Autotransplantation: A Viable Treatment Option For Young Patients With Traumatic Dental Injuries

In recent articles, the frustrations and treatment options for young patients with avulsed or ankylosed teeth have been discussed. An often-overlooked treatment option is the use of autotransplantation. Autotransplantion is a procedure that utilizes the patient's own teeth (typically the mandibular second premolar) as a replacement for missing anterior teeth by extraction and re-implantation.

The transplanted tooth can then serve as an esthetic and functional replacement for the patient. The major concern for most dentists is “how predictable is this type of treatment”? A 2002 paper from the Am J Orthod Dentofacial Orthop (Czochrowska EM, et al.) entitled Outcome of Tooth Transplanation: Survival and Success Rates 17-41 Years Post-treatment showed a 90 percent survival rate (with a mean observation time of 26 years). By comparison with other treatment options, this is an extremely favorable outcome. However, it must be stated that the success rates is highly dependent on the skill and experience of the surgeon performing transplantations.

What are the requirements that are needed for autotransplantation? The harvested tooth needs to have a root length that is 2/3's to fully developed and have an open apex. This will provide the most predictable transplant for retaining vitality as well as having continued root development. Generally, the patient that has a mandibular second premolar that meets these criteria is typically between the ages of 10-12. Hence, this treatment option has a narrow window of time where it is viable.

Although this is not a treatment option that needs to be used every day, it is wonderful to know that autotransplantion can provide a predictable esthetic and functional replacement. This is especially comforting when you realize that if an implant were to be used, you may be waiting 10-12 years (until the patient stops growing) before the implant can be placed. How many patients do you know that want to wait that long for definitive treatment?