The following is the third and final presentation on the management of ectopic eruption of teeth.

Part 3 

As we’ve seen so far, autotransplantation can be used with great success in treating ectopic and/ or transmigration of teeth. This novel treatment has it’s roots (no pun intended) in ancient Egypt, where slaves were forced to give up their teeth for the Pharaohs, but due to biocompatibility issues this practice was abandoned. Autotransplantation is frequently preformed in instances where 1st molar is extracted and replaced with a third molar. Treatment with autotransplantation may serve as a valuable tool when faced with outstanding case scenarios as we’ve seen. Here are some guidelines to success with great thanks to our colleague Dr. Rob Pasch: 
 
 
Treatment Guidelines: 
  1. Medically and dentally healthy patient: Uncontrolled diabetics, recreational drug users, smokers, vapers, and patients suffering from periodontal disease are not good candidates. Autotransplantation has a higher chance of success in younger patients
  2. Donor teeth should be free of decay, with favorable root anatomy, possessing a healthy pulp and periodontium. 1/2 – 2/3 root formation with immature open apex favors pulpal innervation
  3. Selected recipient site with adequate buccal lingual width and favorable osseous structure 
  4. Surgical site preparation must be made adequate in order to accommodate the size of the donor root loosely. Recipient socket must be kept sterile as possible. CBCT and surgical models may aid in planning  
  5. Atraumatic extraction in maintaining PDL integrity and reduce patient discomfort. Pre-transplant ortho in increasing PDL space and thus making extraction easier. Elevator free extraction recommended. 
  6. Preservation of PDL and Hertwig’s epithelial root sheath: onset of ankylosis may occur due to trauma to PDL tissue during extraction or fitment of donor tooth into tight socket. Autotransplantation is technique sensitive 
  7. Transfer time should be reduced to a minimum. Donor tooth should be placed back into original socket in between fit checks minimizing air exposure of the PDL and thus chance of ankylosis
  8. Post op: Patient must maintain excellent gentle hygiene, transplanted tooth must not be subject to traumatic forces
  9. Two weeks of healing prior to application of any orthodontic forces. Flexible splint may be used for initial stabilization of transplanted teeth.
  10. Retainer is indicated after completion of orthodontic treatment.
Final Thoughts
Overall successful autotransplantation of teeth is dependent on successful pulpal regeneration and successful periodontal ligament regeneration. In order for this to happen the procedure must be carried out in an atraumatic and sterile manner on a healthy patient with an uncompromised donor tooth. 

Autotransplantation of ectopic teeth can result in shorter overall treatment time, better aesthetics, reduced cost of treatment, with the added physiological benefit of allowing the alveolus to mature in a normal fashion. Nonetheless, this is an extremely operator sensitive procedure requiring adequate planning, carried out in a coordinated manner by a skillful multidisciplinary team.
Today’s Morning Huddle Case was presented with reference to Dr. Rob Pasch’s Master Thesis on Ipsilateral auto-transplantation and subsequent orthodontic movement for ectopically erupted teeth as part of orthodontic treatment planning. University of Duisburg-Essen.
Category: MH