clinical advantages
and should be strongly considered for adolescent
patients with missing or failing anterior teeth when
alternative treatment options (e.g. orthodontic space
closure,30 paediatric implant placement etc.) are
contraindicated.26,40
Immature teeth with open apices usually have suffi-
cient blood supply, along with stem cells to promote
pulp revascularization following the transplantation
procedure.41 Pulp revascularization appears to permit
root development and the maintenance of pulp
vitality.42 Pulpal chamber obliteration is a normal and
expected sequela following autotransplantation, often
becoming radiographically evident 3 to 6 months
post-transplantation.43–45 Partial pulp chamber
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obliteration and continued root development appear
to be reliable indicators of pulp survival. It has been
reported that at 6 months post-transplantation,
73.5% of teeth with evidence of revascularization also
demonstrated partial pulp chamber obliteration. At
12 months post-transplantation, 100% of teeth had
undergone complete pulp chamber obliteration.44
Pulpal healing is expected following the transplanta-
tion of immature teeth, with endodontic treatment
being unnecessary in most cases. The immature roots
should continue to develop with the closure of the
apex and a positive response to pulp sensibility tests is
eventually expected. It is important to note that pulp
sensibility tests are unlikely to be reliable in the first
few months post-transplantation. Should any signs or
symptoms of pulpal pathology such as irreversible
pulpitis or inflammatory root resorption become evi-
dent, endodontic treatment should be commenced
immediately.46 Inflammatory resorption can develop
quickly, which implores the need for periodic and
attentive endodontic review, particularly in the first
12 months post-transplantation.
It is important to acknowledge that the donor tooth
chosen for autotransplantation should not have any
pre-existing periapical pathology, and that all clinical
interventions have inherent advantages and disadvan-
tages. The primary focus of post-transplantation end-
odontic success criteria is the absence of inflammatory
root resorption and ankylosis. Every individual patient
must be provided with complete information regarding
the potential costs (i.e. biological, financial and oppor-
tunity costs), risks and benefits associated with every
reasonable and relevant treatment strategy.46 Compre-
hensive and ongoing informed consent is of critical
importance, given the potential biological implications
and the financial and emotional investments involved.
Although the survival and success of a tooth trans-
plant are influenced by numerous variables,3 mainte-
nance of a healthy periodontal ligament is of primary
importance.2,17 The average autotransplantation suc-
cess rate is reported to exceed 80% if the root of the
transplant is immature at the time of surgery, with
the ideal root developmental stage suggested to be
one-half to three-quarters of the normal root length
using Moorrees’ root classification.47,48 A premolar
tooth with sufficiently long roots (i.e. desirable root-
to-crown ratio), yet still has an open apex at the time
of autotransplantation is an ideal donor candidate, as
there is still enough room at the apex for
revascularization.2 It has been suggested that the ideal
age for transplanting premolars is approximately
12 years of age,25 as the completion of root develop-
ment of these teeth has been reported to occur around
13–14 years of age.49
Despite this suggestion, this case series demonstrates
favourable autotransplantation outcomes in patients

ranging in age from 9 years and 5 months to 13 years
old at the time of the surgical procedure. This proba-
bly reflects that careful planning and surgical manage-
ment are the critically important factors and that
chronological age and dental development may vary
significantly between patients.
It has been suggested that the potential for compli-
cations such as pathologic root resorption and attach-
ment loss50 may be significantly diminished through
the use of cone-beam computed tomography (CBCT)
radiology and three-dimensional (3D) printing. Such
technology can be utilized to comprehensively assess
the quality and dimensional compatibility of both the
donor tooth and the recipient site. The most suitable
donor tooth can be selected and analysed with respect
to its dimensional size, crown morphology and stage
of root development, along with planning for its
atraumatic removal at the time of transplantation. In
addition, the donor tooth’s ideal 3D orientation and
the pre-existing alveolar dimensions of the recipient
site can be evaluated and confirmed prior to the sur-
gery. Following the pre-surgical anatomical assess-
ment, the 3D data can be used to fabricate a rapid
prototype biomodel to accurately replicate the donor
tooth and 3D print a surgical guiding template to pre-
pare the recipient site.51,52
The 3D printed biomodel facilitates surgical prepara-
tion of the recipient site, which reduces extra-alveolar
time and enables a smooth mechanical insertion and
bone adaptation of the donor tooth. Control of these
factors during surgery is vitally important, as this mini-
mizes any damage to the periodontal ligament and
Hertwig’s epithelial root sheath.53–55 Recent data have
confirmed that careful handling of the donor tooth
during surgery (i.e., its atraumatic extraction and its
subsequent ease of placement into the recipient site)
positively influences the pulpal and periodontal healing
post-transplantation.25
In this current case series, only Case 3 made use of
a 3D printed biomodel of the donor tooth to prepare
the recipient site. The primary reason for this was that
3D printed biomodels were not readily available in
private practice when Cases 1, 2 and 4 underwent
their respective autotransplantation procedures. This
new technology undoubtedly represents a significant
advantage, particularly for operators with less
experience.17 The authors now routinely utilize 3D
radiology and 3D printed biomodels for all autotrans-
plantation cases. Given the contemporary accessibility
of 3D radiology and printing, it has been suggested
that the use of such biomodels is essential to minimize
surgical risks.25
Immediately following the procedure, it is common
for a mattress suture to stabilize the transplanted
tooth.3 For more challenging cases with sub-optimal
primary stability (e.g. Case 2), which due to alveolar
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Anterior tooth autotransplantation
ridge atrophy involved the need for a vertical ridge
split osteotomy, a wire and composite resin splint
may be placed. In the event of inadequate stability, a
flexible splint with a steel wire diameter no greater
than 0.3–0.4 mm, thus allowing physiologic tooth
mobility, can be applied for 2 weeks to reduce the
risk of ankylosis.56 Where there is substantial mobility
of the transplanted tooth, the splinting period may be
extended up to 6 weeks.57 Unfortunately, it has been
reported that the absence of primary stability can con-
tribute to a larger number of complications during
healing.58
With respect to Case 2, although the alveolar bone
volume was reduced, it was deemed that a vertical
ridge split procedure would be adequate to prepare
the recipient site. If a serious alveolar deficiency (e.g.
due to trauma) or atrophy is evident, a pre-
transplantation autogenous block bone graft is gener-
ally required several months prior to the autotrans-
plantation to restore the lost bone volume.59
Unfortunately, such a situation requires two separate
surgeries (with general anaesthesia commonly pre-
ferred for paediatric patients) to complete the auto-
transplantation, with a likely commensurate increase
in potential patient morbidity, emotional, financial
and opportunity costs.
The transplanted 24 has demonstrated impressive
longevity and could be expected to function well into
the future. Should the transplanted 24 eventually fail
later in adulthood, the bone and soft tissue conditions
are likely to be favourable for an immediate implant
treatment. Maintaining a healthy transplanted tooth
in the 21 site has preserved alveolar bone, in both the
vertical and bucco-lingual dimensions. Given that the
maxillary first premolars were likely to require
removal for future comprehensive orthodontic treat-
ment, the autotransplantation option to recycle the
extracted 24 into the 21 recipient site has yielded sig-
nificant short, medium and long-term benefits. It is
pleasing to note that although the autotransplantation
procedure was performed prior to the ideal stage of
root development, the transplanted 24 continued to
develop favourably without any clinical or radio-
graphic evidence of compromise. The clinical reason-
ing for performing the autotransplantation of the 24
at an earlier stage of root development was to avoid
further atrophic alveolar bone changes in the recipient
site following the avulsion of the 21.
Predictably successful autotransplantation generally
requires a collaborative interdisciplinary team, which
ideally consists of an oral surgeon, orthodontist, end-
odontist, periodontist and restorative dentist. The
interdisciplinary treatment is often coordinated by an
orthodontist, as an orthodontist is more likely to see
the patient periodically throughout the overall
process.51 To achieve pleasing aesthetic outcomes for
211

DC-V Ong et al
transplanted teeth in the anterior maxilla, it is impera-
tive that the restorative dentist is involved in the
decision-making for the orientation of the transplant,
as this variable will influence the interim and final
restorative procedures.
Premolar crowns can be reshaped to resemble inci-
sor morphology. An additive direct composite resin
build-up is commonly used as an interim restoration,
with a porcelain laminate veneer offering a potential
long-term solution. With composite resin restorations,
it is often challenging to establish a normal incisor
width along the gingival margin due to the narrower
emergence profile of the transplanted tooth, and com-
posite restorations tend to discolour over time. Porce-
lain laminate veneers may offer solutions to these
issues.60 It has been recently proposed that temporary
veneers designed via computer-aided design/computer-
aided manufacturing (CAD/CAM) technology and 3D
printing may present a viable treatment option for the
restoration of transplanted teeth.61 Full coverage
crowns are generally contraindicated for children and
adolescents, due to their larger pulp chambers and the
potential for apical migration of the gingival margins,
which may lead to unaesthetic root exposure.60
Although limited, the available literature indicates a
high patient satisfaction with the aesthetic outcome of
tooth transplantation in the anterior maxilla. In one
of the first studies to assess this parameter for anterior
tooth transplantation, Czochrowska et al. reported
that 82% of the patients were satisfied with the over-
all aesthetic appearance.62
Shargill et al. reported that 92% of patients
(n = 20) that had undergone autotransplantation of
teeth into the anterior maxilla would recommend the
treatment to others.63 The majority of these patients
were satisfied with the final appearance of their trans-
planted tooth, with a median score of 8 on the Likert
scale (i.e. 1 = unsatisfying result, 10 = excellent
result).
A subsequent study by Stange et al. also found that
the majority of the patients perceived that their trans-
planted tooth appeared similar to the adjacent teeth.31
The prosthodontic literature has become increasingly
interested in the patient-reported outcome for
implant-supported restorations.32 A recent systematic
review has suggested that the patient-reported out-
comes of transplanted premolars appear comparable
to that of dental implants.28
It is generally advised that any traumatized tooth
involving injury to the periodontal ligament should
not be moved orthodontically for at least 6 months
after trauma. As transplanted teeth are considered to
have an iatrogenic injury to the periodontal ligament,
any planned orthodontic movement should be delayed
for 6 months post-surgery.29,64 According to Zachris-
son et al.,60 one sign of successful autotransplantion is
212 © 2023 The Authors. Australian Dental Journal published by John Wiley & Sons Australia, Ltd on behalf of Australian Dental Association.
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the continuation of root development. As the root of
a transplanted premolar continues to develop and a
normal periodontal ligament is established, these teeth
can be moved orthodontically and function similarly
to other healthy teeth. Although the evidence base is
relatively limited, orthodontic movement of healthy
transplanted teeth is considered to be safe, predictable
and effective.21,65,66
The majority of patients who undergo autotrans-
plantation of a premolar tooth into the anterior max-
illa require subsequent orthodontic treatment to align
the transplant with the adjacent teeth, which in gen-
eral, improves the functional and aesthetic
outcomes.20,60,67,68 Although orthodontic treatment is
not imperative for successful autotransplantation,69
interdisciplinary case management which includes
orthodontics is likely to significantly enhance the over-
all treatment outcome.51
Although tooth autotransplantation with an open
apex appears to have the highest success rate, the
prognostic factors that influence transplantation out-
comes have not been clearly identified due to inherent
methodological limitations. The available studies
included in a systematic review and meta-analysis uti-
lized different criteria to define a successful treatment
outcome, with a lack of standardization based on clin-
ical, aesthetic, patient comfort and patient perception
parameters.34 It was concluded that the evidence per-
taining to tooth autotransplantation was of low qual-
ity, due to the heterogeneity in study designs and an
absence of randomized clinical trials.
A subsequent systematic review and meta-analysis
found similar concerns with the existing evidence
base.70 Despite the relatively large number of studies
published on autotransplantation, no randomized clin-
ical trials were found. The prospective and retrospec-
tive studies and series of cases which were reviewed
provided only low-quality data, due to significant
methodological limitations.
Tooth autotransplantation with an open apex was
reported to have a success rate of 89% and a survival
rate of 98% and can be considered to be a viable
therapy in the rehabilitation of growing patients.70
The authors warned that, due to the absence of clini-
cal trials and the high risk of bias in the included
studies, the results of their systematic review and
meta-analysis must be interpreted with caution. A rec-
ommendation was made for future studies to specifi-
cally analyse the prognostic factors for
autotransplantation, with standardization of surgical
protocols and the parameters used to evaluate treat-
ment success.
Despite the current lack of high-quality evidence,
tooth autotransplantation appears to be a very prom-
ising technique, and often represents the treatment of
choice in a paediatric dental patient with missing or

traumatized incisors. It may be argued that the defini-
tion of a successful tooth replacement in an adolescent
patient may be different to the definition of prostho-
dontic success for an adult. For a growing patient
with missing teeth, compromised teeth or traumatic
dental injuries, the maintenance of alveolar bone is
critical. Therefore, a successfully transplanted tooth in
a growing patient may be defined as one that serves
the purpose of being a biological space maintainer
and having achieved a specific patient-oriented goal.
A transplanted tooth which survives until the majority
of vertical facial growth is complete could thus be
considered a success, even if it does not survive for
the patient’s entire lifetime. By surviving until at least
the beginning of adulthood, a healthy transplanted
tooth thus satisfies the specific functional, biological
and aesthetic goals for that particular period of time
and other treatment options can then be considered.3
Autotransplantation is a unique treatment option
for the growing patient because it provides a natural
tooth replacement.29 With appropriate case selection,
tooth autotransplantation has been demonstrated to
be both predictable and successful, providing unri-
valled potential for biological space and alveolar bone
maintenance. Of equal importance though, is that this
technique does not preclude other traditional treat-
ment options in the less likely event of complete fail-
ure of a transplanted tooth. If serious negative
sequelae did occur, the options of decoronation,71–74
localized segmental distraction osteogenesis75 and
future restorative implant placement remain
available.3
CONCLUSION
The success of autotransplantation is directly depen-
dent upon careful case selection, atraumatic removal
of the donor tooth, accurate preparation of the recipi-
ent site, keeping extra-alveolar time to an absolute
minimum and preserving the periodontal ligament.
Appropriate post-surgical care with periodic clinical
and radiographic follow-up is also of great impor-
tance. The contemporary availability of three-
dimensional computed tomography and biomodel fab-
rication has the potential to simultaneously reduce the
technique sensitivity and increase the predictability of
the autotransplantation procedure. This case series
demonstrates the clinical relevance and clear benefits
of autotransplantation for the management of adoles-
cent patients with missing or significantly compro-
mised anterior teeth. There is no other dental
technique or prosthodontic procedure which can offer
the biological and alveolar bone preservation advan-
tages of successful tooth autotransplantation. The
phenomenal value of autotransplantation for growing
patients requires due recognition and appreciation, as
© 2023 The Authors. Australian Dental Journal published by John Wiley & Sons Australia, Ltd on behalf of Australian Dental Association.
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Anterior tooth autotransplantation
this procedure permits cost-effective dental recycling
and truly biocompatible rehabilitation.
ACKNOWLEDGEMENTS
The authors wish to sincerely thank and acknowledge
the following clinicians for their involvement in this
case series: Dr Desmond Ong (Orthodontist – all
cases), Dr Paul Hanrahan (Orthodontist – Cases 1, 2),
Dr Geoffrey Dance (OMF Surgeon – Cases 1, 2), Dr
Osmo Hautaniemi (Restorative Dentist – Case 1),
Dr Todd Horan (Restorative Dentist – Case 2), Dr
Caitlin Stephens (Orthodontist – Case 3), Dr Steve Her-
riott (Orthodontist – Case 3), Dr Michael Burgess (OMF
Surgeon – Case 3), Dr Matthew Moore (Orthodontist –
Case 3), Dr Reena Ohm (Prosthodontist – Case 3) Dr Andy
Tsai (Endodontist – Case 3), Dr Charles Spry (Orthodontist
– Case 4), Dr Francis Monsour (OMF Surgeon – Case 4),
Dr Anders Blomberg (Prosthodontist – Case 4). The
authors wish to gratefully acknowledge the time and
efforts of Dr Paul Hanrahan and Dr Bill Kahler for
kindly reviewing the manuscript. Finally, the authors
also wish to sincerely thank all of the patients in the
case series for kindly granting permission to use their
clinical records and photographs for the purpose of
continuing professional development. Open access pub-
lishing facilitated by The University of Queensland, as
part of the Wiley - The University of Queensland agree-
ment via the Council of Australian University
Librarians.
AUTHOR CONTRIBUTIONS
DC-V Ong: Conceptualization; writing – original draft;
resources. P Goh: Writing – original draft; resources. G
Dance: Writing – original draft; resources.
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Address for correspondence:
Desmond Cheer-Vern Ong
Clinical Academic, Orthodontic Department, School
of Dentistry
The University of Queensland
Brisbane, QLD 4072
Australia
Email: d.ong@uq.edu.au
215