24 May 2024

---

Updates on dental autotransplantation

Lara Figini

---

Dental autotransplantation (AT) is defined as the transplantation of a tooth from one site to a different site in the oral cavity of the same individual. The transplanted tooth can be completely erupted, partially erupted or non-erupted, with fully or partially formed roots. The first case of allogeneic tooth transplantation was reported in France in the early 1700s by Pierre Fauchard. This approach is a valid option especially in a growing patient when the placement of dental implants or fixed bridges is not the most appropriate therapy and when preserving the natural teeth is a priority. However, AT is a complex procedure that requires the specialized skills of a multidisciplinary team and requires careful selection of the patient and teeth and careful planning.

Materials and methods

In a review, to be published soon in the Journal of the American Dental Association 2024, the authors provided a review of the state of knowledge and research on dental TA and presented a case study and the difficulties that may be encountered in implementing this method

Results

Dental AT success rates can vary based on several factors, including those related to the patient's overall health, the specific tooth involved, the skill of the surgeon, and the post-operative care provided. The long-term results of autotransplanted teeth have been cited in the literature with impressive longitudinal follow-ups of up to 26 years. The results of several systematic reviews have shown survival rates of 75% to 98%. 

TA can be an additional approach to managing the treatment of missing teeth, but the following factors should be taken into consideration:

• suitability of the donor tooth in terms of form and function;
• stage of development of the root of the donor tooth;
• ease of removal of the donor tooth and adequate preparation of the recipient site;
• occlusion and post-surgical orthodontic treatment plan;
• restorative needs to obtain the final aesthetic result.

There are many benefits offered by AT, including the appearance, function and healing response of a natural tooth. This includes the natural movement during chewing, the thermal sensation and nociceptive stimuli of a natural tooth, the possible movement by orthodontic forces. Furthermore, a self-transplanted tooth undergoes processes and pathologies that affect natural dentition, including tooth decay, periodontal disease, traumatic injuries and natural damage that can lead to tooth loss. One of the main benefits of replacing natural teeth in growing patients is the continued eruption of the transplanted teeth, which helps correct hard and soft tissue deficiencies that can result from a missing tooth. If the transplant concerns an immature permanent tooth, the root will continue to develop thanks to the vital pulp tissue and there will also be continued development of the alveolar process due to eruption. If the transplant involves a mature permanent tooth, endodontic treatment may be required, but the alveolar bone would still be retained.

Whether the tooth is mature or immature, AT allows the bone to be preserved and regenerated in the recipient site thanks to the cells of the vital periodontal ligament.

As with any autotransplant, AT eliminates the risk of autoimmune responses that can lead to rejection and the need for immune therapy. Furthermore, unlike other autografts, the recipient site usually heals without any particular difficulty.

AT is a viable option in both adult and pediatric patients.

Some clinical scenarios in which AT is applicable are:

• permanent tooth loss due to decay, trauma or other pathologies;
• congenitally missing or malformed teeth;
• ectopic eruption of the teeth, i.e. the canines;
• surgical straightening of severely impacted teeth;
• fissured regions (cleft lip and palate);
• any combination of the above.

The decision about the appropriate treatment approach for a patient with missing teeth depends on the patient's existing occlusion and growth pattern, as well as macroesthetic (e.g., smile line) and microesthetic principles (e.g., tooth size, proportions and colour). Ideally, whatever choice is made to replace the missing tooth it should adapt and complement growth and development in the oral region, restore soft and hard tissue and have long-term survival potential.

Conclusions

From the data of this review, which must be confirmed in other similar studies and reviews, it can be concluded that dental autotransplantation can provide a natural and functional alternative to traditional rehabilitation/prosthetic and implant options.

Autotransplantation allows the alveolar bone to be preserved in growing patients and can offer excellent aesthetic and functional results.