Autotransplantation case - Courtesy ROOTS
The opinions and photographs within this web page are not ours.
Authors have been|
credited for the individual posts where they are - www.rxroots.com
From: Fred Barnett
Sent: Thursday, July 22, 2010 11:39 PM
Subject: [roots] Autotransplantation #32 to #19
Case done with one of my 2nd year residents.....
Here is a Autotransplantation case from today.
18 y/o AA Male. Med Hx: Non-contributory. Ca(OH)2 placed in #19 at
first visit to allow for healing.
#19 sectioned and extracted. Occlusion of #32 reduced prior to
extraction. #32 placed in Hanks Balance Salt Solution during
manipulation of socket. Extraction done with OS.
I reduced the septum bone of the recipient site ~4mm to allow for #32 to
be in hypo-occlusion by 1-2mm.
I sutured the M & D papilla and then splinted #20 and the new #19.
After 4 or 5 tries and adjustments the fit of the donor tooth in the
socket was pretty good. We didn't not use Arestin in this case but
ideally we would've loved to.
Any advice is much appreciated!
Farid Brian Shaikh D.M.D.
Albert Einstein Medical Center
Class of 2011
Fred, very cool case, suprised me at how it fit into the space, and
looked half decent as well.
HOw long before endo is done on the tooth. Do you worry about the
contacts being open on this as it will impact alot of food.
Thanks for sharing a very interesting case, and please post the follow
ups on this, its interesting and it makes you think about how it fits
into Kendos Endo/Implant Algorithm..... : > ) Warmest regards - Glenn
My advice would be to make sure to send us followup photos and rads in
a month or two. I havenít seen this done for a long while, and this was
done beautifully. Congrats.- gary
Hey Fred, Very interesting and well documented case!
Why not splint it to #31 as well? Trying to avoid rigid fixation?
Hi Arturo, The tooth was quite stable, so we decided to just splint it
to one tooth. - Fred
Great case presentation. I wonder if the roots apices will develop
normally before it needs endo? There are probably many pragmatic concerns
related to cost-benefit-outcome comparisons regarding the
implant option versus the autotransplantation option.
Category 1: Favor Autotransplantation versus Implant
a. bone/ridge preservation better than an implant
b. proprioception maintained
c. emergence more natural
d. orthodontically moveable
e. no expensive crap to buy from a heinous specialty-destroying commercial
Category 2: Favor Implant versus Autotransplantation
a. You donít have to worry about fracturing a root on a donor tooth
aborting the plan
b. You donítí have to worry about the potential of malocclusion causing
a complication requiring later ortho
c. You donít have to worry about pulp devitalization and a Cox-Crapped
root resembling the genetic tragic morbidity demonstrated in the
movie ďThe FlyĒ
d. You donít have to worry about potential arrested root formation.
e. You donít have to worry about trying to fit a square peg in a round
hole (ie. Donor to recipient site topographic, volumetric incompatibilities
f. You donítí have to worry about later ankylosis/resorption/attachment/root problems.
Any other I forgot or inaccuracies with what I mentioned? It seems like there
are always pros and cons to everything. - Terry
Terry, Good job with the Pro's and Con's!!
For most of our patients, there are few available options when there is a
'hopeless' tooth. The overall success rate for this procedure is quite high and
they are fun to do with the residents - Fred
Primary to the discussion is if the patientís growth and development has not finished.
Then even an autotransplantation that fails may be successful long enough to hold
the space and the bone for a future implant - Keith
Absolutely!! - Fred
Fred, Thanks for sharing. I remember a lecture at an AAE meeting a couple years
ago about replantation/transplantation (I forget the speaker at the moment).
He showed a case where a cbct scan was used to fabricate a model of the tooth to
be transplanted. This model was then used during surgery to prepare the socket
ideally. Once the fit of the model in the socket was satisfactory, then the
third molar was ext'd and could immediately be placed in the recipient site.
Virtually no out of mouth time.
What steps will now be taken or anticipated regarding the pulp status of 19?
We will follow-up every few weeks then every 3m to assess pulpal and periodontal
healing. I am attaching a slide from Andreasen on healing after
autotransplantation - Fred
this case is in top 5 most amasing cases i;ve ever seen. thank you for sharing.
Here is a case with a 19m follow-up; done with one of my previous residents,
Benedict Bachstein. - Fred
Is that an illusion of angulation or is the pulp chamber of that case calcifying
at a fairly rapid rate? Time to kill the pulp before it gets out of hand? - Terry
The pulp canal space looks obliterated (or soon to be obliterated).
This is expected? even desirable? or does this vary by case, and would it have
been wise to root fill this tooth? Thanks - Kendel
Very nice Fred, some further reading with some recent articles on suuccess/F
Arikan J Period Apr 2008 93.5% success at 5 years
Kim Oral Surg July 2005 95.5% success up to 5 years
MejŠre Oral Surg Feb 2004 81.4% success up to 4 years
- Jorge Vera