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Protocol of Autotransplantion and Orthodontics Domínguez, P; Mendes da Silva, J; Ustrell, JM. AIM Autotransplantion consists in the transposition of a tooth (with open or closed apex) into an alveolous surgically done. The success rate increases when combined with orthodontic treatment because it reduces the risk of ankylosis and has other advantages when compared with implants. The aim is to make a systematic review to achieve an autotransplantation protocol for teeth with open and close apex, compiling multidisciplinary needs of Surgery, Endodontics and Orthodontics. MATERIAL and METHODS This systematic review used the data base of Pubmed and the library UB with the key words: Tooth autransplantation, orthodontics. The total of publications was 635 and applying the inclusion criteria (systematic reviews, prospective and retrospective studies and follow-up of minimum of 5 years) and exclusion criteria (single clinical cases), the end result was 33 publications. RESULTS and PROTOCOL ✓Indications • Dental absence • Surgical reposition of impacted teeth ✓Contra-Indications • Complicated extractions (atypical roots or dilacerations) • Teeth with pockets deeper then 4mm, caries, restorations or root canals • Incompatible size with the receptor site • Teeth in early stages of root development ✓ Success Factors • Best timing: root development of 2/3 or 3/4 of length • Presence of the deciduous tooth • Better prognosis in premolar region than molar as donor site • Minimize surgical trauma with a correct technique • Timings for endodontics and orthodontics treatments Closed Apex Transplant Open Apex Transplant Pre-surgical orthodontics of alignment and space management CT scan / Surgery Autotransplantation ✓ Advantages • Natural structure with periodontal ligament and enamel • Better emergency profile and allows orthodontic movement. • Bone preservation in growing patients • Single surgery, faster and cheaper then implants ✓ Disadvantages • Rootcanal treatment in teeth with closed apex • Incomplete root development in autotransplants with open apex • External apical resorption (main failure in the first year) • Ankylosis • Pulp obliteration or necrosis • Molares are more susceptible to ankyolsis than pre-molares Impacted teeth Erupted teeth CT scan / Surgery Autotransplantation Endodontic Treatment 3 weeks Endodontic Treatment CT scan / Surgery Autotransplantation 2-4 weeks Orthodontic Treatment CONCLUSIONS • Autotransplantation is a treatment with a high success rate (84-94%) • Ideal in growing patients • Patients report a low/moderate discomfort during one single surgery and are satisfied with the result • Postoperative orthodontic forces, within 2-4weeks, decrease the risk of ankylosis and increase the success rate. BIBIOGRAPHY • Plakwicz P, Wojtowicz A, Czochrowska EM. Survival and success rates of autotransplanted premolars: a prospective study of the protocol for developing teeth. Am J Orthod Dentofacial Orthop 2013;144:229–37. • Watanabe Y, Mohri T, Takeyama M, Yamaki M, Okiji T, Saito C, et al. Long-term observation of autotransplanted teeth with complete root formation in orthodontic patients. Am J Orthod Dentofacial Orthop 2010;138:720–6. • Denys D, Shahbazian M, Jacobs R, Laenen A, Wyatt J, Vinckier F, et al. Importance of root development in autotransplantations: a retrospective study of 137 teeth with a follow-up period varying from 1 week to 14 years. Eur J Orthod 2013;35:680–8.
