Autotransplantation is a treatment alternative for replacing missing teeth, either those missing congenitally or those lost due to trauma or disease, by moving a tooth or a root to a more suitable position within the same individual.
Teeth can be transplanted with good prognosis within the same individual. This is called autotransplantation and is defined as an organ or tissue moved from one location and placed in a different location within the same individual. Teeth can be transplanted from one place to another and a tooth or a root can also be transplanted to a more suitable position within the same socket.
Although replacement of lost or missing teeth in adults is nowadays more often carried out by implant treatment, there are a number of situations where autotransplantation seems to be a better alternative, especially in growing children and adolescents where implants should not be used due to the interference with growth of the alveolar process. A transplanted tooth with periodontal ligament (PDL) will follow and contribute to the development of the alveolar process and in many situations is therefore the first alternative for replacement in growing individuals. There are also some situations in adult patients where autotransplantation is a good alternative.
Transplants can be taken by using teeth in crowded regions or by strategic extraction when equalizing the number of teeth between quadrants. Moreover, many premolars are extracted as part of the orthodontic treatment and can be used as transplants. Third molars can also be used. The transplanted tooth must have a suitable root length and shape.
Teeth with roots under development are easier to extract and have a better prognosis. Developing teeth can revascularize while teeth with fully developed roots do not revascularize and have to be endodontically treated. It is also important to take into consideration the development and growth status of the individual and an interdisciplinary approach is important when planning.
Congenitally Missing Teeth
Tooth aplasia is a suitable indication for autotransplantation (Fig. 11.1). Donor teeth can be other erupted or impacted teeth or strategically extracted, e.g. taken from a crowded area or when a tooth does not have an antagonist. Another indication can also be to equalize teeth between quadrants. If the space is too small, preoperative orthodontic widening may be necessary. An advantage with this type of transplantation is that a natural biological condition for bone and soft tissue development of the alveolar process in the young growing patient is achieved and normal eruption is promoted.
Autotransplantation may be indicated in situations with deep caries or where restoration or crown therapy is not feasible, or when endodontic treatment has failed (Fig. 11.2).