Present status and future directions: Surgical extrusion, intentional replantation and tooth autotransplantation

Abstract

Surgical extrusion, intentional replantation and tooth autotransplantation procedures are important treatment options that clinicians may consider performing in their day-to-day clinical practice. Despite compromised teeth are generally considered for extraction, clinicians must be aware that these cases could be suitable for management by these alternative predictable treatment options. Surgical extrusion, intentional replantation or tooth autotransplantation have similar treatment protocols which includes atraumatic tooth extraction, visualisation of the root portion and replantation. Surgical extrusion is defined as the 'procedure in which the remaining tooth structure is repositioned at a more coronal/supragingival position in the same socket in which the tooth was located originally'. Intentional replantation is defined as the 'deliberate extraction of a tooth and after evaluation of root surfaces, endodontic manipulation and repair, placement of the tooth back into its original position'. Tooth autotransplantation is defined as the 'transplantation of an unerupted or erupted tooth in the same individual, from one site to another extraction site or a new surgically prepared socket'. The same team previously published a narrative review (

Combined Application of Virtual Simulation Technology and 3-Dimensional-Printed Computer-Aided Rapid Prototyping in Autotransplantation of a Mature Third Molar

“…Compared with fixed bridge restoration which requires the preparation of adjacent healthy teeth, ATT is a minimally invasive technique for denture defect restoration [ 15 ]. With recent advances in the biological understanding of the periodontal ligament (PDL) healing process, ATT has become an alternative treatment option for nonrestorable teeth [ 5 , 11 ]. Distinct from an osseointegrated dental implant, the viable PDL healing endows the transplanted tooth with physiological mobility, better periodontal margin, and function eruption ability resembling a natural tooth.…”

“…A donor tooth with a mature root is recommended to complete root canal treatment before or two weeks after surgery [ 5 ]. In this case, the impacted donor tooth made it difficult to achieve endodontic access, so endodontic treatment was performed three weeks post-surgery ( Figure 4 D).…”

“…In this case, the impacted donor tooth made it difficult to achieve endodontic access, so endodontic treatment was performed three weeks post-surgery ( Figure 4 D). Extra-oral RCT during ATT is not recommended because of the risk of PDL injury and prolonged extra-alveolar time [ 5 ]. Recent studies stated that only 50% of the patients of CARP-based ATT therapy required a root canal treatment with a 100% autotransplantation survival rate [ 23 , 24 ].…”

“…The survival rate of ATT has been widely reported, with that of immature teeth at approximately 90% [ 2 ] and that of mature teeth varying from 59 to 81% [ 4 ]. The presence of an intact periodontal ligament (PDL) on the donor tooth, whether mature or immature, is crucial to the outcome of ATT [ 5 ]. However, the donor tooth must be used as a surgical guide to prepare the recipient socket, and irreversible damage to the PDL of the donor tooth cannot be avoided during this process.…”

“…ATT is considered technique-sensitive because of the series of complicated surgical procedures, including minimally invasive tooth extraction, precise socket preparation, and donor tooth replacement [ 10 , 11 ]. Retaining ample buccal and lingual/palatal bone plates of the recipient site during the operation is necessary to ensure the transplanted tooth is tightly repositioned [ 5 ]. However, a large shape discrepancy between the root of the donor tooth and the recipient alveolus will increase the difficulty of achieving atraumatic socket preparation and impede transplant stability.…”