15.5.7 Autotransplantation of teeth
Replantation of an avulsed tooth due to trauma has been discussed in 1063HChapter 12. In
this section autotransplantation of teeth is discussed. Autotransplantation of teeth in
children may be considered as a treatment for the following:
(1) repositioning of an ectopic tooth;
(2) replacement of an unrestorable tooth with a redundant member of the dentition.
The ectopic tooth most commonly repositioned by surgical means is the unerupted,
palatally placed, upper permanent canine. An example of using autotransplantation as
a means of tooth replacement is the substitution of an upper incisor that is undergoing
resorption by a premolar tooth scheduled for extraction as part of an orthodontic
treatment plan (1064HFig. 15.29 (a)-(j)). The management regimen for both treatments is
similar and is as follows:
(1) assessment of donor tooth and recipient site;
(2) atraumatic extraction of donor tooth;
(3) preparation of recipient site;
(4) transplantation;
(5) splinting of transplanted tooth;
(6) root treatment of transplanted tooth.
In addition, when autotransplantation is used to replace a tooth in the arch some
coronal preparation and orthodontic movement of the donor tooth may be required.
Transplantation surgery is usually performed under antibiotic prophylaxis (either oral
or intravenous amoxicillin (amoxycillin)), as the use of systemic antibiotics has been
shown to decrease the incidence of root resorption.
Assessment of donor tooth and recipient site
The tooth to be transplanted has to be appraised clinically and radiographically prior
to surgery. The crown of an erupted tooth can be assessed for caries and its
dimensions measured. Root status and shape will be determined using periapical
radiographs. Donor teeth should have an open apex with at least three-quarters of the
root formed. The morphology of unerupted teeth for transplantation can only be
determined radiographically. Teeth with severe root curvature are unsuitable for
transplantation as it is unlikely they can be removed intact without trauma. In
addition, the production of a donor site suitable for a dilacerated tooth may be
difficult to produce without damaging neighbouring vital teeth.
It is important to evaluate the recipient site both clinically and radiographically. The
space available for the transplanted tooth must be assessed in both the horizontal and
vertical dimensions. It may be necessary to create sufficient space using preoperative
orthodontics. Periapical radiographs will alert the clinician to the presence of any
bony pathology or retained dental remnants at the recipient site.
Atraumatic extraction of donor tooth
It is essential to remove the donor tooth using minimal trauma and avoiding contact