AUTOGENOUS TOOTH TRANSPLANTATION

What is “Autogenic Dental Transplantation”? “Autogenic Dental Transplantation can be defined as, 'the transplantation of a tooth from one position to another in the same individual.”More clearly “autotransplantation is the surgical movement in one individual of a vital or endodontically treatedtooth from its original location in the mouth to another site.

How it differs from a Dental implant? “A dental implant is an artificial tooth root used in dentistry to support restorations that resemble a tooth or group of teeth”.

Autogenic tooth transplantation first well-documented in 1954 by M.L. Hale. The major principles of his technique are still followed today.The science of autotransplantation has progressed, as evidenced by the high success ratesreported in studies over the past decade. These studies demonstrate that autotransplantation is a viable option for tooth replacement for carefully selected patients.

Auto transplantation is now fast catching up as a common procedure in dentistry for replacing a missing tooth, especially in children and adolescents where implants and other prosthetic replacements are contraindicated for various reasons.

The general indications of auto transplantation are :

1. transplantation of impacted teeth to their normal position (trans-alveolar transplantation), 2. agenesis of teeth (congenitally missing and lost teeth), 3. in those cases of avulsion where the prognosis for successful re-implantation is poor, 4. replant failure, 5. and untreatable root fractures.6. Ankylosis7. Severe root resorption

Autogenic transplantation is the most reasonable solution to orthodontic problems today in the absence of any skeletal or dental contraindications, as compared to dental implants or other prosthetic reconstructions which may cause delayed aesthetic or functional problems.

Comparison Of Auto Transplants with Dental Implants

Auto Transplant ImplantCost: $600-1,000 $2,500-5,000 *Donor dilemma no problem $$$Success rate: high highBest age: 8- early 20's after 18 yearsOrthodontically viable Excellent anchor unitSusceptible to caries New-tech hygieneProsthodontically complete Needs prosthesis

Osteogenic potential May require surgeriesGood precursor to implants

CRITERIA FOR PATIENT SELECTION

Candidates must be in good health, able to follow post-operative instructions, and available for follow-up visits. They should also demonstrate an acceptable level of oral hygiene and be amenable to regular dental care. The patients must have a suitable recipient site and donor tooth. Patient cooperation is a very important factor again.

Recipient site criteria:1. Sufficient crown space and alveolar bone 2. No periapical or periodontal inflammation 3. Proximity of the transplant to the socket wall to assure rapid organization of the clot between the

alveolar bone and the tooth 4. Excellent oral hygiene, low caries index

Donor tooth criteria:The donor tooth should be in such a position that extraction will be as atraumatic as possible.Abnormal root morphology, which makes tooth removal exceedingly difficult and may involve tooth sectioning, is contraindicated for this surgery.Teeth with either open or closed apices may be donors; however, the most predictable results are obtained with teeth having between one-half to two-thirds completed root development. Surgical manipulation of teeth with less than one-half root formation may be too traumatic and could compromise further root development stunting maturation or altering morphology. Whenroot development is greater than two-thirds, the increased length may cause encroachment on vitalstructures such as the maxillary sinus or the inferior alveolar nerve13. Furthermore, a tooth withcomplete or near complete root formation will generally require root canal therapy, while a toothwith an open apex will remain vital and should continue root development after transplantation. Inthe latter case, successful transplantation without the need for further endodontic therapy is usually.

Best suited for:1. Transplant from lower 3rd molar to lower 1st molar2. Transplant from upper 3rd molar to upper 1st molar 3. Transplant from lower premolar to upper premolar or upper premolar to lower premolar 4. Transplant from premolar to upper central incisor

Because, The premolars and the third molars remain the most desirable choices for autogenic transplantation due to the shape of the roots, the relative dispensability of these teeth, and the later age at which they remain viable.

Surgical procedure:Step 1:The tooth to be replaced is extracted with aseptic precautions. The extraction site was pressed with gauze piece to maintain haemostasis.Step 2:The socket is enlarged with surgical bur Then the socket is expanded and rinsed with saline .Step 3:Testing the size of socket by a glass replica of the tooth to be transplanted.Step4:Removing the donor tooth using gentle luxation movement.Step5:Extraoral endodontic treatment is carried out.Care should be taken not to extend the extraoral time.

Step 6:As soon as the socket was prepared the tooth was transplanted in the prepared socket and fixation wasdone by functional splint.Step7:Complete treatment, after grinding and restore with crown .

Antibiotic (cap. Sefrad 500 mg eight hourly for seven days) was prescribed pre- and post-operatively.The patient was instructed to take soft diet, maintenance of oral hygiene and not to use the tooth for fewweeks, and advised to come after two weeks. On the next appointment the transplanted tooth wasexamined clinically but there was no pain, discomfort and mobility, the tooth was firm in position and theradiograph revealed no signs of developing pathology .The splint was removed after fourweeks and the patient was advised to come for the follow-up visit after three months, six months, thenyearly for five years.

EVALUATION FACTORS AFTER TRANSPLANTING:

1.radiographic evaluation,2.pulpal canal obliteration (PCO) 3.presence of perirradicular area 3.Inflammatory root resorption (IRR) 4.replacement resorption (RR) 5.stage of root development 6.lamina dura formation 7.outline of the periodontal membrane And 8. arrest in root growth were registered.