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Autotransplantation case - Courtesy ROOTS
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From: Fred Barnett To: ROOTS Sent: Thursday, July 22, 2010 11:39 PM Subject: [roots] Autotransplantation #32 to #19 Case done with one of my 2nd year residents..... Hello Everyone, 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! Thanks, Farid Brian Shaikh D.M.D. Albert Einstein Medical Center Class of 2011Fred, 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 haven’t 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? - Arturo 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 interest JJJ Category 2: Favor Implant versus Autotransplantation a. You don’t have to worry about fracturing a root on a donor tooth aborting the plan b. You don’t’ have to worry about the potential of malocclusion causing a complication requiring later ortho c. You don’t have to worry about pulp devitalization and a Cox-Crapped root resembling the genetic tragic morbidity demonstrated in the movie “The Fly” d. You don’t have to worry about potential arrested root formation. e. You don’t have to worry about trying to fit a square peg in a round hole (ie. Donor to recipient site topographic, volumetric incompatibilities f. You don’t’ 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 patient’s 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? - Kendel 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. - Sergiu 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 Mejáre Oral Surg Feb 2004 81.4% success up to 4 years - Jorge Vera
