Michael D. O'Donnell
| Michael D. O'Donnell |
Introduction
Replacement of an unsalvageable, mature tooth in adults often leaves clinicians with the options of dental implant placement or fixed partial denture placement. Autotransplantation presents clinicians with an alternative option of a biological replacement for a tooth planned for extraction.
Methods
A 22-year-old male presented to the PDM Endodontic graduate clinic for treatment of tooth #19. Based on thorough clinical and radiographic examinations, tooth #19 was diagnosed as previously endodontically treated with symptomatic apical periodontitis. Additionally, a cone beam computed tomography (CBCT) scan displayed a periapical low-density lesion 20 x 15 mm in diameter extending around the apices of mesial and distal roots to the furcation; the lesion perforated the buccal and lingual cortex. The prognosis of tooth #19 was deemed hopeless and planned for extraction. The existing treatment plan included extraction of all four of the patient’s third molars. Given the fact that tooth #17 was intact and exhibited similar morphology to tooth #19, autotransplantation of tooth #17 to tooth #19 position was proposed and accepted. Tooth #19 was first extracted, followed by immediate extraction of tooth #17. Extraoral procedure combining root-end resection, preparation, and retrofilling was performed on tooth #17 under Hank’s balanced salt solution. The total extraoral time of the donor tooth was 16 minutes. The donor tooth was transplanted into tooth #19 socket and splinted using a flexible wire. After 10 days, the splint was removed and root canal treatment was performed.
Results
Biopsy of the tissue sac removed from tooth #19 socket site revealed a diagnosis of radicular cyst. At 10-day follow-up, the patient was asymptomatic and the transplanted tooth exhibited class I mobility. At 4.5-month follow-up, the patient stated that transplanted tooth had remained asymptomatic and fully functional. Based on the follow-up CBCT scan, the size of the periapical radiolucency decreased significantly and the buccal and lingual cortex showed signs of reestablishment.
Conclusion
The transplanted mature third molar replaced the first molar, allowing the patient to resume normal function in a timely manner. In selected cases where a suitable donor tooth is available, autotransplantation is a viable treatment option for the replacement of an unsalvageable tooth.