The design and development of surgical templates for premolar transplants in adolescents

Abstract

The aim of designing and fabricating the surgical templates was to assist the surgical component of premolar transplantation, by establishing and replicating the root dimensions of the donor premolar tooth. The correct template could be used to assess the socket preparation (width and depth) prior to placement of the transplant in the recipient site, obviating the need to repeatedly try the donor tooth for fit at the recipient site, thereby minimising trauma to the periodontal ligament of the donor tooth. Seventy-five mandibular premolars and 50 maxillary second premolars were selected with varying stages of root development. All teeth had been extracted for orthodontic reasons. The root was measured for its length (maxL) and maximum (maxW) and minimum width (minW) with digital callipers from standardised reference points. These measurements were then used in the design of premolar transplant templates. The mean measurements for second maxillary premolars were maxL 14.6 mm (± 1.7), maxW 8.3 mm (± 0.5) and minW 4.9 (± 0.3). The mean measurements for mandibular premolars were maxL 14.8 (± 1.6), maxW 7.4 (± 0.6) and minW 5.3 (± 0.5). From these measurements, a range of maxillary second premolar and mandibular premolar templates have been fabricated. These figures also inform the multidisciplinary planning process for the space requirements at the donor site prior to transplantation.

Successful autotransplantation of a mature mesiodens to replace a traumatized maxillary central incisor

“…The use of a surgical template instead of the transplanted tooth itself, during the preparation of the socket, has been shown to reduce unnecessary additional periodontal ligament trauma caused by the adjustment of the donor tooth in the recipient socket (Day et al . ). The donor tooth can also be placed back in its original socket after its removal whilst waiting to be placed in the donor socket (Tsukiboshi ).…”

“…Computer-aided rapid prototyping (CARP) can be used to prepare the recipient site and thus minimise the extra socket time and the possible injury of the transplanted tooth during the process of autotransplantation (Lee et al 2001, Bae et al 2010. The use of a surgical template instead of the transplanted tooth itself, during the preparation of the socket, has been shown to reduce unnecessary additional periodontal ligament trauma caused by the adjustment of the donor tooth in the recipient socket (Day et al 2012). The donor tooth can also be placed back in its original socket after its removal whilst waiting to be placed in the donor socket (Tsukiboshi 2002).…”

In the dental implant era, why do we still bother saving teeth?

“…Autotransplantation involves moving a donor tooth to a receptor site in the same patient ( Figure 2). 48 Success rates for this procedure are as high as 96% and survival rates as high as 98% for autotransplanted teeth. [49][50][51][52] Reported complications of autotransplantation include pulp necrosis, root resorption, and hypermobility.…”

Autotransplantation of third molars with completely formed roots to replace compromised molars with the computer‐aided rapid prototyping

“…The longevity of the transplanted tooth could be influenced by various factors such as case selection, atraumatic tooth removal, and vitality of PDL, among which the preservation of the healthy PDL cells and good tissue adaptation is the most critical factors to consider in the healing of autotransplanted tooth . These factors may be ascribed to several intraoperative factors including the number of fitting attempts of the donor tooth, distance between donor tooth and recipient bone tissue site, extra‐alveolar time, the skill of the surgeon, and level of trauma during donor tooth extraction …”