PRINCIPLE OF TOOTH TRANSPLANTATION

- Clinically successful transplants must show a radiolucent space between the roots and the
surrounding bone

- There must be no evidence of ankylosis, no permanent root resorption, normal probing depth around
the roots, no inflammation, no clinical discomfort, and tooth mobility that harmonizes to that of the
-

residual teeth
The most ideal situation after ATT (Autogenous Tooth Transplant) is that the transplanted tooth has

the same functions as if it had erupted at the recipient site originally

Histologically the criterion of success seems simple; a normal and functional PDL between the root

surfaces of transplants and the bone or the gingival connective tissue

In other words, the success of ATT depends mostly on reattachment and partially on a new

attachment phenomenon
The criteria of obvious failure are pocket formation, which means the failure of reattachment, and

permanent (progressive) root resorption (i.e damage of vital PDL of transplanted tooth)
Although the osteoclast is a negative factor in replantation and transplantation, it plays an important

role in tooth eruption, growth, bone remodeling, and the defense against infection
Root resorption after replantation and transplantation may be classified into two types: (1) infection
or immune reaction, and (2) remodeling phenomenon of bone. The mutual trigger of the two root
resorptions is the loss of a viable PDL, which usually protects the root (cementum and dentin)

against resorption
The latter type of resorption is accompanied by bone deposition, and is considered a physiological

pathway
Reattachment is the reunion of connective tissue and root separated by incision or injury. However
this reunion in ATT may not be simple for two reasons. First, the PDL on the root is often so thin that
only a few cell layers have been preserved after the careful extraction. Second, it is impossible to
gain close contact of the root to the bony tissue of the recipient site. The reconstruction of normal
PDL layer and structure depends on the survival and proliferation of the transplanted PDL cells on
the root in the socket

- Reattachment in ATT occurs in two phases; (1) the primary reattachment around the cervical area
between the PDL on the root and the gingival connective tissue, which will be accomplished in a few
days, and (2) secondary reattachment in the socket between the bone and the PDL on the root,
which requires a few weeks