Autotransplantation is a viable treatment option to restore esthetics and function impaired by abnormally shaped teeth when a suitable donors tooth is available. This paper describes the autotransplantation and 2-year follow-up of a supernumerary maxillary incisor as a replacement to a misaligned maxillary incisor with abnormal crown morphology and size. The supernumerary incisor was immediately autotransplanted into the extraction site of the large incisor and was stabilized with a bonded semirigid splint for 2 weeks. Fixed orthodontic therapy was initiated 3 months after autotransplantation. Ideal alignment of the incisors was accomplished after 6 months along with radiographic evidence of apical closure and osseous/periodontal regeneration. In autogenous tooth transplantation, a successful clinical outcome can be achieved if the cases are selected and treated properly.
Autotransplantation (autogenous tooth transplantation) refers to the repositioning of autogenous teeth in another tooth extraction site or a surgically prepared recipient site to replace teeth that are congenitally missing or have poor prognosis [
The success of autotransplantation can be influenced by a number of factors, which include patient age, developmental stage of the transplanted tooth, type of tooth transplanted, surgical technique employed, and extra alveolar time span before the tooth is transplanted [
Autotransplanted teeth result in the maintenance and regeneration of alveolar bone, and the procedure can be performed in growing patients. The aim of this paper is to present the autotransplantation, orthodontic treatment, and 2-year follow-up of a supernumerary incisor as a replacement to a large, fused central incisor.
A healthy, 10-year-old boy was admitted to pediatric dentistry clinic for the management of crowding associated with a large tooth present in the upper jaw. On intraoral examination, the patient’s chief complaint was confirmed by the presence of a misaligned maxillary right central incisor. The tooth had a talon cusp-like enamel projection on the labial aspect of the crown and had a large mesiodistal dimension. Owing to the patient’s gagging reflex, a proper radiographic examination of the incisor could not be made. However, the occlusal and periapical radiographs were highly suggestive of a large pulp chamber, and even of the possibility of a fused tooth. The occlusal radiograph also indicated an unerupted supernumerary incisor located on the contralateral side between the central and lateral incisors. The supernumerary incisor had a well-shaped crown and showed advanced root formation with incomplete apical closure (Figure
(a) Occlusal radiograph of the patient, demonstrating the large incisor and the unerupted supernumerary incisor. (b) Close-up view of the tooth, showing abnormal crown dimensions and morphology.
Among possible treatment options, esthetic reduction of the crown in both the proximal and labial aspects was considered unfavorable due to the presence of a large pulp chamber. Extraction of the tooth and consequent orthodontic correction were also discarded as a treatment alternative, since orthodontic movement of the supernumerary tooth over the midline could result in resorption of the alveolar bone. Finally, the use of the contralateral supernumerary incisor as a replacement for the existing large incisor was considered the best treatment option, since both the radiographic crown dimensions and presence of the immature apex favored the possibility for autotransplantation. The patient and his parents were informed about the treatment options and their possible outcomes. The patient showed up four months later, approving the treatment plan of autotransplantation. During the time, the supernumerary incisor erupted into the crowded maxillary arch in a rotated fashion (Figure
View of the supernumerary incisor (arrow), which erupted 4 months after the initial examination.
(a) View of the extraction socket of the large incisor; (b) the extracted incisor, demonstrating large crown and root dimensions and morphological appearance of a fused tooth; (c) view of the supernumerary incisor, immediately after implantation into the recipient site.
Radiographic view of the autotransplanted incisor at the 3rd week.
View of the incisors during fixed orthodontic treatment.
Clinical and radiographic view of the maxillary incisor at 2 years.
Esthetic management of anterior teeth with abnormal crown dimensions and/or morphology may be quite challenging. As seen herein, the large coronal pulp space may limit the chance of successful reduction of the crown dimensions without possible endodontic complications. In such cases, autotransplantation appears to be a viable treatment option to restore esthetics and function, especially when a suitable donor tooth is available [
High long-term success rates of autotransplantation have been reported in the dental literature [
As observed in the present case, calcific metamorphosis of the pulp is a common finding in transplanted teeth [
The presence of intact and viable periodontal ligament cells on the root surface of the donor tooth is the most critical factor that determines the prognosis of an autotransplanted tooth [
Along with rapid and atraumatic surgical technique, adequate recipient site affects the prognosis as well [
Various techniques have been described to stabilize transplanted teeth, including loose fixation with sutures, ligatures, orthodontic brackets, acid-etch composite and wire splints, and ligature wires or orthodontic appliances [
Transplantation of teeth with immature roots offers high success rates due to the chance of revascularization as well as unimpeded development of the donor tooth and adjacent alveolar bone growth [
Transplanted teeth can be submitted to orthodontic treatment 3 to 6 months after transplantation [
The outcome of autotransplantation can be considered successful if there is no progressive root resorption, the adjacent periodontal tissues adjacent are normal and the crown-to-root ratio is less than 1 [
In the presence of a well-shaped supplementary tooth, autotransplantation may be considered as a viable treatment option for replacement of large, misaligned teeth, which impair both esthetics and function. The procedure is cost-effective, one-stage surgery can be used and orthodontic movement is possible. Hence, autotransplantation can be considered as a successful and atraumatic treatment option in growing patients, especially when compared with treatment alternatives such as interim removable prostheses.