Autotransplantation of teeth – An overview

Amrita Journal of Medicineroots, or single but concave or enlarged root, becauseof the potential for fracture at extraction or mechanicaldamage to the PDL because of a difficult extraction.Follow-up resultsReported survival rates of autotransplantation varyfrom 74–100% 33 . The follow-up periods and the kindsof teeth transplanted are different in each study. Severalfactors would affect the results of autotransplantation.The author has performed over 250 conventionalautotransplantations of teeth in 15 years. Of those, mostwere done with fully developed teeth; about 20 casesinvolved developing teeth. A total of 220 consecutivecases, which were observed for more than 2 years, wereanalyzed. The average follow-up period is about 6 years.The survival rate is in the range of 90% and success rate82%. The survival rate of the transplants into extractedsockets is 100% and their success rate is 95%. The survivaland success rate of intra-alveolar transplantationare high as well. On the contrary, the survival rate ofthe transplants into artificially formed sockets is about75% and their success rate is 60%. The decrease insuccess for transplants into artificial sockets mirrors thehistological results of a study in monkeys and appearsto highlight the importance of the periodontal ligamentcells remaining on the socket wall after extraction 34 .Another reason may be the increased extra-oral timewhen forming a large recipient socket into a compactbone which is time consuming and increased PDL damagedue to socket adjustment and occlusal adjustmentthat is more difficult in these cases. However, as withall procedures, the younger the patient the higher thesuccess rate. It is nearly 90% if patients are youngerthan 40 years of age 35 .Comparison of dental implant and autotransplantationof teethIt is inevitable to compare transplants with implantsbecause the two techniques have similar purposes.So, the criteria for choosing each must be discussed.Implants are indicated to all patients (who can affordthem) while transplants are limited to those who haveappropriate donor teeth 36 . The techniques for transplantsand implants are similar in difficulty and so is the highprognosis. However, the post-surgical restorative optionsare generally much simpler for transplanted teeth.Studies shows, transplants would be chosen prior toimplants in the following cases:• Patients treated before pubertal growth: If osseointegratedimplants are placed in these patients, theydo not erupt along with adjacent teeth and result ininfraocclusion with functional and esthetic problems.Transplanted teeth erupt in harmony with the adjacentteeth. However, it should be emphasized that transplantationshould not be carried out too early, since atthis stage of root development, the prognosis is not aspredictable 37-41 .• When patients have an unrestorable tooth requiringextraction and an ideal donor tooth is present:Transplants have several advantages over implants interms of function, esthetics, time and cost. Immediatetransplantation with extraction at the recipient siteis a procedure that provides significant time savingcompared to implants. Healing is rapid and function isobtained almost immediately. The transplanted tooth hasosteoinducing properties that results in bone regenerationof the bony defects around transplants without graftmaterials, significantly reducing time and cost comparedto implants. Transplants have the potential for superioresthetic results, since the natural emergence profileand the natural beauty of enamel and crown form ismaintained. Usually, the total cost of transplantation ismuch lower than implant treatment.• When intra-alveolar transplantation or intentionalreplantation is indicated: Severely decayed teeth andcrown-root fractured teeth can often be saved by surgicalextrusion 42-45 . In addition, intentional replantation is atreatment option for teeth with endodontic disease thatcannot be treated by conventional means. In clinicalpractice, it usually makes sense to maintain the use ofnatural teeth for as long as possible. With such proceduresavailable, extractions can be avoided or at leastdelayedConclusionAutotransplantation is often not considered as atreatment option when teeth are lost. This is very unfortunategiven that the biological principles for success areunderstood and the correct indications are present; it isan extremely successful treatment form with significantsavings in time and cost compared to implants. From thepatient’s perspective, the dentition is preserved using anatural tooth rather than a mechanical prosthesis. Thedental practitioner should definitely have the knowledgeto recommend and carry out this procedure to the appropriatepatient. Autotransplantation of teeth based onscience and the state of art will promise happiness andhealthy smiles of patients for a long time.References1. Apfel H. Autoplasty of enucleated prefunctional third molars.JOral Surg 1950;8:189–200.2. Andreason J, Paulsen H, Yu Z, Bayer T, Schwartz O. Alongtermstudy of 370 autotransplanted premolars. Part II.Tooth survival and pulp healing subsequent to transplantation.Eur JOrthod 1990;12:14–24.3. Lee S-J, Jung I-Y, Lee C-Y, Choi SY, Kum K-Y. Clinicalapplicationof computer-aided rapid prototyping for toothtransplantion. Dent Traumatol 2001;17:114–9.20

Amrita Journal of MedicineAutotransplantation of teeth – An overview4. Roberts JA, Drage NA, Davies J, Thomas DW. Effective dosefromcone beam CT examinations in dentistry. Br J Radiol2009;82:35–40.5. Andreasen JO, Paulsen HU, Yu Z, Bayer T, Schwartz O.Along-term study of 370 autotransplanted premolars, Part II.Tooth survival and pulp healing subsequent to transplantation.EurJ Orthod 1990;12:14–24.6. Guerini V. A history of dentistry from the most ancient timesuntil the end of the eighteenth century. Philadelphia: Lea&Febiger; 1909, p. 280–336.3. Hunter J. The natural history of human teeth. London: J JJohnson; 1771.4. Cserepfalvi M. Clinical report of homotransplantations.J AmDent Assoc 1963;67: 35–40.5. Cserepfalvi M. Experimental homogenous transplantation ofhuman teeth obtained from a human cadaver. J Oral ImplantTransplant Surg 1966;12: 66–726. Shulman LB. Allogenic tooth transplantation. J Oral Surg1972;30: 359–4087. Cserepfalvi MP. Homotransplantation of human teeth withand without pulp tissues. J District Colombia Dent Soc1976;11–5.8. Baum AT, Herts RS. Autogeneic and allogeneic tooth transplantsin treatment of malocclusion.Am J Orthod 1977;72:368–969. Schwartz O, Frederiksen K, Klausen B. Allotransplantationof human teeth. A retrospective study of 73 transplantationsover a period of 28 years.Int J Oral MaxillofacSurg 1987;16:285–301.10. Nordenram Å. Allogenic tooth transplantation with an observationtime of 16 years. Clinical report of 32 cases.SwedDent J 1982;6: 149–5611. Apfel H. Autoplasty of enucleated prefunctional third molars.J Oral Surg 1950;8: 289.12. Apfel H. Preliminary work in transplanting the third molarto the first molar position. J Am Dent Assoc 1954;48:13. Apfel H. Transplantation of the unerupted third molar tooth.Oral Surg 1956;9: 9614.14. Miller HM. Transplantation and replantation of teeth. OralSurg 1956;9: 84. Links15. Fukuro K. Bone morphometrical studies of intentional replantationin monkeys’ teeth.Jpn J Conserv Dent 1991;34:957–85[in Japanese].16. Ichinokawa H. Ultrastructural studies on periodontal tissuereactions following intentional tooth replantation in adultmonkeys. Jpn J Conserv Dent 1995;38: 63–8717. Ohyama K. The effect of storage media on periodontalhealing after intentional replantation of teeth in monkeys.Ahistopathological and morphometrical study.Jpn J ConservDent 1996;39: 685–70618 Isono T. Effect of storage media upon periodontal healingafter replantation of teeth in adult monkeys. J JpnSoc OralImplantol 1998;11: 375–8519 Löe H, Waerhaug J. Experimental replantation of teeth indogs and monkeys.Arch Oral Biol 1961;3: 176–84.20. Najleti CE, Caffesse RG, Castelli WA, Hoke JA. Healing aftertooth reimplantation in monkeys.A radioautographic study.Oral Surg 1975;39: 361–75. Links21. Andreasen JO. A time-related study of periodontal healing androot resorption activity after replatation of mature permanentincisors in monkeys.Swed Dent J 1980;4: 101–1022. Proye MP, Polson AM. Repair in different zones of the periodontiumafter tooth reimplantation. J Periodontol 1982;53:379–8923. Shimada T. Effect of periodontal ligament curetted in alveolarsocket for autotransplantation of tooth in adult monkeys. JJpnSoc Oral Implantol 1998;11: 492–500[in Japanese24. Andreasen JO. Periodontal healing after replantation andautotransplantation of incisors in monkeys.Int J Oral Surg1981;10: 54–61.25. Andreasen JO. Analysis of topography of surface and inflammatoryroot resorption after replantation of mature permanentincisors in monkeys.Swed Dent J 1980;4: 135–4426. Andreasen JO. Analysis of pathogenesis and topographyof replacement resorption (ankylosis) after replantation ofmature permanent incisors in monkeys.Swed Dent J 1980;4:231–4027. Andreasen JO. Relationship between cell damage in theperiodontal ligament after replantation and subsequent developmentof root resorption.ActaOdontolScand 1981;39:15–25.33.28. Andreasen JO, Kristerson L. The effect of limited drying orremoval of the periodontal ligament.Periodontal healing afterreplantation of mature incisors in monkeys.ActaOdontolScand1981;39: 1–13.[PubMed link]Links29. Andreasen JO, Skougaard MR. Reversibility of surgicallyinduced dental ankylosis in rats. Int J Oral Surg 1972;1:98–102.35.30. Andreasen JO. Histometric study of healing of periodontaltissues in rats after surgical injury. I. Design of a standardisedsurgical procedure. Odontol Revy 1976;27: 115–3032. Andreasen JO. Histometric study of healing of periodontaltissues in rats after a surgical injury.Healing events of alveolarbone, periodontal ligaments and cementum.Odontol Revy1976;27: 131–44.33. Yoshida M. An experimental study on regeneration ofcementum, periodontal ligament and alveolar bone in theintradentinal cavities in dogs.The ShikwaGakuho 1976;76:1179–222[in Japanese].34 Andreasen JO. Review of root resorption systems and models.Etiology of root resorption and the homeostatic mechanismsof the periodontal ligament. In: The biological mechanismsof tooth eruption and root resorption. Birmingham, Alabama:EBSCO Media; 1988. 9–21.35. Atrizadeh F, Kennedy J, Zander H. Ankylosis of teeth followingthermal injury. J Periodontal Res 1971;6: 159–6736 Cvek M, Lindvall A. External root resorption following21