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Abstract: The effectiveness of tooth replantation were studied in order to reduce surgical trauma. The study was conducted on 18 patients diagnosed with "chronic apical periodonitis" and "cyst". According to the results of the study, tooth replantation was recognised as one of the most optimal and non-traumatic tooth-preserving operations.
Methods: 18 patients (8 men and 10 women) underwent tooth extraction and replantation with clinical diagnoses: "chronic periodontitis". The diagnosis were based on the clinical pictures and radiography data. Subjective postoperative feelings were evaluated on a visual-analogue scale (VAS). Tooth stability was determined by Periotest 6 months post surgery. The index values range from -8 to +50. According to the degree of mobility, the indexes are distributed as follows: 0 degree - from -8 to +09; I degree - from +10 to +19; II degree - from +20 to +29; III degree - from +30 to +50.
Observation: In the early and remote postoperative period, no patients had significant complications. The average of pain by the visual-analogue scale were recorded at 2-3 points on the 3rd day. When visiting 6 months post surgery, clinical and radiological studies showed satisfactory functional and aesthetic results. Also, 6 months after surgery, all patients were diagnosed with Periotest. The indicator ranged from -0.8 to +0.9, which according to the table of the device, indicates lack of mobility in the examined teeth.
Conclusion: Based on the analysis of patient data, the indications for replantation:
- impossibility/unpredictability of root canal treatment;
- difficult access during resections and retrograde sealing with a high probability of damage to anatomical structures (e.g.second molar of the lower jaw);
- probability of large bone defects and loss of tooth functionality during endodontic surgery (e.g. lower jaw incisors). Replantation is one of the possible dental preservation operations, which allows you to maximise the preservation of body tissues, increasing the effectiveness of treatment, and significantly reduces the intensity of postoperative pain, the risk of postoperative complications and reduces the overall period of rehabilitation for patients.
AIMS: Reconstruction of lost central incisor with autotranplantation in a growing patient is one of the few possible ways, how to treat this defect. Parallel orthodontic anomalies could complicate creating appropriate treatment plan. The aim of this presentation is to describe the treatment of patient with lost upper central incisor combined with agenesis and teeth retention.
SUBJECT AND METHOD: An 11-year 11-month-old boy with missing tooth 11, which was traumatically lost 6 years ago. Tha patient is suffering from agenesis of teeth 12 and 22, closed space for teeth 15 and 43, the eruption of 13 in reg. 11 and persisting deciduous tooth 53. Angle class II. molar relationship. As a treatment plan, it was decided to reconstruct missing teeth with canine mesialization and tooth autotransplantation instead of prosthodontic solution with bridges or removable prostheses. For better visualization, model setup was made.
RESULTS: Treatment started with creating space for transplantation with distalization of 13 into reg. 12. As donor was chosen tooth 45, whose removal created space for retained tooth 43. Space for 15 was created with distalization of 16 and mesialization of 14 into reg. 13. After alignment, canines were reshaped to lateral incisors, transplanted premolar to central incisor and first premolars to canines - noninvasively with direct composite veneers.
CONCLUSION: Considering growth, reconstruction of missing frontal teeth in children is challenging. Tooth autotransplantation is one of the few possibilities, how to treat this condition with stable results. Close cooperation between an orthodontist, surgeon and prosthodontist is necessary.
AIM: Primary failure of eruption (PFE) is very rare in general population, however there may be much higher percentage of occcurence in orthodontic office. The aim of this paper is to present a solution to this problém by using autotransplantation of teeth.
SUBJECT AND METHODOLOGY: The patient was a 16-year old woman suspected of PFE of tooth 37. The upper and lower dental arch relationship was Angle I class with crowding in both frontal segments, supernumerary teeth 19 and 29 were present. The set treatment plan included extraction of teeth 19, 29, 37, 38, 48 in under general anesthesia, healing time of a large defect of region 37, orthodontic fixed apliance therapy with IPR in both dental arches followed by extraction of 29, autotransplantation of tooth 28 to site 37 and its root canal treatment (RCT).
RESULT: Orthodontic treatment started with upper fixed appliance, followed by autotransplantation and 2 weeks later RCT. Later the lower appliance was fixed and the transplanted tooth was fixated. Healing proceeded without complications. Orthodontic therapy solved all initial problems - crowding, midline shift and deep bite. Also intrusion in the upper left lateral segment was done to prevent early contact with the transplanted tooth. Final composite filling of the crown of tooth 37 was made after the fixed appliance removal.
CONCLUSION: In case of PFE, autotransplantation is a method of choice. This type of therapy provides enormous benefits and considering the young age of most patients, it is advisable to offer this option as a prefered one.
PURPOSE: To present treatment options for post-autotransplantation root resorption. In the patient (aged 12 years) with agenesis of the teeth 45 and 35, the tooth 15 was indicated for autotransplantation to position 45 and the tooth 25 to position 35.
RESULTS: 6 weeks after the surgery, signs of aggressive external resorption were observed in both the teeth. In the tooth in position 45 resorption reached the root canal. In the tooth in position 35 surface resorption in the cervical area of the tooth was observed.
TREATMENT: The condition of the tooth 45 was managed through RCT and Biodentine filling. In the tooth 35, revision surgery, raising of the mucoperiosteal flap, root defect revision and filling with MTA were performed.
CONCLUSION: The condition was assessed after 11 months. Both the teeth are functional, the tooth 35 is vital. Both the teeth were aligned, so far with no signs of evolving resorption. Long-term follow-up is necessary.
OBJECTIVE:Transplantation of third molars, such as Autologous Dental Bioprosthesis in patient with exodontics of lower permanent molars.
Introduction: Autologous dental bioprosthesis (BDA) consists of the transfer of a tooth from one particular position to another in the same patient, these teeth are usually those that by their position in the arc are not functionally active (included, retained or erupted), which are moved into the alveolar space of a recent extraction or a surgically created tooth alveolus. For young patients, BDA is performed with fully formed teeth or tooth germs. In the present case the use of the third molars as biologically transplanted tooth parts in the same patient is shown covering a 2-year case control period, and performed in two surgical times and with different techniques transplant surgical: the immediate technique for part 4-8 towards the dental socket 4-7 and the two-step technique of 2-8 towards the dental socket 3-6.
METHODOLOGY: A bibliographic review of the different BDA techniques was carried out. Once the theoretical criteria (surgical protocol) were defined, the application phase of the technique was carried out, with the criterion of one or two teeth indicated for extraction. The patient candidates for this treatment, should have the following characteristics: Patient wholly healthy, without diagnosed systemic disease. Arrangement of the patient to carry out the proposed technique. Adequate oral hygiene. Complementary tests (Laboratory and image).
CLINICAL CASE: Female patient of 26 years of age who consults at the Faculty of Dentistry of the University of El Salvador, healthy patient and referred by orthodontist for exodontics of third molars upper and lower, explains the techniques of BDA and accepts perform them on the condition that they do not give up treatment.
RESULTS: During the X-ray checks of the BDA, no internal or external reabsorption, or obliteration of the pulp chamber, was observed. Absence of dental mobility, and complete reintegration of donor teeth.The clinical control of the patient was applied the endodontic test (table No. 1) included in the clinical sheet of the faculty evaluating in each tooth: pain, thermal, electrical tests, clinical examination and radiographic considerations with positive results.
CONCLUSIONS: Proper patient selection ensures the success of this technique. The most commonly transplanted donor teeth correspond to the third molars. Prostodontically a restoration of occlusion. Low cost.
OBJECTIVES: After tooth extraction, restoration of dentition integrity becomes an issue. Tooth autotransplantation is an effective and reliable method which also requires coincidence of conditions determining success of the treatment. It also includes the presence of a suitable „candidate“ for transplantation in the place of the extracted tooth. In this clinical case we present autotransplantation of two teeth (28 and 38 instead of 26 and 36) in the same patient and a two-year follow-up.
MATERIAL AND METHODS: Patient E. T., born 1986, generally healthy, without chronic medication, non-smoker, came to our office for dental examination and treatment. Clinical and X-ray examinations revealed carious lesions of teeth 26 and 36 which were indicated for extractions, as well as semi-impacted teeth 18,28,38,48. Considering the localization of teeth 28, 38 as well as indication for extractions, it was decided to perform autotransplantation of the teeth 28 and 38 in the area of 26 and 36. The teeth 26 and 36 were extracted atraumatically, dental alveoli were rinsed with CHX 0.2 % solution, afterwards the teeth 28 and 38 were extracted in gentle way, paying attention not to damage the area of the roots, then preparation of recipient sites in loco 26 and 36 was performed to ensure congruence with transplanted teeth 28 and 38. After the transplantation, tooth 28 was fixed with a splint (orthodontic wire + photo composite) and tooth 38 - with a non-absorbable monofilament suture 5/0, which was replaced with a splint on the 5th day after the surgery. Endodontic treatment of the transplanted teeth was performed in 2 days after AT 28 in loco 26 and in 5 days after AT 38 in loco 36. In both cases, the procedures were followed by uncomplicated healing, removal of splints, build-ups, and delivery of adhesively cemented all-ceramic crowns.
RESULTS: The clinical outcome (incl. X-ray) is stable both in functional and aesthetic aspect 25 months after AT of 28 in loco 26 and 38 in loco 36. Tooth autotransplantation can be a reliable alternative to dental implants. Correct indications and treatment performed lege artis are crucial factors for successful treatment outcome.
The presentation shows the experience of replanting the second molar on the upper jaw with a longitudinal crack of one of the roots. A clinical case further complicated by periapical lesion and proximity of the maxillary sinus.
The patient was concerned about periodic pain in the tooth when chewing. During the replantation operation, a thorough evacuation of the periapical lesion, retrograde filling of the root apexes, and rigid mobilization of the replant were performed. The replanted tooth is set with an offset in the coronal direction for a more predictable overlap of the crack boundary with the future ceramic crown. 2 months after the operation, a stable position of the tooth, a stable state of the surrounding soft tissues, and the beginning of the formation of the native bone in the periapical zone were obtained. Ceramic crowns are installed on the teeth after 3 months.
After 6 months of replantation, bone restoration was observed on an x-ray image. More than half of the defect was radiographically filled with native bone. The dynamic positive dynamics of periapical bone restoration was confirmed by the complete absence of pain in the tooth and the absence of pathological tooth mobility. The successful functioning of the entire tooth is due to the rapid recovery of the ligamentous apparatus. Careful treatment of the tooth ligament during the replantation operation is an important nuance.
BACKGROUND: Tooth autotransplantation can provide an effective biological replacement for central incisors following dental trauma, when options to restore the original tooth have been exhausted. Subsequent failure of the transplanted tooth can be challenging to manage. This case report describes the management of an ankylosed upper central incisor by autotransplantation of a premolar and subsequent ankylosis of the transplanted tooth.
METHODS: A healthy 12 year old boy presented to the Leeds Dental Institute, UK with history of enamel-dentine fractures with lateral luxation injury to upper right and left central incisors at the age of 10. These had been immediately restored with resin composite, however, two years post-injury the upper right central incisor became ankylosed and had poor prognosis. The patient had Class II division 1 malocclusion on caries-free mixed dentition. Following assessment on the inter-disciplinary clinic the ankylosed upper right central incisor was extracted under general anaesthesia and a maxillary second premolar with incomplete root development transplanted to the socket. Orthodontic movement of the tooth with fixed appliance therapy was commenced three months after transplantation.
FOLLOW UP: Six months after transplantation, orthodontic movement of the transplanted tooth was unsuccessful due to ankylosis. Following further discussions of the treatment options, the ankylosed tooth will be decoronated in order to retain bone for likely implant replacement in the future. Fixed appliance therapy will be completed to correct the malocclusion.
CONCLUSION: Failure of tooth autotransplantation can present a significant challenge. It is essential that all options are presented to the patient from the outset, including the risk of failure. With careful attention to shared decision making and encouragement of full patient/parent engagement then compliance and dentist-patient relationship can be maintained, even in challenging circumstances.
The maxillary canines play an important role in aesthetics and function; therefore, patients with impacted canine usually undergo more difficult and longer treatment than patients with other malocclusions. We deal with impacted maxillary canines in orthodontic departments quite often; on average 1.5%-2% of the population is affected. The buccal location of maxillary impacted canines is observed in 15% of cases. The treatment of impacted caninces mostly needs interdisciplinary cooperation betwen an orthodontist and a dental surgeon.The main task for the orthodontist is a creation of enough space for impacted caninen by fixed appliance. The main task for the surgeon is an expositon of the crown of the canine for orthodontic device by the method of fenestration, patefaction, apically positioned flap or another method of surgical exposure of canines crown. Neverthelees the orthodontic treatment in the meaning of right aligment of impacted canine can sometimes fail. In such situations, an autotransplantation could be considered. We present case report of this treatment in young girl.
It is commonly accepted that vitality of periodontal ligament of the autotransplanted tooth is basic step for uncomplicated healing. We know the periodontal ligaments capability of bone induction too but mostly only used during ortodontic movement of tooth. On the other hand we know osseoinductive effect of the autotransplantated teeth with vital periodontal ligaments placed into sinus lift. But the question is: Could we expect this osseoinduction in another situation then sinus lift? In this case report we demonstrate this osseoinductive effect by CBCT proof, 2 years after autotransplantation of upper premolar to lower jaw position.
Current studies consider teeth autotransplantations and replantations as realiable methods of treatment. From the point of view of indication the autotransplantation may be performed in the following cases:
1) When the extracted tooth is placed into a different position.
2) When the position of a tooth is adjusted.
3) When the tooth is extracted, treated and returned into its dental alveolus (socket) again.
The common indication within orthodontic treatment autotransplantation is carried out in 1) and 2). In this case report we used the third indication for tooth autotransplantation mentioned above. After the proper endodontic treatment, the periodontally compromised tooth was extracted and after the extraction, the socket and root surface of the tooth was cleaned. It means exccavation of granulation tissue from teh socket and scaling and root planing of the tooth. After that, the root of tooth was conditioned with EDTA, washed and covered by Emdogain. The tooth was replantated into its own socket and splinted. This technique seems to be a treatment possibility in the periodontally compromised tooth with poor prognosis.
AIMS: Periodontal ligament (PDL) plays a fundamental role in periodontal regeneration. This ability is significantly enhanced following orthodontic preloading and is advantageous for the success of tooth autotransplantation (TAT). The purpose of this study was to assess the changes of PDL thickness in extracted premolars following application of orthodontic loading.
MATERIALS AND METHODS: Fourteen patients, requiring premolars extraction, received orthodontic preloading for 4 and 8 weeks. Unloaded contralateral premolars were used as control. The extracted premolars were fixed with 10% buffered formalin and stained with 0.04% (w/v) toluidine blue. Premolars were embedded in acrylic blocks and then cross-sectionated in coronal, middle and apical regions. Digitized cross-sectional images were recorded under a stereomicroscope and the percentage of stained PDL was analysed using ImageJ software.
RESULTS: Orthodontic preloading for 4 and 8 weeks significantly increased the percentage of stained PDL on the root surface compared to the control. However, the PDL thickness at 8 weeks was increase two-folded compared to 4 weeks (p<0.05). Although the thinnest PDL was observed at the middle region of the control, the highest increase of PDL thickness was also observed at the middle (4.6 times) region at the 8 weeks (p<0.01). The coronal regions also presented with a significant increase of PDL thickness (4.1 times) at the 8 weeks compared to control. The duration and difficulty of extraction were significantly reduced in preloaded than control unloaded teeth.
CONCLUSION: A 8-week duration of orthodontic preloading provides increase PDL thickness at the coronal and middle regions. Increased PDL thickness ease tooth extraction, and provide intact PDL coverage that might be advantageous for the success of TAT.
AIM: Preservation of periodontal ligament (PDL) is vital to the success of tooth autotransplantation (TAT). Orthodontic loading prior to the extraction increases PDL volume, thus improving success rates for transplantation. Additionally, orthodontic loading results in stimulation of various cells in the PDL including bone cells which may be essential in healing of TAT. Therefore, this study aims to evaluate the effect of orthodontic loading on human PDL, by determining the expression of bone biomarkers: osteoblast transcription factor, runt-related transcription factor 2 (RUNX2); and osteoblast marker, alkaline phosphatase (ALP) at different loading durations.
SUBJECTS: Seventy-two first premolars from 18 participants (21.0±3.82 years) who required extraction for orthodontic treatment were recruited.
METHODS: The premolars were randomly assigned into experimental groups that received orthodontic loading for 1, 2 or 4 weeks, and a control that received no loading. After extraction, the amount of PDL tissue proliferation was evaluated by toluidine blue staining. The expressions of the bone biomarkers were isolated from PDL of the extracted premolars and analyzed by immunoblotting and densitometry. The Friedman Test and Wilcoxon Signed Ranks Test were used for statistical evaluation.
RESULTS: The percentage of stained PDL was significantly increased at two and four weeks compared to the unloaded (p<0.05). Varying expressions of RUNX2 and ALP were detected at their predicted sizes in both control and experimental groups. Compared to the control group, the expression levels of RUNX2 and ALP increased significantly at different time periods (p< 0.05).
CONCLUSIONS: The results demonstrate time-dependent nature of PDL alteration. Orthodontic preloading for four weeks enhances the amounts of PDL tissue together with RUNX2 and ALP expression. These may be beneficial to healing of TAT.
One of the options for autotransplantation of an immature tooth into the maxillary lateral region in case of insufficient bone volume is the autotransplantation using the sinus augmentation technique (sinus lift). Sinus lift is an augmentation technique in implantology using the augmentation materials, contrary to the sinus lift in autotransplantation. In autotransplantation only PRGF (plasma rich in platelet and growth factors) is used for augmentation. When this technique is applied, of key importance is the cooperation between the surgeon and the orthodontist, 3D planning and correct timing. Based on our experience, the autotransplantation of an immature tooth into sinus lift with PRGF augmentation results in an increase of bone volume and completion of root formation.
CONCLUSION: Autotransplantation of an immature tooth into sinus lift with PRGF augmentation leads to the bone volume increase and completion of tooth development.
Canines have a specific and unique role in the mouth and dentition, but they are often affected by severe eruption problems. From the functional aspect they are supporting the overall dentition, they guide the mandible when it moves. Canines are the second most frequently impacted teeth following third molars. Tooth may become impacted because of local factors, systemic factors or a genetic abnormality. Most often, the cause of impaction is inadequate arch length and space in which to erupt. Impacted upper canines affected approximately 2 % of the population. It’s impaction incidence is twice higher in maxilla than mandible. Bilateral impactions of canine have 8 % of patients. Palatal impaction is more frequent, it affects about 85 % of impacted maxillary canines. Approximately one third of impacted maxillary canines are positioned buccally. My case report presents the success of autotransplantation of maxillary canines and lower canines with almost closed apices and also shows the complications associated with malposition. I present some important cases from our everyday practise - 2 maxillary canines and 2 lower canines in children age 11...13 years. Patient age at transplantation is important, the success rate in open apices is higher. In our cases upper canines were impacted in horizontal position and lower canines were bilaterally impacted or impacted due to odontoma. All teeth were transplanted when root development was almost complete and no endodontic treatment was performed prior to or after implantation. The procedure is technique sensitive. Very important is atraumatic removal that maintains the viability of the periodontal ligament. In conclusion, I demonstrate the potential of aligning an extremely displaced canine, success, complications and survival in 4 years. Because of the aesthetic and functional importance of the canines, the autotransplantation is one of treatment opportunities.
AIM: Since 2020, I have been working on the Baltic Biomaterials Centre of Excellence project to improve tooth autotransplantation survival and success rates. A pre-operative cone beam tomography is performed for all patients and a donor tooth replica is created and printed to reduce total surgery time, donor extra-alveolar time and the number of donor tooth fitting attempts. The aim of the study is to demonstrate immature third molar autotransplantation with and without a printed donor tooth replica. Surgeries were planned with BBCE and performed in the Institute of Stomatology, Riga Stradins University.
METHODS: Two groups of immature third molar autotransplantation were described, one conventional and the second with a printed donor tooth replica. Total surgery time from first incision to last suture was taken, donor tooth extra- alveolar time was measured, and donor tooth fitting times were counted.
RESULTS: Group 1. Convectional immature third molar autotransplantation. 22 patients, (average age 17.81, range 13- 22). Average total surgery time- 65.91 min., donor tooth extra alveolar time 63.63 s, average fitting attempts – 2.00 Group 2. Surgery was done with printed donor tooth replica. 19 patients, (average age 16.10, range 14- 19). Average total surgery time- 45.00 min, donor tooth extra alveolar time 61.32 s, average fitting attempts – 1.53
CONCLUSIONS: The use of a replica made the procedure less traumatic, reduced the total surgery time by 20.91 min, the donor extra-alveolar time by 2.3 s, and the number of times of fitting the donor tooth was reduced by 0.47 times. The study with the aim to investigate efficiency of cone-beam replicas is under way.
ACKNOWLEDGMENTS: The authors acknowledge financial support from the European Union's Horizon 2020 research and inovation programme under the grant agreement No 857287.
Presenting author’s e-mail address: M.firstname.lastname@example.org.
Autotransplantation of teeth with completed root development as a method of replacing missing teeth in an adult patient is a predictable procedure. The osteoinductive properties of the transplanted tooth can be advantageously used in situations where the lack of bone complicates the insertion of an implant.
In the present case report, the patient had significant alveolar bone resorption due to advanced periodontitis and the presence of a massive radicular cyst in tooth 16. After extraction of the molar 16 in the upper dental arch and stabilization of the soft and hard tissues, tooth 28 was transplanted in place of tooth 16. The transplanted tooth was endodontically treated under OM, orthodontically extruded, rotated and prosthodontically fitted with a lithium-disilicate crown.
One and a quarter years after autotransplantation, the tooth is stable, free of ankylosis, with no evidence of root resorption on CBCT, and vertical bone growth along the roots of the transplanted tooth is clearly visible.
Background: The purpose of the present study is to increase the effectiveness of mandibular molars apical root resection surgery. The present study included 21 patients with diagnosis “persistent apical periodontitis”, “root cyst”, in 11 of cases was performed surgery with less traumatic access formation that included using piezoelectric surgery system during formation and separation of cortical bone block and subsequent reposition after resection and retrograde root filling. The planning and performing of the surgery was described on the base of 2 clinical cases.
Methods: 21 patients with a diagnosis of "persistent apical periodontitis", "root cyst" was performed the clinical examination and surgical treatment. Patients were divided into 2 groups: § Operation process. Group 1 included 11 patients which was performed surgery with less traumatic access formation achieved by using piezoelectric surgery system during formation and separation of cortical bone block and subsequent reposition after resection. The inclusion criteria was the presence of the dense mandibular cortical plate in the molars region. Group 2 included 10 patients. The access to apical part of the roots during surgery was performed by using traditional technique. It means trepanation of the cortical plate in the projection of the root tips in the form of an oval or circle with a diameter of 5 to 10 mm by using mechanic handpiece, the speed of which is 150000-20000 rpm with obligatory sterile saline cooling to prevent overheating and burn of the bones. § Postoperative period. Patients of 2 group marked intense pain in first 3 days after surgery (level of the scale VAS was 5-7 points in 7 of 10 patients). Patients of 2 group had a high need for painkillers. Hyperemia and swelling of the mucosa in the area of intervention were observed in 7 patients, swelling of the face soft tissues was observed in 3 patients. Its severity on a scale VAS was 3-4 from 3 of 11 patients, Pain syndrome in patients of 1 group was observed on the day of operation and during next day, its severity was 3-4 points on VAS scale in 3 of 11 patients. Swelling and hyperemia of mucosa in region of intervention were observed 3 patients. Swelling of face soft tissue was not observed in this group. There were no complications like suture disruptions and high temperature. Severe complications in both group of patients were not observed in early and late postoperative period. Analysis of the periapical intraoral x-ray results in the second group showed a difference in bone density at 108±5 units, which indicates the tendency of bone regeneration in the region of surgery, but density decrease was also observed. The value of this criteria in the first group was significantly higher (p<0.05) with meaning 137±5, that shows a slight decrease in bone density after surgery and complete bonding of the bone block with the surrounding bone.
Сonclusion: The results shows that technique that includes bone window closing by autograft is more effective and acceptable when resection of apical parts of molar roots is performed. The introduction into clinical practice improved technique of operative access can significantly reduce the intensity of postoperative pain, the risk of postoperative complications and reduce the duration of patients treatment.
Premolar autotransplantation to the place of ankylotic central incisor is first choice treatment plan, particularly when the patient requires orthodontic treatment involving the extraction of immature premolars. Autotransplantation has been shown to have a high level of success and is accepted as a viable method for replacing teeth lost due to trauma (Slagsvold & Bjercke 1974, 1978a, b, Andreasen 1981, Kristerson & Andreasen 1984, Kristerson 1985, Andreasen et al. 1988). Case report shows 11years old patient with external replaced resorption and ankylosis of left central incisor after dental traumatic injury. Autotransplantation of lower second premolar to the place of ankylotic central incisor was planned because orthodontic treatment plan involved extractions. Autotransplantation was performed in two stages because of soft tissues deficiency. Extraction of ankylotic 21 was done first with soft tissue reconstructing by remnants of dental sac. After soft tissue had healed and space had been opened 2 months after extraction, autotransplantation of 45 was done. Donor tooth was placed in the left maxillary central incisor region after drill of shaft with internal cooling according to measurements done on CBCT (+1mm for periapical tissues). Donor tooth was fixed with cross suture and 90° rotated to mimic cervical width of right central incisor. X- ray controls of autotransplanted tooth were done according to protocol of Andreassen et al. 1990. Continuing root formation without pathological changes were seen on x-rays. After the autotransplantation the tooth was freed of all occlusal contacts and orthodontic traction was applied 17 months after. Provisional build-up was done in the long axis of the root. The anatomic situation allowed non-prep composite build-up placement in relative dry field without silicone index. Bite plate was used to avoid articulation blocking after build-up. Teeth 14 and 45 were extracted 2 years after autotransplantation, because there were “saved” as spare donor teeth. Orthodontic treatment is continuing. Autotransplanted tooth development continues and is without complication. Up to date it is 4 years after autotransplantation.
Treatment of Class II with extraction of first premolars is the first-choice method for autotransplantation of extracted first upper premolars to the place of second lower premolars agenesis [Zachrisson B.U. et al. 2004]. Case report shows 8 years old patient with class II. in both molars, agenesis of second lower premolars and lack of space for upper lateral incisors eruption. Serial extractions of 53,54,63,64 were performed to gain space for upper lateral incisors eruption and enhancing eruption of upper first premolars. Fully erupted upper first premolars were used as donors for autotransplantation to replace agenetic lower second premolars at the age of 9. Transpalatal bar was used for molars anchorage and his arm to avoid eruption of 25 and its occlusal contact with autotransplanted tooth, because of premature loss of 65 with large caries leason. 1 year after autotransplantation after spontaneous elimination of 55 and eruption of 15 transpalatal bar was removed. Start of fixed appliance treatment was performed after full eruption of all permanent teeth including second molars at 14 years of age (5 years after autotransplantation) because deep bite treatment demand. Autotransplanted tooth were x-ray evaluated according to protocol [Andreassen J.O. 1990]. Further root development of autotransplanted tooth, without periapical changes, with pulp obliteration can be seen on x-rays. Orthodontic treatment continues up to date.
AIMS: The aim of this case report is to discribe the effect of osseodensification burs in the preparation of the recipient site before autotransplantation.
SUBJECT AND METHOD: An 39-year old man with missing maxillary right lateral incisor, which was treated by using metal ceramic crown on tooth 13 and cantilever at the place of missing 12, about 6 years ago. The patient is suffering from low space for teeth 35 and 45 and missing teeth 12 and 37. Because of severe crowding in the lower jaw and one side missing lateral incisor, as a treatment plan, it was decided to reconstruct the missing tooth with autotransplantation of lower incisor instead of prosthodontic solution with implant or bridge.
TREATMENT: Therapy started with root canal treatment on tooth 32. Transplantation of this tooth to the position 12 was realized 4 weeks after RCT. Osseodensification burs (DensahTM) for recipient site preparation were used to preserve vestibular bone and achieve better primary stability of the transplanted tooth. Treatment with aligners started 4 weeks after transplantation. Provisonal crown on tooth 13 and provisonal composite veneer on tooth 12 were placed in another 10 weeks to improve smile aesthetics. Lithium-disilicate reconstructions are planned after orthodontic treatment.
CONCLUSION: In the compromised sites, especially in frontal maxila, we are able to preserve buccal bone when preparing recipient bed for transplanted tooth. Moreover, better primary stability could be achieved and there is no need to splint with neigbouring teeth. Implantation is still possible in the worst case of complicasions.
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