Successful pulp revascularization of an autotransplantated mature premolar with fragile fracture apicoectomy and plasma rich in growth factors: a 3‐year follow‐up

Abstract

Aim This case report demonstrates a positive outcome of the adjuvant use of fragile fracture (FF), which is a technique used to harvest dental pulp stem cells (DPSCs), and platelet‐rich plasma (PRP) in a mandibular premolar (tooth 44) with a completely formed root that was transplanted into a surgically created socket and which maintained pulp vitality and function. Summary After virtual surgical planning, a 3D tooth replica of tooth 44 was fabricated. A surgical socket was created in the position of tooth 14; then, tooth 44 was extracted and the root dentine was abraded using a turbine diamond bur 3 mm from the apex until a circular groove was prepared around the outer circumference of the root; and then, an FF was performed without damaging the pulp tissue. PRP was placed in the socket, after which the donor tooth was inserted in the recipient area. At 2 weeks post‐treatment, orthodontic traction was applied. At 3‐year follow‐up, the tooth had adequate alignment and was asymptomatic. Response to pulp testing was positive, and the presence of pulp canal obliteration was observed as a sign of pulpal healing. Key learning points Autotransplantation is a good alternative for replacing missing teeth, with repair of tissues and pulp revascularization. Revascularization of an autotransplanted mature tooth using the fragile fracture technique and PRP scaffold is a feasible option and might have positive effects on the long‐term outcome of the procedure. Including completely formed teeth as donors in autotransplantation, maintaining vitality and their functions is an option that warrants further study.

Enhanced conservation of vital pulp and apical tissues by the application of crown rotation surgery for inversely impacted central incisors: A follow‐up analysis of two patients over 4 years

“…As with the replantation of avulsed immature teeth, PCO formation was also observed in impacted incisors when treated by existing surgical methods. Although PCO is considered as a form of pulp revascularization (Tsukiboshi et al, 2019) and a sign of pulp healing (Gavino Orduna et al, 2020; Plakwicz et al, 2015), this condition may be accompanied by yellow discolouration in the crown (Fouad et al, 2020; McCabe & Dummer, 2012), loss of pulpal sensibility (Amir et al, 2001; Gavino Orduna et al, 2020; Oginni et al, 2009) and difficulties when performing further root canal treatment (American Association of Endodontics, (Edited 2010); McCabe & Dummer, 2012).…”

Autotransplantation of the Third Molar: A Therapeutic Alternative to the Rehabilitation of a Missing Tooth: A Scoping Review

“…Furthermore, regeneration materials such as platelet-rich plasma (PRP) used as scaffold materials [ 80 ] can be used inside the alveolus of the recipient site in order to favor the revascularization of the transplanted tooth as reported by Gaviño et al (2020) [ 81 ] and also confirmed by a case series on 11 transplanted teeth by Gonzalez-Ocasio and Stevens [ 82 ].…”

A retrospective analysis of autotransplanted teeth including an evaluation of a novel surgical technique

“…This was shown to be effective in dog studies [24][25][26]38], where necrotic pulp tissue was replaced by wellvascularized and cell-rich connective tissue within 90 days in two-thirds of the cases. Three recent case reports proved the feasibility of this approach for single-rooted teeth scheduled for autotransplantation and showed promising initial outcomes [21][22][23].…”

“…Recently, a novel surgical technique using extraoral apical resection for preservation of pulp vitality in mature autotransplanted teeth was presented [21]. Subsequently, two case reports have also shown successful outcomes using similar techniques [22,23]. The promising data obtained with this novel approach is corroborated by animal studies, where root-end resection of mature transplants has yielded high revascularization rates [24][25][26].…”