BY

JANANI.N
OMFS PG
 INTRODUCTION
• Tooth autotransplantation has been used in dentistry since 1951.

• Multiple studies have reported varying degrees of success rates ranging from 60 to 90%.

• This success rate supports this procedure as a viable option to replace an edentulous
space.

• Tooth autotransplantation provides several advantages; one, it is a cost-effective option

compared to implants or fixed prostheses, two, it avoids the preparation of adjacent teeth
for fixed prostheses requirements, three, transplants can be moved orthodontically when
necessary, and finally, it maintains or promotes alveolar bone formation.
 The disadvantages associated with autotransplantation are: the prognosis decreases on patients older
than 40 years of age, therefore, their outcome can be difficult to predict, and complications may result
in early or premature loss of the tooth and consequently, the need of a traditional space maintainer.
 There is a high incidence of tooth loss in the pubertal patient,especially, in the first molar site due to
caries.

 Etiologies for premature tooth loss in young patients are, severe hypoplasia, and trauma, among others.
 The consequences of premature loss of posteriormolar teeth are significant.
 There is a collapse of the posterior dental arch space during growth and eventually the loss can affect
the opposing arch and occlusal plane.

 During eruption of the second molar, early loss of the first permanent molar causes significant forward
bodily movement and subsequent space loss.
 If the first molar is lost after eruption of the second molar, significant mesial tipping or bodily
movement of the second molar usually occurs rapidly.
 Teeth anterior to the first molar, primarily the premolars, exhibit distal drifting. Regaining this space is
challenging.
 In addition, the opposing first molar erupts at a faster rate than adjacent teeth.
 The alveolar process usually follows this supraeruption pattern and makes future prosthetic care more
complex and difficult.

 Methods to control these unwanted changes include longterm space maintenance, removable/fixed
prosthetics, or orthodontic repositioning.
 The purpose of this study was to provide patients with an alternative option for the premature loss of a
permanent molar.

 The advantages of the procedure were to also maintain that pre-mature edentulous space during their
growth and maturation years and provide function similar to that of an original tooth.
 Multiple authors have studied tooth autotransplantation with overall good results no matter what approach
or technique was used. Success vary from 74 to 100.
 Tsukiboshi reported 82% of success rate, Reich reported 95.5% success rate with 4.5% failing due to
infection to the transplanted teeth.
 Mertens (2) reported a success rate of 61.1% in a long-term study of 10 years.
 Andreasen reported 370 cases with success rates from 95-98%.
 Little literature exists where vitality of transplanted teeth is quantified.

 Akkocaoglu reported 84% of success rate in transplanted molars and 24% of the teeth required endodontic
treatment. He also reported vitality in 59% of the transplanted molars.
 The two most common reasons for failure were necrosis, endodontic complications, and external root
resorption.

 Lubkowska reported numerous growth factors derived from platelet rich plasma such as platelet-derived growth
factor (PDGF), transforming growth factor (TGF), platelet factor interleukin (IL), platelet-derived angiogenesis
factor (PDAF), vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), insulin-like growth
factor (IGF), and fibronectin.

 Taking advantage of this growth factors provided by PRP might enhance the healing of transplanted teeth.
 Adding platelet rich plasma to autotransplantation of teeth may increase the likelihood of maintaining vitality,
therefore may limit common causes of failure.
 MATERIALS AND METHOD
 Institutional review board (IRB) approval was obtained prior to proceeding with the study.
 Ten young healthy patients of 10-17 years of age, ASA I or II (according to the American Society of
Anesthesiologists Classification System) underwent the procedure.

 Inclusion criteria were that patients had immature third molars present with one-third to two-thirds of roots
formed (confirmed by radiographs), and possessed a non-restorable first or second maxillary/mandibular
molar in need of extraction.
 Candidates also met the criteria for intravenous sedation and blood collection.

 They were able to follow post-op instructions, and were available for follow-up visits.
 Exclusion criteria were : Patients unable to follow post-op instructions, not able to complete follow up visits.
Patients with any systemic illnesses that would compromise intravenous sedation.
 Patients with fully formed roots and/or closed apices on third molars.
 Patients underwent intravenous sedation for extraction of impacted third molars and the non-restorable
tooth/teeth.
 The intravenous site was used to obtain 30 mL of blood for preparation of the platelet rich plasma.

 The affected tooth was extracted first in an atraumatic fashion. Third molars were extracted and one of them was
used as the donor to replace the extracted tooth.
 The recipient socket was modified using a 701-cross cut fissure bur to remove any interferences.

 The third molar was adapted and transplanted into the recipient site. Once in ideal position, the tooth was
removed, PRP was prepared and injected into the socket.
 The molar was placed back in site and stabilized using orthodontic wires and dental composite to the adjacent
teeth .

 Occlusion was checked and adjusted as needed, to maintain infraocclusion immediately after the transplantation.
 Patients were safely recovered after surgery and a post-op periapical radiograph was taken to ensure adequate
position of transplanted molar in the recipient site.
 Patients were followed using the study protocol of one, three, six, and twelve months.

 The splint was removed at the one-month post-op visit in all patients. During follow-up visits,
periodontal probings were recorded to monitor periodontal health of the transplanted tooth.

 Root development was confirmed and measured through periapical radiographs, and tooth vitality was
measured using thermal/cold tests .
 RESULTS
 All patients were asymptomatic regarding the transplanted tooth during the course of the study.
 Physiologic type I tooth mobility was observed after splint removal at one month.

 Periodontal probings were measured at six sites (mesiobuccal, buccal, distobuccal, distolingual, lingual,
mesiolingual) of the transplanted third molar and at no point and time did they show measurements greater
than four millimeters.
 Vitality tests were done at three, six, and twelve months. Patients recorded a positive response to
thermal/cold test

 Patients received periapical radiographs during their follow up visits which showed incremental
development of the immature roots of the transplanted third molar.
 Measurements were done from the cementoenamel junction (CEJ) to the apex of the mesiobuccal root.

 An average of 2.01 millimeters gain in root development was recorded during a period of one year
 None of the patients required root canal therapy in the transplanted tooth during the period of this study.
 DISCUSSION
 The aim of this study to take advantage of the unique situation where patients who present with non-
restorable teeth and have impacted third molars indicated for extraction, could undergo simultaneous
extraction and autologous tooth transplantation.
 The past literature is replete with reports of good success rates in tooth autotransplantation.

 However, since the advent of dental implants, autotransplantation has become less prominent.
 Nonetheless, the rationale for autotransplantation still exists, especially in a subset of young patients
where dental implants may be contraindicated.

 Secondly, the more recent development of growth factors as an adjunct in promoting rapid healing is also
now well established.
 The combination of autotransplantation with PRP should increase the success rates of autotransplantation.
 The advantageous of this combination treatment may be extremely valuable as previously discussed, by
possibly avoiding the need for future dental implant placement and/or improvement of the implant site if
indicated.
 Clinical studies have shown that application of PRP can help reduce bleeding, minimize pain, reduce
infection rates, as well as, optimize overall healing

 Tooth autotransplantation literature statistics have shown that the most common complication of failure in
tooth transplantation is infection.
 This study adds the advantages of PRP in a free tissue transfer, i.e. tooth to an osseous defect in pubertal
population, where rapid enhanced healing was extremely desirable.

 The addition of concentrated platelets, i.e. PRP, aids in promoting early angiogenesis Attracting other
growth factors helps to “jump start” tissue regeneration and repair in an oxygen depleted site
 Another minor advantage of PRP is that it also provides a “seal” around the transplant due to the
adhesiveness of the clot, helping to fill small defects within the socket which may provide minor
stabilization.
 Utilizing the growth factors provided by PRP may have assisted in maintaining vitality of the transplanted teeth, therefore
limiting chances of failure.
 By conserving vitality of the teeth, no endodontic therapy was required, and root development was appreciated and
quantified.

 Outcome metrics and success of the study were defined as the following over one year follow up:
1. Asymptomatic transplant
2. Transplant required no endodontic therapy (vitality was evaluated)
3. Transplanted tooth within the physiology norm of mobility,
4. Healthy periodontium,
5. Normal probing depths,
6. Additional root development. Utilizing these criteria and established parameter to evaluate autologous tooth transplant,
this protocol appears to be statistically valid and practical.
 Long-term follow-up studies will be required to assure the long-term success for these patients.
 In the event of a future transplant lost after a several years, conventional options are still available, and preservation of the
site maintain if a dental implant is the best option.

 In this case, tooth autotransplantation of third molars with PRP can also be considered a temporary solution, as well.
 In conclusion third molar autotransplantation with the use of platelet rich plasma should be considered a viable option
when treating an edentulous space in a subset of younger patients.

 The study also shows predictability and lack of morbidity associated with autotransplantation of teeth.
 The idea of this study was not to compare traditional autotransplantation of molars to autotransplantation with platelet rich
plasma, but to provide enough cases to support this technique.
 The authors have shown that this option is viable and successful.

 Once the technique has been further validated, it can be expanded for application of transplantation of teeth with mature
roots, periapical radiolucency, and other conditions.
 PRP may also have other advantages, such as, maintenance of periodontal health, promotion of root, and neurosensory
development.
THANK YOU