Autogenous tooth transplantation, or autotransplantation, is the surgical movement of a tooth from one location in the mouth to another in the same individual. Once thought to be experimental, autotransplantation has achieved high success rates and is an excellent option for tooth replacement. Although the indications for autotransplantation are narrow, careful patient selection coupled with an appropriate technique can lead to exceptional esthetic and functional results. One advantage of this procedure is that placement of an implant-supported prosthesis or other form of prosthetic tooth replacement is not needed. This article highlights the indications for autogenous tooth transplantation using 3 case reports as examples. A review of the recommended surgical technique as well as success rates are also discussed.

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Autogenous tooth transplantation: an alternative to dental implant placement?

The anterior maxilla is the most traumatized region during childhood. Posttraumatic complications occasionally lead to tooth loss as well as the need for future implants. Unfortunately, it is contraindicated to place dental implants during childhood. A waiting period of approximately 8 to 10 years before completion of growth is required. For this patient to become a candidate for future dental implants, it is necessary to ensure the continuous growth and to preserve the dimensions of the alveolar process until growth has ceased from time of injury until joint maturation. To achieve these goals, it is essential to coordinate the treatment sequence at the time of trauma. After loss of a traumatized anterior permanent maxillary incisor in young adults, treatment options are limited: orthodontic closure of the gap and reshaping the adjacent teeth, or tooth extraction and maintaining the gap with a temporary restoration. Orthodontic space closure has limited indications and requires prosthetic restoration of at least 2 teeth. Extraction and temporary restoration will usually lead to bone augmentation before implantation. Other possible treatment options include orthodontic extrusion of the root remnant (in cases of untreatable root fracture or complicated crown-root fracture) and a temporary crown to serve the patient until the completion of growth and development, autogenous tooth transplantation, intentional extraction and immediate tooth replantation, distraction osteogenesis, and decoronation. Because general rules do not apply, individual treatment plans are necessary.

Treatment options of untreatable traumatized anterior maxillary teeth for future use of dental implantation.

Autotransplantation of mandibular third molars in a precocious phase of development is indicated when a substitute for adjacent compromised or missing molars is needed, and when mesial movements of the posterior teeth, the resultant loss of space, and overeruption of opposing teeth and consequent changes in the occlusion must be avoided. Provided that the apices of the mandibular third molar are immature, the immediate replacement of a lost or compromised tooth usually ensures a good outcome. Transplantation of third molars helps to maintain alveolar bone and enables endosseous implantation without requiring bone regeneration. We present examples of transplantation of mandibular third molars and review the factors that affect the success or failure of this procedure, such as atraumatic extraction and adequate immobilization of the transplanted tooth and root development after transplantation. Sex or age seem to have no effect on the final outcome.

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Mandibular third molar autotransplantation--literature review with clinical cases.

Autotransplantation can provide patients with all the benefits of a natural tooth, but is seldom considered as a treatment option, in large part because of a lack of knowledge about periodontal tissue or the anatomy of teeth. The authors conducted a literature search using the PubMed database. They searched for key words including "autotransplantation," "clinical indications," "sequence and treatment procedures," "healing factors and prognosis" and "treatment options". Autotransplantation demonstrates as a viable treatment alternative, especially in growing adolescents. It provides a biological and economical treatment option for tooth replacement.

Tooth autotransplantation as a treatment option: a review.

We review the basic functions of neurotrophins and their receptors and discuss the expression and functions of neurotrophins and their specific receptors based on recent data using cultured cells from human periodontal tissues. Neurotrophins, nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), and neurotrophin-3 (NT-3) play crucial roles in the differentiation and survival of neural cells. Neurotrophins activate 2 different receptor classes: the tropomyosin-related kinase (Trk) family of receptor tyrosine kinases (TrkA, TrkB, and TrkC) and the p75 receptor, a member of the tumor necrosis factor receptor superfamily. Neurotrophins regulate both cell death and cell survival through activations of Trk receptors and/or p75 neurotrophin receptor. It has been reported that neurotrophins are also produced from non-neuronal cells, such as leukocytes, osteoblasts, or fibroblasts, and act in many other ways on nonneuronal cells. Neurotrophin expression during bone fracture healing is especially int...

Neurotrophins in cultured cells from periodontal tissues

Autotransplantation of teeth, if carried out successfully, ensures that alveolar bone volume is maintained due to physiological stimulation of the periodontal ligament. Autotransplantation has been carried out for many years, but with varying success rates. As a result, it is seldom regarded as an appropriate treatment option for patients with missing teeth especially with the continued development of osseo-integrated implants. Since placement of osseo-integrated implants in growing alveolar bone is contra-indicated, transplantation of available teeth remains a suitable choice for replacing missing units in the young patient. The role of autotransplantation of teeth in several clinical situations, the clinical techniques involved and factors influencing success of the transplant are discussed. The aim of this paper is to underline the evidence based principles for successful autotransplantation and present the technique as a viable treatment option in present day orthodontic practice.

S Thomas

Papers

Autotransplantation of teeth: is there a role?