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Evaluation of Bone Growth around Autotransplanted Teeth Using Cone-Beam Computed Tomographic Images
Introduction
The aim of this study was to evaluate root development in autotransplanted teeth using cone‐beam computed tomography (CBCT) images.
Methods
Twelve premolars with incomplete root formation, which were selected to replace prematurely lost upper central incisors, were analyzed by CBCT on two different occasions. The first CBCT examination (T1) was conducted before tooth autotransplantation. The second CBCT examination (T2) was performed over a follow‐up period of at least 12 months and < 5 years. Three previously calibrated evaluators assessed root development. The positions of the tomographic planes were standardized. The mean root length in sagittal and coronal tomographic sections was used to validate the root length at T1 and T2. Longitudinal root development of the transplanted tooth was determined by calculating the difference in root length between T2 and T1. The intraclass correlation coefficient (ICC), paired t ‐test, and Pearson test were applied, with significance set at 5%.
Results
The mean time elapsed between T1 and T2 was 962 days/2.6 years. The ICC was > 0.75. The measurements obtained at T2 were significantly greater than at T1 ( p = 0.001). The mean increase in root length was 2.83 mm. There was no significant correlation ( p = 0.413; r = 0.261) between root length increase and the time elapsed between T1 and T2.
Conclusion
Premolar teeth with incompletely formed roots transplanted to the upper central incisor region showed continued root development during postoperative follow‐up.
Tooth autotransplantation is a versatile procedure with several clinical applications among patients across different age groups. The success of this procedure depends on multiple factors. Despite the wealth of studies available, no single primary study or systematic review is able to report on every factor affecting the outcomes of autotransplantation. The aims of this umbrella review were to evaluate treatment‐related and patient‐related outcomes of autotransplantation and to assess the pre‐, peri‐ or post‐operative factors that could affect these. An umbrella review was conducted according to the PRISMA statement. A literature search of five databases was performed up to 25 September 2022. Systematic Reviews (SR) with and without meta‐analysis evaluating autotransplantation were included. Calibration among reviewers was carried out prior to study selection, data extraction and Risk of Bias (RoB) assessment. Study overlap was calculated using corrected covered area. Meta‐meta‐analysis (MMA) was performed for suitable SRs. The AMSTAR 2 critical appraisal tool was used to evaluate the quality of evidence. Seventeen SRs met the inclusion criteria. Only two SRs were suitable for conduct of MMA on autotransplantation of open apex teeth. The 5‐year and 10‐year survival rates were >95%. A narrative summary on factors that could affect autotransplantation outcomes and comparisons of autotransplantation to other treatment options were reported. Five SRs were rated as ‘low quality’ and 12 SRs were rated as ‘critically low quality’ in the AMSTAR 2 RoB assessment. In order to facilitate a more homogenous pool of data for subsequent meta‐analysis, an Autotransplantation Outcome Index was also proposed to standardise the definition of outcomes. Autotransplantation of teeth with open apices have a high survival rate. Future studies should standardise the reporting of clinical and radiographic findings, as well as the definition of outcomes.
Objectives: To determine the survival of intentional autotransplantation of developing teeth.
Material and methods: An electronic search was carried out in the MEDLINE database, Web of Science, and Cochrane Library. The criteria used are the ones described in the PRISMA Declaration. The following MeSH terms were used: ("tooth" [MeSH Terms] OR "tooth" [All Fields]) AND ("transplantation, autologous" [MeSH Terms] OR ("transplantation" [All Fields] AND "autologous" [All Fields]) OR "autologous transplantation" [All Fields] OR "autotransplantation" [All Fields]) AND ("humans" [MeSH Terms]. Randomised clinical trials and prospective and retrospective clinical studies were included.
Results: The meta-analytic study of overall survival included a total of 14 studies, yielding an overall survival rate of 97.9%. In studies with 1-year follow-ups, survival was 98%. The resulting 2-year follow-up rate was 97%, while the 5-and 10-year survival rates were 95.9% and 96.9%, respectively.
Conclusions: The autotransplantation technique performed in a single-phase and on teeth that have not completed their development is a predictable technique, with a described survival rate at a 2-year follow-up of more than 97%. Clinical Relevance The technique of dental autotransplantation is considered an important resource for the resolution and rehabilitation of tooth loss in patients, especially in those who are still in a growth period. Moreover, this technique has a low complication rate and a 10-year survival rate of 96.9%. It should therefore be considered a safe and reliable procedure.
Background/Aims
Autotransplantation of developing premolars is an established treatment to replace missing teeth in the anterior maxilla in growing patients with a reported success rate of over 90%. The normal shape of the alveolus is observed after transplantation, but data on the presence and amount of alveolar bone after healing has not been previously reported. The aim of this study was to look for potential differences in alveolar bone dimensions between sites where autotransplanted premolars replaced missing incisors and control sites of contralateral incisors.
Material/Methods
There were 11 patients aged between 10 and 12 years five months (mean age: 10 years and 7 months) who underwent autotransplantation of a premolar to replace a central incisor. Cone Beam Computed Tomography (CBCT) performed at least 1 year after transplantation served to evaluate bone at sites of autotransplanted premolars and controls (contralateral maxillary central incisor). The thickness of the labial bone, plus the height and width of the alveolar process were measured on scans and compared at transplant and control sites.
Results
Mean thicknesses of the labial bone at the transplant and control sites were 0.78 mm and 0.82 mm respectively. Mean alveolar bone height was 15.15 mm at the transplant sites and 15.12 mm at the control sites. The mean marginal thickness of the alveolus was 7.75 mm at the transplant sites and 7.98 mm at the control sites. Mean thicknesses of the alveolus for half of its vertical dimension at the transplant and control sites were 7.54 mm and 8.03 mm, respectively.
Conclusion
The mean values of bone thickness, width and height of the alveolar process at sites of transplanted premolars were comparable to the mean values for the control incisors. Successful autotransplantation of developing premolars to replace missing central incisors allowed preservation of alveolar bone in the anterior maxilla.
Objectives:
The objective of this systematic review and meta-analysis was to determine the rates of survival and success and the complications related to autotransplantation of teeth with incomplete root formation. Additionally, we attempted to identify the prognostic factors that influence the outcome of tooth autotransplantation.
Materials and methods:
A literature search for all data published until July 2016 was conducted. Inclusion and exclusion criteria were specified. Risk of bias was assessed with the Newcastle checklist. Meta-analysis was performed by using the DerSimonian-Laird random effect model. The 1-, 5-, and 10-year survival rates and the weighted estimated survival, success, and complication rates per year were calculated.
Results:
Thirty-two studies were included for analysis. The survival rates reported after 1, 5, and 10 years were 97.4, 97.8, and 96.3%, respectively. The annual weighted estimated survival rate (98.2%), success rate (96.6%), and complication rates in terms of ankylosis (2.0%), root resorption (2.9%), and pulp necrosis (3.3%) were analyzed. No firm conclusions could be drawn with respect to the prognostic factors due to insufficient evidence of high quality.
Conclusion:
The survival and success rates of autotransplantation of teeth with incomplete root formation were high (> 95%), with a low rate of complications (< 5%).
Clinical relevance:
Current evidence from the literature on autotransplantation of teeth with incomplete root formation shows favorable survival and success rates and low complication rates, indicating it is a reliable treatment option.
Much biomedical research is observational. The reporting of such research is often inadequate, which hampers the assessment of its strengths and weaknesses and of a study's generalisability. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) initiative developed recommendations on what should be included in an accurate and complete report of an observational study. We defined the scope of the recommendations to cover three main study designs: cohort, case-control, and cross-sectional studies. We convened a 2-day workshop in September, 2004, with methodologists, researchers, and journal editors to draft a che-cklist of items. This list was subsequently revised during several meetings of the coordinating group and in e-mail discussions with the larger group of STROBE contributors, taking into account empirical evidence and methodological considerations. The workshop and the subsequent iterative process of consultation and revision resulted in a checklist of 22 items (the STROBE statement) that relate to the title, abstract, introduction, methods, results, and discussion sections of articles. 18 items are common to all three study designs and four are specific for cohort, case-control, or cross-sectional studies. A detailed explanation and elaboration document is published separately and is freely available on the websites of PLoS Medicine, Annals of Internal Medicine, and Epidemiology. We hope that the STROBE statement will contribute to improving the quality of reporting of observational studies.
Introduction
Autogenous transplantation of a natural tooth to another site has significant advantages over dental implants, particularly in cases of agenesis, accidental tooth loss, or poor prognosis for the maintenance of tooth function.
Methods
This report describes a case of autogenous premolar transplantation into an artificial socket in the site of a missing maxillary lateral incisor in a 13-year-old girl. Clinical examination and radiography revealed tooth agenesis (#4, #10, #13, and #20) and microdontia (#7). The occlusion and skeletal maxillomandibular relations were normal.
Results
Tooth #29 was chosen for transplantation into the site of tooth #10 because of its size, stage of root formation, and possible closure of the spaces created by agenesis.
Conclusions
Autogenous transplantation is a feasible alternative to dental implants in cases of tooth agenesis or tooth loss because of trauma. Autotransplantation was indicated in this case because it ensures the natural (facial) growth of the alveolar process and preserves the function of periodontal tissues. A multidisciplinary approach (ie, combining techniques from different dental specialties) was important for treatment success. Clinical and radiographic follow-up confirmed that the transplanted premolar was esthetically comparable with the lateral incisor and that root development and pulp canal obliteration were complete.
Objective:
The aim of this study was to validate a method used to assess dental asymmetry, in relation to the skeletal midline, by means of CBCT.
Methods:
Ten patients who had CBCT scans taken were randomly selected for this study. Five different observers repeated 10 landmarks (x, y and z variables for each) and 12 linear measurements within 10 days. Measurements were taken in both arches to evaluate symmetry of first molars, canines and dental midline in relation to the skeletal midline. Intraclass correlation coefficient (ICC) was carried out to assess intra- and interobserver reliability for landmarks and distances. Average mean difference was also assessed to check measurement errors between observers.
Results:
ICC for the landmarks was, respectively, ≥ 0.9 for 27 (90%) and 25 (83%) variables for intra- and interobserver; ICC for distances was ≥ 0.9 for 7 (58%) and 5 (42%), respectively. All ICC landmarks for distances were >0.75 for both intra- and interobserver. The mean difference between observers was ≤ 0.6 mm for all the distances.
Conclusion:
The method used to assess dental asymmetry by means of CBCT is valid. Measurements of molars, canines and dental midline symmetry with the skeletal midline are reproducible and reliable when taken by means of CBCT and by different operators.
This article describes the long-term outcome of 40 consecutive patients having transplanted premolars. The objective of this ongoing study is to investigate survival rate, pulp survival rate, periodontal condition, and root development of autotransplanted premolars in orthodontic patients. This report covers 17 years; 32 orthodontic patients had 40 premolars transplanted into contralateral or opposing jaw quadrants where a premolar was missing. The teeth were examined systematically with clinical and radiographic measures at 1, 2, 6, 12, and 60 months or more after autotransplantation. The observation time varied from 2 years 5 months to 22 years 3 months, with a mean of 10 years 4 months. Bonded.018-in edgewise appliances were used, subjecting 87.5% of the transplanted teeth to normal orthodontic forces. One tooth was removed because of root fracture during the observation period, and 2 more had complications possibly related to the transplantation. The remaining 37 teeth and their supporting structures were all healthy at the last examination--a 92.5% success rate. Transplants with closed apices received endodontic therapy, but, in those with open or half-open apices, a 66% pulp survival rate was observed. No teeth in the sample had signs of replacement resorption or developed periodontal attachment loss. Inflammatory resorption in 2 teeth was arrested after endodontic treatment. Root formation, when not complete, continued on transplanted teeth, giving normal root form and adequate root length for normal function. It is concluded that autotransplantation of premolars combined with orthodontic treatment should be the first treatment alternative in cases of missing premolars, when a suitable donor tooth is available.
Background/aim:
There is a little research on the experiences and opinions of patients who have had autotransplantation of a tooth. The aim of the study was to assess the satisfaction of patients who underwent the autotransplantation of a developing premolar to replace a traumatised maxillary central incisor.
Materials and methods:
Eighty patients (with a mean age of 10.7-years) and 32 parents were surveyed with 13 and 7 questions, respectively, to determine their opinions about the surgery, post-operative period, orthodontic and restorative treatment they had received.
Results:
Patients and their parents were very satisfied with the outcomes of the autotransplantation treatment. The majority of patients and all parents declared that they would choose this treatment again if needed. Patients who already had aesthetic restoration of the transplanted toothscored significantly better in position, similarity to other teeth, alignment and aesthetics, when compared to patients before restoration of the premolar to the shape of incisor. Patients after orthodontic treatment considered the alignment of the transplanted tooth between the adjacent teeth as better when compared to patients before or during their orthodontic treatment.
Conclusions:
Autotransplantation of developing premolars to replace traumatized maxillary central incisors proved to be a well-accepted treatment option. A delay of restoration of the transplanted premolars to the shape of the maxillary incisors did not have a negative impact on the satisfaction with the treatment.
Introduction
The aim of this retrospective study was to assess the success, survival rate, and soft tissue esthetic of autotransplanted teeth.
Methods
This study included patients with at least 1 tooth autotransplanted to the maxilla during childhood or adolescence. The autotransplantation technique included the removal of an immature tooth from a donor site and its placement in the maxilla as a replacement for a missing or extremely compromised tooth. The cases were properly restored to assure function and esthetic. To be considered successful, the tooth should be asymptomatic at the time of assessment, no pain to palpation and percussion, have no signs of apical periodontitis or sinus tract, have a periodontal probe ≤ 3, and have an absence of root resorption and development of at least 70% of the normal root. The esthetic evaluation of the soft tissue was based on the Pink Esthetic Score (PES) and graded as very unsatisfactory, unsatisfactory, poor, fair, good, or excellent. Data were statistically analyzed at a significance level of 5%.
Results
Thirty-five patients (23 male and 12 female) had 43 anterior teeth replaced, including 42 central incisors and one lateral incisor. The follow-up period ranged from 1 year to 25 years. In regard to success and survival rate, 43 teeth were assessed; 34 cases (79.07%) were considered successful and 9 (20.93%) unsuccessful. Only 1 tooth was lost, and 42 teeth remained functional (survival rate 97.67%). In regard to the esthetic, 40 teeth could be assessed and were considered as excellent (30%), good (35%), fair (27.5%), and poor (7.5%); there were no reports of unsatisfactory or very unsatisfactory cases.
Conclusions
Tooth autotransplantation can be considered a valid procedure to replace lost teeth in the maxilla, presenting high survival and success rates. The overall esthetic of the patients was considered as satisfactory.
Aim
To systematically review buccal bone thickness (BBT) in the anterior maxilla in different teeth, age groups and genders.
Materials and Methods
PubMed, EMBASE and Cochrane databases were searched up to April 2020. Clinical and radiographic studies reporting on BBT of maxillary anterior teeth, with at least 10 patients were included. A meta‐analysis was performed using random effect models to report differences of BBT.
Results
50 studies were included. Using bone crest (BC) as a reference point, no significant differences were found in BBT between different tooth types, except for 0.16 mm (95%‐CI:0.02‐0.30) increased mid‐root thickness of premolars compared to canines. Using the CEJ as a reference point, canines presented with a significantly increased thickness of 0.32 mm (95%‐CI:0.11‐0.54) coronally compared to laterals. When BC was used as reference, males demonstrated a significantly increased thickness of 0.21 mm (95%‐CI:0.15‐0.27) apically, while middle‐aged adults showed a 0.06 mm (95%‐CI:‐0.12,‐0.01) statistically significant increase in the coronal level compared to older adults.
Conclusions
Few maxillary anterior teeth have BBT greater than 1mm. Buccal bone tends to get thicker from a coronal to apical position along the root surface and from an anterior to posterior position in the arch.
Objective:
Premolar autotransplantation represents an effective therapeutic option for the treatment of juvenile dentition with either aquired or congenital hypodontia. The objective of this prospective clinical study was to quantitatively assess bone and soft tissue levels after autogenous premolar transplantation by clinical and radiographic parameters.
Study design:
In the study, 26 premolars were transplanted in 20 patients after traumatic tooth loss (n = 16) or congenital aplasia (n = 10) in the anterior maxilla. Based on standardized photographic documentation, the relative soft tissue level was measured compared to the healthy adjacent teeth. Radiographic findings included evaluation of root resorption, pulp canal obliteration, and relative bone height.
Results:
Average survival rate of transplanted premolars (n = 26) was 100% over a follow-up period of 29 months (range 10-60 months). The relative soft tissue level significantly increased by +1.1 mm (P < .01). Radiographs showed a tendency toward vertical bone growth. Continuous root development and signs of pulpal healing were observed postoperatively in 18 transplants (69.2%).
Conclusions:
Autogenous premolar transplantation represents a safe method to ensure functional and aesthetic rehabilitation in the anterior maxilla irrespective of the nature of tooth loss.
The aim of this investigation was to assess the currently available evidence concerning the complications and risk factors influencing the outcome of autotransplantation of teeth in humans.
Electronic searches were conducted to identify randomized controlled and prospective clinical trials. Risk of bias within studies was assessed with the Downs and Black tool. Random-effects meta-analyses were conducted to pool the adverse event rates and relative risks with their 95 % confidence intervals. Risk of bias across studies was assessed with the GRADE framework followed by sensitivity analyses.
Thirty-eight studies were included in the analysis. Reported complications included the need for extraction, failure, hypermobility, pulp necrosis, pulp obliteration, and root resorption. Pooled complication event rates varied considerably, with small studies (<100 teeth) reporting greater complication rates. The analysis of risk factors was associated with both the primary outcome (extraction need) and secondary outcomes (failure, hypermobility, pulp necrosis, pulp obliteration, root resorption). The stage of root development seems to influence both the future survival, as well as the success of the transplanted teeth. Teeth with open apex were less likely to be extracted in comparison to teeth with closed apex (3 studies; 413 teeth; relative risk 0.3; 95 % confidence interval 0.2-0.6).
Due to the small number of the contributing studies, their methodological limitations, and the heterogeneous results reported, no firm conclusions can be drawn.
Root development of the donor teeth has been established as one the most important factor related to the success of tooth autotransplantation.
Abstract The aim of this study was to investigate the prognosis of replacing molars with advanced periodontitis by autotransplanted fully developed third molars. The patient sample consisted of 18 subjects, 24–58 years of age. The patients selected had at least 1 molar with advanced periodontal tissue destruction. After extraction of the diseased molar, autotransplantation of a third molar was immediately performed. After a splinting and healing period of 2–3 weeks, endodontic treatment was carried out. The follow-up included recordings of the clinical parameters, probing periodontal pocket depth, probing attachment level, percussion sound, and mobility. Radiographs were taken immediately after the surgical procedure, after 6 months, 1 year, and thereafter annually. The results of this study indicate that autotransplantation may be an alternative treatment procedure for molars with advanced periodontal disease.
Background: Knowledge on long-term clinical performance of more than 5 years on the single-implant CeraOne™ (Nobel Biocare AB, Gothenburg, Sweden) concept is limited.
Purpose: The aim of this study is to report the long-term clinical performance of the first CeraOne single-implant restorations, installed 17 to 19 years ago.
Materials and Methods: The group comprised 57 patients provided with 65 CeraOne single-tooth restorations. Sixty-two all-ceramic and three metal-ceramic crowns were cemented between 1989 and 1991. Patients were followed up clinically and with intraoral radiographs at placement, after 1, 5, and between 17 and 19 years after placement.
Results: Data were available for altogether 48 patients, followed up on an average time of 18 years. Excluding deceased patients (n = 2) and failed implant patients (n = 2), only five patients were lost to follow-up (8.8%). Two implants failed, resulting in an 18-year implant cumulative success rate (CSR) of 96.8%, and altogether eight original single-crown restorations were replaced (CSR 83.8%). The most common reason for crown replacement was infra-position of the implant crown (n = 3). Many of the remaining original crowns showed various signs of implant crown infraposition at the termination of the study. In general, the soft tissue at the restorations was assessed to be healthy and comparable with the gingiva at the adjacent natural teeth. Bone levels were on an average stable with only few patients exhibiting bone loss of more than 2 mm during 18 years in function.
Conclusion: This long-term follow-up study of single-implant restorations shows encouraging results with few implant failures and minimal bone loss over an 18-year period. Original single-crown restorations were replaced more frequently, because of, for example, implant crown infraposition and veneer fractures. The CeraOne concept proved to be a highly predictable and safe prosthodontic treatment.
This retrospective case-series study aimed to examine the long-term outcomes of autogenously transplanted premolars.
Twelve patients in whom donor premolars were used to replace maxillary central incisors lost by trauma were clinically and radiologically monitored. Standardized clinical and radiographic records were systematically obtained during the follow-up period of 14 years, to determine the influence of specific clinical criteria on the overall success rate of transplantation.
The success rate of premolar autotransplantation in the maxillary central incisor area was 80% after 14 years follow-up. The highest success rate occurred in those teeth transplanted with two-thirds of full root development. Complete pulp obliteration was positively related to autotransplant viability, followed by root formation in the bony crypt.
Autotransplantation of donor teeth, at the stage of ½ to ¾ of their expected root length, can provide a successful treatment solution for over 14 years.
Tooth autotransplantation has recently become a method of treating certain orthodontic problems. Over a 13-year period 370 premolar transplants were monitored by electrometric pulp sensibility testing and radiographic examination for pulp and periodontal ligament healing as well as root growth. This article describes the surgical technique as well as the precision of sensibility testing and radiographic examination for evaluating transplant healing. The sensibility response was found markedly related to the stage of tooth development but not to the type of premolar. The precision of sensibility testing (i.e. deviation of two consecutive measurements at a few weeks' interval) was found to range from 15-36 per cent for the different stages. Film holders were used to standardize the intraoral radiographic exposures. The precision percentage for the measuring technique of tooth length and crown width based on a single radiograph read twice (reading error) ranged from 1.1 to 1.8 with only small variations among the different types of premolar. The precision percentage of the radiographic exposure technique evaluated from two consecutive radiographs (measuring plus exposure error) was found to range from 1.2 to 4.2, again with small variations among the different premolars. The accuracy of the radiographic technique (i.e. deviation of radiographically determined tooth dimensions from the true values) was found to range from 2.0 to 2.9 with only small variation between the various types of premolar. In conclusion the evaluation of electrometric sensibility testing should take into account the stage of root formation of premolars.
The purpose of the present investigation was to determine the long-term prognosis of autotransplanted premolars with respect
to tooth survival and pulpal healing. The material consisted of 195 patients aged 7 to 35 years, with a total of 370 autotransplanted
premolars with observation period ranged from 1 to 13 years. Teeth transplanted with incomplete and complete root formation
showed 95 per cent and 98 per cent long-term survival respectively: Pulp healing as evaluated by sensibility testing and radiographic
signs of partial pulp canal obliteration was usually verified 6 months after transplantation. The frequency of pulpal healing
(versus pulp necrosis), appeared to be closely related to stage of root development at time of transplantation. Teeth transplanted
with incomplete and complete root formation showed 96 per cent and 15 per cent pulp healing respectively. Another and associated
factor which could equally well predict pulpal healing was the diameter of the apical foramen of the graft. Finally, in teeth
with completed root formation, the use of burs with internal cooling and no extra-alveolar storage prior to transplantation
seemed to increase the chance for pulpal healing. The present study indicates, that the size of the apical foramen and possibly
the avoidance of bacterial contamination during the surgical procedure are explanatory factors for pulpal healing.
In a retrospective study of a sample of 291 autotransplantations of human teeth carried out by 27 oral surgeons over a period of 25 years, the clinically and radiologically available factors at the time of surgery were analysed with reference to their prognostic relevance. Prognostically relevant factors related to loss of the transplanted teeth were determined by both univariate life-table analysis and multivariate Cox regression analysis. Of the 11 factors analysed in the Cox regression analysis, the following seemed to be prognostically relevant to loss or retention of the graft: developmental stage of the graft, age of the patient, donor tooth type, ectopia of the donor tooth, extraoral storage of the graft, and oral surgeon. In the present material, the prognosis of the grafts did not seem to be significantly influenced by such factors as prophylactic administration of antibiotics and fixation time. Using relevant parameters, it is possible to create a prognosis forecast for the individual patient. A case with a favourable set of parameters is shown.
The factors which controlled or influenced incorporation of the replant or transplant into the host site were complex and vague. Certain similarities between animal and human studies were noted. Preservation of the periodontal membrane seemed to be an important consideration, as did proper storage of teeth, even for short times prior to replanting or transplanting. Although long-term results were favorable in many cases, resorption of the root was often seen. This resorption was unpredictable in its degree and onset. Generally, where pulpal elements were left intact, degeneration of vital elements followed and eventually produced a pulp that was replaced with a bonelike substance. Both replants and transplants showed successful clinical results well beyond 2 years. Rarely did periodontal pocket formation result from the procedure, and teeth were usually immobile and functional in a relatively short period of time. Root radiolucencies were infrequent, and the regeneration of bone about the root of the tooth was the usual finding. Partially formed teeth did have the ability to complete amelogenesis and cementogenesis, as well as to re-establish a normal periodontal membrane space. The variations in the odontoblast layers seen in normal teeth¹⁴⁶ made this a difficult measure of transplant success, although odontoblasts were observable in many successful transplants.
Autotransplantation of developing premolars to replace maxillary incisors has been documented to provide physiologically sound results, but comprehensive studies of the esthetic outcome have not been made previously. In order to assess the applicability of this approach and to identify factors important for planning of treatment, 22 autotransplanted premolars reshaped to incisor morphology were compared to their natural, contralateral maxillary incisors by scoring of features considered important for esthetics (color, soft tissue appearance, tooth morphology, and position). The sum of scores for each feature was used to place the reshaped transplant in one of three categories - Match, Deviate, Mismatch. The 22 patients were asked to fill in a questionnaire which addressed the same features that were examined professionally, and the responses were categorized as either Satisfied, Acceptable, or Dissatisfied. Eleven of the 22 patients had received orthodontic treatment with fixed appliances following the transplantation. Most of the transplanted premolars matched the contralateral incisor, and the majority of patients were satisfied with the appearance of the transplant. Fourteen percentage of the transplants were categorized as Mismatch and 18% of patients reported dissatisfaction. The distribution in categories assessed professionally and by the patients was not significantly different. The color and gingival width of the transplanted tooth were scored as different from the natural incisor in about half of the bilateral comparisons. For those teeth categorized professionally as Mismatch and by patients as Dissatisfied, a potential for esthetic improvement could be identified, as allocation to these categories was primarily due to suboptimal positioning and restorative build-up of the transplant. Inter-disciplinary planning is important for successful esthetic results.
To evaluate the effects of the tooth eruption process on the position of teeth adjacent to implant-borne restorations in adult patients compared to patients in their late adolescence.
The sample included 28 patients divided into two groups. A "young adult" group consisting of 14 patients, aged from 15.5 to 21 years, and a "mature adult" group consisting of 14 patients, aged from 40 to 55 years. All patients presented missing anterior teeth, requiring insertion of 40 implant fixtures (16 central incisors, 12 lateral incisors, 12 canines). The implants were of the Straumann Dental Implant System, clinically and radiologically re-evaluated 1 year or more after the surgical procedure (mean interval=4.2 years). Assessment of the eruption of the adjacent teeth was performed using the implant as a stable point of reference: measurements of the different reference points were compared after implant placement and at follow-up examination.
In the "young adult" group, all patients showed infra-occlusion of the implant-supported crowns: the vertical step measured on radiographs varied between 0.1 and 1.65 mm. In the "mature adult" group, all patients showed a vertical difference between the teeth adjacent to the implant-supported crown and the implant: the measured step ranged from 0.12 to 1.86 mm. No difference was found in the amount of vertical eruption between male and female patients, nor according to localization of the implant.
Mature adults can exhibit major vertical steps after anterior restorations with osseointegrated fixtures to the same extent as adolescents or "young adult" individuals with residuous growth potential.
Success, survival rate, and soft tissue esthetic of tooth autotransplantation
- de Freitas Coutinho
The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies
- von Elm