Autogenic Tooth Transplantation

International Symposium on Early Orthodontic Treatment, Phoenix, AZ, February 2002

Relevant Questions

1) Are autogenic dental transplants successful?

Slagsvold, '78 34 premolars 100%
Alberg, '83 33 maxillary canines 88%
Pogrel, '87 416 transplants 72%
Andreasen, '90 370 premolars incomplete root: 95%
complete root: 98%

[1] Alberg
[3] Andreasen
[14] Czochrowska
[19] Pogrel
[20] Slagsvold
[22] Tsukiboshi

2) What is the most important factor in determining the success of a transplant?

The technique, and therefore, the surgeon!

Slagsvold and Bjercke; Azaz,B.; Andreasen, J.O.; Andreasen and Paulsen; Alberg, K; Pogrel, M.; and Czochrowska, Zachrisson

[1] Alberg
[2] Andreasen
[4] Andreasen
[11] Andreasen
[5] Andreasen
[7] Andreasen
[6] Andreasen
[12] Azaz
[19] Pogrel
[21] Slagsvold
[20] Slagsvold

3) Will incompletely formed roots continue to grow in length after being transplanted?

14% show total arrest of root formation
65% show partial arrest
21% show no arrest (normal rest formation)

[3] Andreasen
[18] Paulsen
[21] Slagsvold

4) What is the best age to affect a transplant?
At what stage of root development?
Can you accept calcium hydroxide and endodontics?

Andreasen, '70:
"optimum developmental stage for 3rd molar transplant is 3/4 root length"

Slagsvold. '78:
"root open premolars any stage after crown completion; the closer to root completion, the greater the pulp obliteration... Ideally, 4-7mm root length."

[16] Monsour
[19] Pogrel

5) How much space is required for a transplant?

Slagsvold. '78:
"other considerations: space problems, depth considerations, genetics of the tooth (number of roots, morphology). "

Andreasen, '92:

[3] Andreasen
[22] Tsukiboshi

6) At what level (height) should the transplant be placed?

Andreasen, '92:
Where possible, the transplant should be placed at the same height that it occupied while in its donor site;

Not so high that the gingival tissue would be placed on the root surface; and not in occlusion.

[5] Andreasen
[16] Monsour
[19] Pogrel
[22] Tsukiboshi

7) How is the transplant secured?

Andreasen, '92:
The first principle for the prevention of permanent ankylosis is the omission of rigid fixation after transplantation.

[10] Andreasen
[15] Kristerson
[19] Pogrel

8) Can a transplant be placed into an infected site?

Pogrel, '87:
No transplants should be delivered into sites of acute infection.

Andreasen, '92:
The presence of bacteria can permanently arrest revascularization: extraoral handling bacteria from saliva and coagulum.

Use antibiotics!

[1] Alberg
[19] Pogrel

9) Can a transplant be orthodontically moved?

Andreasen, Paulsen, '92:
Orthodontic movement can be done about 3 months after transplantation, when revascular-ization is maximized,but should be completed by 6-9 months following transplantation, when pulp obliteration is conspicuous.

[3] Andreasen
[18] Paulsen
[22] Tsukiboshi

10) Does the pulp regenerate?

Öhman, '65: (for teeth with open apices)
Positive response from pulp vitality can be detected by about 2-4 months after trans-plantation. This is a sign of revascularization and is generally followed by obliteration of the pulp canal. Alternatively, it might be followed by an in-growth of bone and periodontal ligament.

Andreasen, '90:
In an optimal case, canal calcification and radiographic disappearance do not occur. There is a regeneration of capillary vessels through the apical foramen, and a relatively normal root canal remains - partial obliteration . In both cases the tooth responds to vitalometer, but this tapers off, especially in cases where the canal has calcified.

[9] Andreasen
[8] Andreasen
[13] Byers
[16] Monsour
[17] Öhman
[22] Tsukiboshi

11) What are the advantages and disadvantages of transplants vs. implants?
Are there sites where a transplant is preferable to an implant?

Applying transplants to contemporary methodology, implants?
Czochrowska, Zachrisson, et.al., 2000: "transplants may involve other benefits...the potential for bone induction and reestablishment of a normal alveolar process." Even if they fail, they can preserve the ridge for an implant at a later date.

Transplant
Cost: $600-1,000
Donor dilemma
Success rate: high
Best age: 8- early 20's
Orthodontically viable
Susceptible to caries
Prosthodontically complete
Osteogenic potential
Good precursor to implants

Implant
$2,500-5,000 *
no problem $$$
high
best after 18 years
Excellent anchor unit
New-tech hygiene
Needs prosthesis
May require surgeries

[14] Czochrowska

Definitions:

Transplant
v., to transfer (an organ, tissue, etc.) from one part of the body to another, or from one person or animal to another (autograft) (allograft)

n., an organ that has been transplanted

Bibliography:

Must reads from Andreasen:

Andreasen JO, Paulsen HU, Yu Z, Ahlquist R, Bayer T, Schwartz O.
A long-term study of 370 autotransplanted premolars. Part I. Surgical procedures and standardized techniques for monitoring healing.
Eur J Orthod. 1990 Feb;12(1):3-13.

Andreasen JO, Paulsen HU, Yu Z, Bayer T, Schwartz O. A long-term study of 370 autotransplanted premolars. Part II. Tooth survival and pulp healing subsequent to transplantation.
Eur J Orthod. 1990 Feb;12(1):14-24.

Andreasen JO, Paulsen HU, Yu Z, Schwartz O. A long-term study of 370 autotransplanted premolars. Part III. Periodontal healing subsequent to transplantation.
Eur J Orthod. 1990 Feb;12(1):25-37.

Andreasen JO, Paulsen HU, Yu Z, Bayer T. A long-term study of 370 autotransplanted premolars. Part IV. Root development subsequent to transplantation.
Eur J Orthod. 1990 Feb;12(1):38-50.

Always striving to perform to the best of our ability.