You are on page 1of 35

+

TRANSPLANTATION
Huong T Le DDS
LSU Health Sciences Center University of Texas Dental Branch 2009

+ Basic Definition of Auto Transplantation
Transplantation of teeth from one site to another in the same individual, involving transfer of embedded or impacted or erupted teeth into extraction sites or into surgically prepared sockets

+

General Considerations 

Transplantation superior to other treatments options 
  

Implants Removable prosthesis Fixed partial dentures Orthodontics 

  

Better in function, time, cost, prognosis, and biocompatibility Patient factors: health and age Donor tooth factors: stage of development, shape, and size Recipient site factors: width and height and presence of periodontal ligament

intra-alveolar transplantation. and intentional replantation .+ Classification three groups: conventional transplantation.

possible to premolar area or anterior area Donor tooth not limited to third molars    Malpositioned or impacted premolars or canines can serve as donor tooth .+ Conventional Transplantation Indications  Unrestorable tooth and non-functioning third molar or malpositioned tooth Often indication is third molars to extraction site to unrestorable first or second molars ‡ If size of donor tooth is appropriate.

+ Conventional Transplantation Transplantation of third molars to area of second molars .

pulpal healing may not be expected  . underdevelopment of root may result If development stage is more than 5.+ Conventional Transplantations Donor Tooth Factors   Nonfunctional with appropriate root form Developing teeth prefer over fully developed teeth   Easier to extract Good healing potential  Developing tooth root should be at stage 4 or 5  If development stage is lower than 4.

+ Conventional Transplantation Donor Tooth Factors  Ideal Root Shape ² relatively smooth. conical single root  Very large roots. or curved roots have a tendency towards mechanical trauma to periodontal ligament during extraction or transplantation ‡ Makes procedure more challenging  Short Root Trunks tend to develop periodontal pockets at furcation area after transplantation Multi-rooted with enamel projection or periodontally involved teeth with attachment loss of more than one third of roots are contradicted  . widely spread roots.

+ Conventional Transplantation Indications and Contradictions for donor teeth based on shaped of roots .

+ Conventional Transplantation Donor Tooth Factors  If more than 2 teeth are available. the choice of donor tooth depends on shape of crowns of the teeth ‡ Mandibular third molars are more similar to other mandibular molars than maxillary third molars in shape and more suitable for replacement .

by enlarging the socket surgically    In case of maxillary sockets. sinus lifts may be needed .+ Conventional Transplantation Recipient Site Factors  Ideal recipient socket should have enough width and height to receive donor tooth completely Better healing expected if bony supports of recipient socket have periodontal ligament tissue still attached after extraction of condemned tooth Recipient site improved. if needed.

the more difficult it is to gain attachment in distal area of autotransplanted tooth ‡ Leads to development of distal periodontal pocket  It is desirable for lowest part of crowns of horizontally impacted teeth to be located coronal to middle of root of second molar .+ Conventional Transplantation Other Considerations  Transplantation should occur within 1 day to 1 month after extraction Horizontally impacted third molars can be transplanted to adjacent second molar are   Prognosis depends on position of third molars ‡ More apically it is located with respects to second molar.

+ Conventional Transplantation Relationship of position of horizontally impacted third molar to prognosis for transplantation .

+ Intra-Alveolar Transplantation Considerations  Surgical uprighting and surgical extrusion also follow the same healing process as autotransplantation   Considered same category Could be defined as intra-alveolar transplantation  Problems in cervical area of tooth ² deep decay ² is indication for surgical extrusion Prognosis depends on shape of root   Conical single-rooted have a less change of attachment loss or resorption .

+ Intra-Alveolar Transplantation Illustration of Surgical Uprighting .

+ Intra-Alveolar Transplantation Surgical Extrusion .

+ Intra-Alveolar Transplantation Illustration of Surgical Extrusion .

+ Intra-Alveolar Transplantation Surgical Extrusion .

surgical up righting. or extrusion without complete extraction may be an option.+ Intra-Alveolar Transplantation Indications  If Restoration or preservation of tooth is difficult due to deep caries or crown fracture. Should be investigated and compared to minor tooth movement. MTM   MTM has better predictability . exchanging position of tooth or extrusion by replantation.

+ Intra-Alveolar Transplantation Indications  Surgical extrusion or uprighting indicated when: 1. Difficulty in extrusion and less predictability in obtaining attachments Pulp Vitality  Surgical extrusion or up righting of teeth with vital pulps require root canal therapy either before or immediately after replantation  Pulpal healing expected when repositioning developing teeth  Pulpal obliteration is common outcome  Orthodontic movement is preferable if tooth is vital . Proper Root Form  Conical single-root ² comparable to orthodontic extrusion  Concave roots. curved roots or thickened apices ² surgical extrusion avoided ‡ 2. short root trunks.

Orthodontic Appliances  Surgical extrusion is indicated if patient cannot wear orthodontic appliance ‡ Insufficient interocclusal arch space ‡ Isolated tooth needs to repositioned 4. Rotational Movement    More beneficial if deep caries or fracture line caused by trauma is located mesiodistally or palatally Maximum amount of root surface can be placed in bone by locating most broken part buccally while keeping healthy tooth structure about the bone crest Maximize contact between root and bone .+ Intra-Alveolar Transplantation Indications 3.

Requires definitive diagnosis of traumatized teeth   Teeth with trauma-induced fractures require extrusion Unnoticed fracture lines in the root can sometimes be detected with surgical extrusion .+ Intra-Alveolar Transplantation Indications 5. Time and Cost   Takes less time than orthodontic treatment Restoration treatment is possible 3-5 months after surgical extrusion Relapse tends to happen after orthodontic movement if duration or retention is inadequate Less costly because it does not require any special appliances   6.

+ Intentional transplantation Indications  Should be last treatment option for Lesions of Endodontic Origins (LEO)  When conventional root canal treatment or surgical endodontics is not feasible Teeth with LEO with irremovable post and core. accessory canals. calcified apex. etc Apicoectomy is first choice but intentional replantation would be the choice of treatment   ‡ Accessibility or definitive diagnosis of suspected root fractures .

+ Intentional Transplantation Failure of Intentional Replantation .

+ Intentional Transplantation Lesions of Endodontic Origins .

fixed. autotransplantation makes placement of fixed partial denture (instead of removable) possible  .Transplantation relative to Various + Dental Disciplines Prosthodontics  First and foremost indication for transplantation is in the treatment of edentulous areas  Still remains unclear if one missing first molar would be ideal indication for dental implant  Presence of nonfunctional teeth  Transplantation and removable. or implant prostheses considered treatment of choice In some cases.

Transplantation relative to Various + Dental Disciplines Orthodontics  Orthodontic treatment not indicated due to technical reasons or time limitations. surgical repositioning or transplantation is an option Congenitally missing teeth Trauma-induced tooth loss   .

+ Wound Healing Five Categories: Healing of Periodontal Ligament. and Healing of Pulp and Continuation of Root Development . Mechanism of Root Resorption. Healing of Gingival Tissue. Healing of Alveolar Bone.

reattachment occurs in 1-3 weeks   .+ Healing of the Periodontal Ligament Reattachment in Replantation  Defined as reunion of connective tissue and root surface that have been separated by incision or injury  Connective tissue (fibrous) reunion with root surface ² vital periodontal ligament is attached and surrounds root after replantation  Ideal healing occurs when extracted tooth is replanted in original extraction socket within a short period Takes more than 1 month for periodontal ligament healing to reach initial stage gingival area and cervical areas of root.

+ Ideal Healing of Periodontal Ligament Replantation in Original Extraction Socket .

+ Healing of Periodontal Ligament Healing Process  3 days post replantation  Fibrin and Erythrocytes scattered between root·s attached periodontal ligament and left in extraction socket Hemorrhage is observed in some areas   1-2 weeks post replantation   Fibroblasts and collagen fiber are visible in torn area Indicates beginning of repair of periodontal ligament  3-4 weeks post replantation  Proliferation of fibroblasts and regularly aligned bundles of collagen fibers .

+ .

+ Vitality of Periodontal Ligament  Success of autotransplantation of teeth depends mainly on vitality of periodontal ligament attached to donor tooth Prevention of root resorption   Desirable to extract tooth with as much periodontal ligament as possible attached to it. even though the cementoblast layer by itself seems to effective in prevention of root resorption  Survival rate of periodontal ligament is susceptible to changes in QH and osmotic pressure    Vital > 18mins NonVital : 30-60mins Necrotic <120mins  Vital for hours (<24hrs) in milk or recently developed preservation liquids .

+ Mechanism of Root Resorption  Occurs when donor tooth with partial or total lack of vital periodontal ligament is transplanted or replanted Categories:     Replacement Resorption Inflammatory resorption Surface Resorption  Extent of missing periodontal ligament and existence of pulp infection determines type of resorption .

+ Classification of Root Resorption Replacement Resorption .