Tooth Transplantation

Tooth Transplantation

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

Hertwig’s epithelial root sheath

Tooth transplantation

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

1. Transplantation from one region to another

2. Transalveolar transplantation

Sagne S. : Autotransplantation of teeth Int Dent J. 1985 : 35 , 280-283

 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
 Transplant from
lower 3rd molar to
lower 1st molar
 Transplant from lower
3rd molar to lower 1st molar

Most reported cases of autotransplantation

1. a result of caries the first molar is frequently
missing or removal in adolescents
2. Developing third molars are usually available
in adolescents
3. In a majority of case the rate of success is well
over 95%* for an extended period of time
*Andreasen et al. 1992
 Indication for
3rd molar to 1st molar
1. Appropriate candidates are adolescent patients
( 13 to 20 years )
2. Recent lost or about to lose a permanent first molar
3. 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
 Indication for
3rd molar to 1st molar
3. 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
 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
 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
 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
 Surgical technique

2. 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
 Surgical technique

2. 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
 Surgical technique

3. 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
 Surgical technique

3. 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
 Surgical technique

3. 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
 Surgical technique

3. 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
 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
 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
 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
 Precautions

The precaution that help ensure successful autogenous

transplantation are the following :
1. Root development of donor tooth is between 1/3 to 1/2 of the
total root
2. Hertwig’s epithelial root sheath is not injured during surgery
3. The host site is prepared to avoid injury to the epithelial root
sheath
4. The patient should be healthy with adequate oral hygiene
5. Pulpy foods that might pack into the cervicular space should be
avoided
6. The patient should consider the procedure important, keep
operative site clean and avoid trauma from occlusion
 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
 Transplant from
premolar to
upper central incisor
Transplant from premolar
to
upper central incisor
 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
Surgical technique

The maxillary central incisor is extracted

Surgical technique

The socket is enlarged with surgical bur

The socket is expanded palatally , then rinse with saline
Surgical technique

Testing the size of socket by a glass replica of a premolar

 Surgical technique

Removing maxillary second premolar using gentle luxation movement

 Surgical technique

Repositioning of the transplant, it is placed 45◦ rotate in order to

achieve sufficient cervical width
Surgical technique

Splint the transplant with 0.20 mm stainless steel wire

Surgical technique

Complete treatment, after grinding and restore with crown

 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
 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