Autotransplantation of Teeth

104

13 min read31 July 2025

Machine translation

Original article is written in RU language (link to read it) .

The method of autotransplantation in adults involves the transplantation of a wisdom tooth to the place of any other tooth in the lower or upper jaws. It can be performed either in the socket of the removed tooth or in a newly formed alveolus. Recent studies have shown that after the tooth integrates, a complete periodontal ligament is formed, and functionally the transplant does not differ from other teeth. Significant differences between tooth autotransplantation and implantation include integration times of up to 2 months and the formation of a complete periodontal ligament, which prevents bone resorption and simplifies prosthetics.

The aim of the study is to increase the effectiveness of treatment for adult patients with partial tooth loss through autotransplantation.

Materials and methods: the study was conducted on 64 patients aged 18 to 62 years without somatic diseases. Autotransplantation of 39 upper and 15 lower teeth was performed in natural and artificially created tooth sockets. Splinting was carried out with a non-rigid wire splint for 3 weeks. Endodontic treatment was performed within 2 weeks after the surgery. Results were evaluated using clinical and radiological methods at 6, 12, and 18 months after the surgery.

Results. According to the study, the success rate of this method was 82.4% (n = 56); mobility of II degree or higher was found in 1.5% (n = 1); ankylosis was determined in 4.5% (n = 3); 5.8% (n = 4) were removed due to inflammatory resorption.

Conclusions: the effectiveness of the autotransplantation method depends on many factors, such as the patient's age, the condition of the periodontal ligament of the donor tooth, and the techniques used during the operation. This should be taken into account when selecting a clinical case.

Fig. 1. Autotransplantation into the socket of the extracted tooth. a — similar situation: the wisdom tooth is impacted and does not participate in chewing; the second molar is to be removed for indications; b — removal of the second molar and transplantation of the third molar into the socket. After transplantation, the viability of the periodontal ligament cells will be supported by the blood clot. The fibers lining the alveolar wall do not reduce during the healing process; restoration of the missing volume occurs due to bone tissue remodeling; c — the remodeling process is complete; the bone has formed relative to the new shape of the tooth root; the periodontal space is uniform throughout. Endodontic treatment is performed within 2 weeks after the operation.

Introduction

Long-term observations prove that the effectiveness of autotransplantation is about 95% (tooth survival for more than 10 years). This method can be applied for the restoration of single included and terminal defects of the dental arch. Understanding the processes of periodontal complex regeneration has allowed the development of the most effective techniques for performing tooth-preserving surgeries. For example, using a wisdom tooth as a graft in the molar area allows for the creation of a full chewing unit within 2-3 months and, in most cases, does not require further prosthetics. It should also be noted that after complete regeneration, the functioning periodontal ligament serves as the basis for stable microcirculation and prevents bone resorption, which is a huge advantage over other methods. The increase in research on tooth transplantation, modification of the technique itself, as well as stable long-term results open new opportunities for dental care for patients.

Undoubtedly, the limitation on the number of possible transplant teeth does not place this method on the same level as implantation, but if the clinical situation allows for the use of a tooth instead of an implant, it may be the best solution for the patient.

Fig. 2.a — initial situation. Tooth 1.8 is impacted, not visualized in the oral cavity. Tooth 1.7 is not suitable for restoration; b — preoperative X-ray; c — condition immediately after autotransplantation. Endodontic preparation of tooth 1.8 was performed ex vivo before positioning, the tooth was out of occlusion; d — positioning control; e — stitches were removed after 1.5 weeks, the splint was replaced with a wire; f — radiological control after 1 month; g — condition after 2 months. The splint was removed, and the tooth surfaces were polished; h — control X-ray after 2 months; Bone tissue recovery is observed in the distal area, as well as uniform width of the periodontal ligament space throughout; i — condition after 1 year. The tooth is functioning, in occlusion; j — restorations on adjacent teeth were replaced. The contact point between 1.7 and 1.6 was restored. k — on the X-ray, the periodontal space is uniform. No apical changes were detected.

Fig. 3. Autotransplantation into the socket of the extracted tooth with a chronic inflammatory process. a — initial situation: the tooth to be extracted with a large periapical process; there is a displaced wisdom tooth; b — after transplantation, the viability of the periodontal ligament cells will be maintained by a blood clot; c — the finally formed ligament is usually thinner, the fibers do not have parallel orientation. Despite this, the tooth functions fully.

Operations

Clinical case.

A 31-year-old female patient was referred by her treating physician for the extraction of teeth 1.7 and 1.8, followed by implantation and prosthetics in the area of tooth 1.7. After consulting with the referring physician, an alternative plan was proposed to the patient, which included the extraction of tooth 1.7 and autotransplantation of 1.8 into the socket of tooth 1.7. Since both teeth were to be extracted, the possibility of preserving one of them was decisive in choosing the optimal treatment plan.

1. Autotransplantation into the socket of the extracted tooth with a chronic inflammatory process

Clinical case.

A 29-year-old female patient presented with complaints of aching pain in the area of tooth 4.6. The diagnosis was chronic periodontitis, root resorption. Tooth 4.8 has a conical root and does not participate in chewing. A decision was made to autotransplant tooth 4.8 into the socket of 4.6. Since the crown of tooth 4.8 was fully erupted, with full mouth opening, endodontic treatment was performed, and the canals were temporarily filled with calcium hydroxide. Subsequently, tooth 4.6 was extracted, followed by curettage of the socket and autotransplantation of 4.8. Fixation with a bilateral non-rigid splint. Soft tissue suturing. The splint was removed after 3 weeks.

2. Autotransplantation into an artificially created socket

Fig. 4. Initial situation. Tooth 4.6 is to be removed, tooth 4.8 is fully erupted, the root has a conical shape.

Fig. 5.a — condition before transplantation. Tooth 4.8 has a conical root shape; b — condition after transplantation. Endodontic preparation of the tooth has been performed, temporary filling, splinting.

Fig. 6. Tooth 4.8 positioned in the socket, splinted with a bilateral non-rigid splint for 2 weeks.

Fig. 7. Three months after the surgery. a — clinically, the depth of the gingival attachment is determined to be 2 mm, mobility is within physiological norms; b — on the X-ray, the bone tissue has fully restored, the periodontal space is uniform.

Fig. 8. After 6 months, the tooth is covered with an artificial crown to restore its anatomical shape.

Fig. 9. Two years after the surgery. The periodontal space is uniform throughout, with no signs of resorption observed.

Clinical case.

A 25-year-old female patient presented with the absence of tooth 1.6. The tooth had been extracted in childhood. Upon examination, tooth 1.7 was found to be mesially displaced, there was atrophy of the bone tissue in the area of 1.6, and microdontia of 1.8 was observed. To reduce surgical manipulations and the cost of procedures in the case of implant placement, an autotransplantation of tooth 1.8 was performed into an artificially created socket. The socket was formed taking into account the shape and size of the root of 1.8 using a custom piezo attachment. The attachment was modeled using a computed tomography scan and manufactured in the laboratory.

Fig. 10. Autotransplantation into an artificially created socket. a — initial situation: there is a wisdom tooth that is not involved in chewing; there is a need to restore the defect in the area of the missing tooth; b — during the formation of the bone bed, a stereolithographic model of the donor tooth is used; c — after preparing the socket, the transplanted tooth is extracted and positioned in the socket; d — the finally formed ligament is usually thinner, the fibers do not have parallel orientation. Despite this, the tooth functions fully.

Fig. 11. The bone bed is formed using a custom piezoelectric tip.

Fig. 12. Tooth 1.8 is transplanted into the socket. The soft tissues are sutured.

Fig. 13.a — fixation with a wire splint; b — the surfaces of the formed socket and transplant are maximally congruent.

Fig. 14. a — condition after 2 weeks. The splint has been removed; b — completed endodontic treatment.

Fig. 15.a — condition after 2 years. The tooth is covered with an artificial crown; b — condition after 2 years. The periodontal ligament space is uniform, there are no periapical changes.

Conclusion

Operations of this kind are perceived by patients with great enthusiasm and are well tolerated. In the postoperative period, pain syndrome and swelling in the area of transplantation are absent, which indicates the biological nature of the method. The appointment of antibiotics is done selectively, for preventive purposes.

Transplantation of teeth from the same morphological group in most cases does not require further prosthetics, allowing for the restoration of the dental arch defect in one visit.

Authors: Badalyan V. A., Zedgenidze A. M.

Literature:

Ichinokawa H., et al. The pathological analysis in the experiments on autotransplantation of teeth. Jpn J. Conserv. Dent. 1998; 41: 38.
Ichinokawa H., et al. The pathological analysis in the experiments on autotransplantation of teeth part 2. The microstructural changes in the healing process. Jpn J. Conserv. Dent. 1998; 41: 91.
Andreasen JO. Periodontal healing after replantation and autotransplantation of incisors in monkeys. Int J. Oral Surg. 1981; 10: 54—61. Tsukiboshi M. The criteria of implant or transplant. The Quintessence Yearbook. 1995; 132—44.
Yamamura T., et al. Pathology and Healing. Tokyo: Ishiyaku; 1988.
Andreasen J. O. Review of root resorption systems and models. Etiology of root resorption and the homeostatic mechanisms of the periodontal ligament. In: Biological Mechanisms of tooth Eruption and root resorption. EBSCO Media; 1988: 9—21.
I-Kai Wang, Ho-Tai Wu, A retrospective survival analysis of autotransplanted molars in Taipei Veterans General Hospital 1996~2004. J. Dent. Sci. 2007; 2(4): 226—9.
Yu-Kang Tu, Hsein Kun Lu, Outcomes of Autotransplanted Teeth with Complete Root Formation: A Systematic Review and Meta-Analysis. Art. J. Clin. Periodontol; 2014.
Machado L. A., do Nascimento R. R. Long-term prognosis of tooth autotransplantation: a systematic review and meta-analysis. Int. J. Oral Maxillofac. Surg. 2016; 45: 610—7
Abu-Hussein Muhamad, Nezar Watted Tooth Autotransplantation; Clin. Concepts J. Dent. Med. Sci.; 2017.
Tsukiboshi M. Autotransplantation of teeth: requirements for predictable success. Dent Traumatol. 2002; 18: 157—80.
Tobe O. Histological studies on periodontal tissue reactions following intentional replantation of incisors in monkeys: with special reference to computer-aided three-dimensional reconstruction of replanted teeth. Jpn J. Conserv. Dent. 1990; 33: 772—802. (in Japanese).
Proye M. P., Polson A. M. Repair in different zones of the periodontium after tooth reimplantation. J. Periodontol. 1982; 53: 379—89.
Andreasen J. O. Histometric study of healing of periodontal tissues in rats after surgical injury. I. Design of a standardized surgical procedure. Odontol. Revy. 1976; 27: 115—30.

Surgical periodontology Apical surgery Orthognathic surgery Technologies in maxillofacial surgery