Tooth transplant

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Tooth transplant
Autotransplantation of wisdom tooth into unrestorable first permanent molar position.jpg
A) Unrestorable upper right first permanent molar (FDI: 16).

B) Extraction socket of unrestorable upper right first permanent molar.

Contents

C) Extracted upper right wisdom tooth (FDI:18) immediately transplanted into socket of upper right first permanent molar.

D) Transplanted wisdom tooth splinted into position.

E & F) Gold shell crown fitted onto transplanted tooth to restore contact with adjacent tooth and anatomy. Note: Faulty restoration of upper right second permanent molar replaced with gold inlay. Both photos taken 7 years after initial surgery.
Specialty Dental

Tooth transplantation is mainly divided into two types:

Indications and Contraindications

Indications

Autotransplantation of teeth can be considered in the following circumstances:

Autotransplantation has the best outcome in growing patients with some root development complete but incomplete development at the apex. If fully developed, autotransplantation can still be successful if an RCT is performed prior to autotransplantation or within 4 weeks following. [5] It has been suggested that tooth autotransplantation may be a successful alternative to osseointergrated dental implants in growing patients, as osseointergrated dental implants are contra indicated in growing patients as they do not grow down with the developing dentition and become fused to the bone. [6]

Contraindications

Contraindications include the autotransplantation of deciduous teeth, transplant to an infected site, if the donor tooth is already restored and if the patient has poor oral hygiene and compliance [7] [8]

Risks and complications

Reported complications of tooth autotransplantation include:

Factors that could influence the risk of complications can range from the age and gender of the candidate to stage of root development, donor and recipient site and extraoral timing of transplantation. [9]

The stage of root development seems to be the biggest influencer of both the future survival, as well as the success of the transplanted teeth. [9] Teeth with open apex are less likely to be extracted in the future compared to teeth with closed apex. [9]

The recipient site should be free from acute infection and chronic inflammation. [3] Adequacy of bone support is crucial criteria for success. [3] To ensure stabilisation of the transplanted tooth and to avoid infection there must be sufficient bone support in all dimensions with adequate attached keratinised tissue. [3]

Timing also plays an important role as immediate replantation of extracted teeth is known to have a good prognosis. [3] Ideally, extraction of the tooth from recipient site should be performed on the same day when donor tooth is removed for transplantation. [3] In cases when tooth from recipient site must be extracted earlier due to toothache or other reasons, transplantation should be scheduled within a month. [3] The later donor tooth will be transplanted, the less support it will have as resorption of the bone would occur at the recipient site. [3]

Furthermore, risk of complications is also increased in cases where candidate selection criteria are not met, where ideally candidates must be in a good health, demonstrate excellent level of oral hygiene, and be amenable to regular dental care. [3]

Procedure

The procedure of tooth transplant is technique sensitive and it requires a team approach involving orthodontist, oral surgeon, paediatric dentist, dental radiologist and technical support. [10] Imaging is needed for radiographic planning of tooth transplant. Two-dimensional imaging is usually sufficient but three-dimensional imaging can be a useful adjunct to treatment planning. [10] Data from Cone Beam Computed Tomography (CBCT) helps to create an accurate surgical template, thereby enhancing the success of autotransplantation of teeth. [10] The procedure of tooth transplant generally involves three stages:

Pre-surgical orthodontics

The aim of pre-surgical orthodontics is to plan the treatment of the malocclusion and to prepare adequate space in the recipient site before the surgical procedure. [10] This may involve having fixed or removable appliances for a few months before the transplant is done. [10] Occasionally the tooth to be transplanted will need to be removed before there is enough space available at the donor site. [10] These teeth can be kept in liquid nitrogen until pre-surgical orthodontic treatment is completed. [10]

Tooth transplant surgery

The classical tooth transplant technique involves the extraction of the donor tooth and preparation of the recipient site using the donor tooth as a template. [10] The use of surgical template has been proposed to minimise extra-alveolar time for the donor tooth. [10] The recipient site is accurately contoured to ensure good blood supply to promote revascularization after tooth transplant. [10] Donor tooth is carefully extracted then placed into the prepared socket and sutured in place. [10] The literature suggests splinting teeth post-operatively but there is limited evidence to support type of splinting material and duration for transplanted teeth. [11]

Post-surgical treatment

Post-surgical treatment involves post-surgical orthodontics and restorations. [10] Post-surgical orthodontics is required to straighten the teeth and achieve the final positioning of the transplanted tooth before definitive restoration. [10] It also provides an additional advantage in the first few months to keep the transplanted tooth free from occlusal trauma. [10] In some cases, endodontic treatment is indicated, but the timing of endodontic treatment is debated in the literature. [11] Restorative work is carried out to improve the appearance of the transplanted tooth. Composite is used either as a temporary or definitive restoration. [10] Partial porcelain veneer can be used as a definitive restoration to match the shape and shade of the natural tooth. [10]

History

A 1787 caricature by Thomas Rowlandson depicting the "Transplantation of Teeth". In the center stands a fashionably dressed dentist removing a tooth from a poor chimney-sweep. The aristocratic lady seated to the left of the viewer is watching and waiting to receive the tooth. However, the caricature was aimed at highlighting the abuse of the poor, not the transplant procedure. Rowlandson - Transplanting of Teeth.png
A 1787 caricature by Thomas Rowlandson depicting the "Transplantation of Teeth". In the center stands a fashionably dressed dentist removing a tooth from a poor chimney-sweep. The aristocratic lady seated to the left of the viewer is watching and waiting to receive the tooth. However, the caricature was aimed at highlighting the abuse of the poor, not the transplant procedure.

Tooth transplantation has been reported from as early as ancient Egypt where mummies were found with human teeth transplanted from other individuals. [3] It was said that slaves were forced to give up teeth to their pharaohs. [3] One of the earliest written accounts of tooth transplantation was by Ambroise Paré, which he wrote around 1562 and was translated by Thomas Johnson in 1634, pp. 658:

Charles Allen, in 1685, wrote of tooth transplantation in the first English dental textbook, The Operator for the Teeth. [12] He encouraged tooth transplantation from animals over humans, stating the latter to be "inhumane" and "attended with too many difficulties". [12] Pierre Fauchard shared his experience in tooth transplantation in the acclaimed Le Chirurgien Dentiste ("The Surgeon Dentist"), published in 1728. In it, he detailed transplanting a canine from a soldier to a captain in an army. The donor tooth was too wide and long for the Captain and Fauchard resorted to reducing its size to fit into the receiver's socket. This resulted in a cavity on the tooth which Fauchard filled once the tooth stabilized. The filling was removed the next day however, as it caused extreme pain. Fauchard saw the patient eight years later who had lost the donor tooth by then but the Captain insisted that the tooth had lasted him six years before being extracted due to caries. [13] [14]

Philipp Pfaff, credited as Germany's first "state-appointed dentist", [15] published Abhandlung von den Zähnen des menschlichen Körpers und deren Krankheiten, (Treatise on The Teeth of the Human Body and Their Diseases) in 1756. He was not fond of tooth transplantation from corpses but emphasized the importance of preserving periodontal ligaments of the transplanted tooth and sealing the apical foramen with lead or wax. [13] [16]

John Hunter documented successful transplantation between humans in 1772, at the peak of the procedure's popularity, stating that it is "without great difficulty, Nature assisting the operation, if it is done in such a way she can assist". [17] [10] Hunter appreciated that the tooth transplanted should ideally be smaller than the socket, and if not, should be adjusted to fit the socket. [17] Hunter is guilty however, of not acknowledging the significance of tooth transplantation in spreading syphilis to seven of his patients following the procedure. [13] Benjamin Bell wrote in 1785 on tooth transplanting in his book, A system of surgery (volume 5), pp. 76, on how the transplanted tooth must be "free from scurvy and the lues venera" thereby appreciating the significance of the procedure in the transmission of various infections. [18]

Following Nicholas Dubois de Chemant's development of "mineral paste dentures", which he patented in 1788, allotransplantation was gradually replaced by dentures that at that time were claimed to not decay in the mouth. [19] [20]

Towards 1950, autotransplantation began to appear in dental literature, renewing interest in tooth transplantation. [21] However, the success rate of the procedure was only about 50%. [21]

Related Research Articles

<span class="mw-page-title-main">Dentistry</span> Branch of medicine

Dentistry, also known as dental medicine and oral medicine, is the branch of medicine focused on the teeth, gums, and mouth. It consists of the study, diagnosis, prevention, management, and treatment of diseases, disorders, and conditions of the mouth, most commonly focused on dentition as well as the oral mucosa. Dentistry may also encompass other aspects of the craniofacial complex including the temporomandibular joint. The practitioner is called a dentist.

<span class="mw-page-title-main">Dentist</span> Health care occupations caring for the mouth and teeth

A dentist, also known as a dental surgeon, is a health care professional who specializes in dentistry, the branch of medicine focused on the teeth, gums, and mouth. The dentist's supporting team aids in providing oral health services. The dental team includes dental assistants, dental hygienists, dental technicians, and sometimes dental therapists.

Cosmetic dentistry is generally used to refer to any dental work that improves the appearance of teeth, gums and/or bite. It primarily focuses on improvement in dental aesthetics in color, position, shape, size, alignment and overall smile appearance. Many dentists refer to themselves as "cosmetic dentists" regardless of their specific education, specialty, training, and experience in this field. This has been considered unethical with a predominant objective of marketing to patients. The American Dental Association does not recognize cosmetic dentistry as a formal specialty area of dentistry. However, there are still dentists that promote themselves as cosmetic dentists.

<span class="mw-page-title-main">Dental implant</span> Surgical component that interfaces with the bone of the jaw

A dental implant is a prosthesis that interfaces with the bone of the jaw or skull to support a dental prosthesis such as a crown, bridge, denture, or facial prosthesis or to act as an orthodontic anchor. The basis for modern dental implants is a biological process called osseointegration, in which materials such as titanium or zirconia form an intimate bond to the bone. The implant fixture is first placed so that it is likely to osseointegrate, then a dental prosthetic is added. A variable amount of healing time is required for osseointegration before either the dental prosthetic is attached to the implant or an abutment is placed which will hold a dental prosthetic/crown.

Prosthodontics, also known as dental prosthetics or prosthetic dentistry, is the area of dentistry that focuses on dental prostheses. It is one of 12 dental specialties recognized by the American Dental Association (ADA), Royal College of Surgeons of England, Royal College of Surgeons of Edinburgh, Royal College of Surgeons of Ireland, Royal College of Surgeons of Glasgow, Royal College of Dentists of Canada, and Royal Australasian College of Dental Surgeons. The ADA defines it as "the dental specialty pertaining to the diagnosis, treatment planning, rehabilitation and maintenance of the oral function, comfort, appearance and health of patients with clinical conditions associated with missing or deficient teeth or oral and maxillofacial tissues using biocompatible substitutes."

Hypodontia is defined as the developmental absence of one or more teeth excluding the third molars. It is one of the most common dental anomalies, and can have a negative impact on function, and also appearance. It rarely occurs in primary teeth and the most commonly affected are the adult second premolars and the upper lateral incisors. It usually occurs as part of a syndrome that involves other abnormalities and requires multidisciplinary treatment.

Periodontology or periodontics is the specialty of dentistry that studies supporting structures of teeth, as well as diseases and conditions that affect them. The supporting tissues are known as the periodontium, which includes the gingiva (gums), alveolar bone, cementum, and the periodontal ligament. A periodontist is a dentist that specializes in the prevention, diagnosis and treatment of periodontal disease and in the placement of dental implants.

<span class="mw-page-title-main">Dental extraction</span> Operation to remove a tooth

A dental extraction is the removal of teeth from the dental alveolus (socket) in the alveolar bone. Extractions are performed for a wide variety of reasons, but most commonly to remove teeth which have become unrestorable through tooth decay, periodontal disease, or dental trauma, especially when they are associated with toothache. Sometimes impacted wisdom teeth cause recurrent infections of the gum (pericoronitis), and may be removed when other conservative treatments have failed. In orthodontics, if the teeth are crowded, healthy teeth may be extracted to create space so the rest of the teeth can be straightened.

<span class="mw-page-title-main">UCLA School of Dentistry</span> Medical school in Los Angeles, California, United States

The UCLA School of Dentistry is the dental school of the University of California, Los Angeles (UCLA) located in the Center for Health Sciences building in the Westwood neighborhood of Los Angeles, California, United States. The school has several educational and training programs, conducts oral and dental health research, and offers affordable dental care at three locations: Westwood, Venice, and Inglewood. The school also participates in several outreach endeavors, including numerous health fairs during the year, STEM pipeline programs and provides dental care for underserved populations in the region. The School of Dentistry is considered among the nation's best research-intensive dental schools.

<span class="mw-page-title-main">Pierre Fauchard</span> French dentist (1679–1761)

Pierre Fauchard was a French physician, credited as being the "father of modern dentistry". He is widely known for writing the first complete scientific description of dentistry, Le Chirurgien Dentiste, published in 1728. The book described basic oral anatomy and function, signs and symptoms of oral pathology, operative methods for removing decay and restoring teeth, periodontal disease (pyorrhea), orthodontics, replacement of missing teeth, and tooth transplantation.

A dental emergency is an issue involving the teeth and supporting tissues that are of high importance to be treated by the relevant professional. Dental emergencies do not always involve pain, although this is a common signal that something needs to be looked at. Pain can originate from the tooth, surrounding tissues or can have the sensation of originating in the teeth but be caused by an independent source. Depending on the type of pain experienced an experienced clinician can determine the likely cause and can treat the issue as each tissue type gives different messages in a dental emergency.

<span class="mw-page-title-main">Crown lengthening</span> Dental procedure

Crown lengthening is a surgical procedure performed by a dentist, or more frequently a periodontist, where more tooth is exposed by removing some of the gingival margin (gum) and supporting bone. Crown lengthening can also be achieved orthodontically by extruding the tooth.

<span class="mw-page-title-main">Root canal treatment</span> Dental treatment

Root canal treatment is a treatment sequence for the infected pulp of a tooth which is intended to result in the elimination of infection and the protection of the decontaminated tooth from future microbial invasion. Root canals, and their associated pulp chamber, are the physical hollows within a tooth that are naturally inhabited by nerve tissue, blood vessels and other cellular entities. Together, these items constitute the dental pulp.

<span class="mw-page-title-main">Tooth impaction</span> Prevention of tooth eruption by a physical barrier

An impacted tooth is one that fails to erupt into the dental arch within the expected developmental window. Because impacted teeth do not erupt, they are retained throughout the individual's lifetime unless extracted or exposed surgically. Teeth may become impacted because of adjacent teeth, dense overlying bone, excessive soft tissue or a genetic abnormality. Most often, the cause of impaction is inadequate arch length and space in which to erupt. That is the total length of the alveolar arch is smaller than the tooth arch. The wisdom teeth are frequently impacted because they are the last teeth to erupt in the oral cavity. Mandibular third molars are more commonly impacted than their maxillary counterparts.

A gum lift is a cosmetic dental procedure that raises and sculpts the gum line. This procedure involves reshaping the tissue and/or underlying bones to create the appearance of longer or symmetrical teeth, thereby making the smile more aesthetically pleasing. This procedure is typically done to reduce excessively gummy smiles or to balance out an asymmetrical gum line. The procedure, also known as crown-lengthening, has historically been used to treat gum disease. It is only within the past three to five years that dentists have commonly used this procedure for aesthetic purposes. The practice of cosmetic gum lifts was first developed in the late 1980s, but there were few oral surgeons and dental practitioners available to perform the procedures. Gum lifts can also include bone shaping to reduce the prominence of the upper jaw and even out the tooth and gum ratio. This method provides permanent results, while simple gum contouring may result in relapse or regrowth of the gingiva.

<span class="mw-page-title-main">Dental avulsion</span> Medical condition

Dental avulsion is the complete displacement of a tooth from its socket in alveolar bone owing to trauma. Normally, a tooth is connected to the socket by the periodontal ligament. When a tooth is knocked out, the ligament is torn.

Digital dentistry refers to the use of dental technologies or devices that incorporates digital or computer-controlled components to carry out dental procedures rather than using mechanical or electrical tools. The use of digital dentistry can make carrying out dental procedures more efficient than using mechanical tools, both for restorative as diagnostic purposes. Used as a way to facilitate dental treatments and propose new ways to meet rising patient demands.

The history of dental treatments dates back to thousands of years. The scope of this article is limited to the pre-1981 history.

Tooth replantation is a form of restorative dentistry in which an avulsed or luxated tooth is reinserted and secured into its socket through a combination of dental procedures. The purposes of tooth replantation is to resolve tooth loss and preserve the natural landscape of the teeth. Whilst variations of the procedure exist including, Allotransplantation, where a tooth is transferred from one individual to another individual of the same species. It is a largely defunct practice due to the improvements made within the field of dentistry and due to the risks and complications involved including the transmission of diseases such as syphilis, histocompatibility, as well as the low success rate of the procedure, has resulted in its practice being largely abandoned. Autotransplantation, otherwise known as intentional replantation in dentistry, is defined as the surgical movement of a tooth from one site on an individual to another location in the same individual. While rare, modern dentistry uses replantation as a form of proactive care to prevent future complications and protect the natural dentition in cases where root canal and surgical endodontic treatments are problematic. In the modern context, tooth replantation most often refers to reattachment of an avulsed or luxated permanent tooth into its original socket.

<span class="mw-page-title-main">Gingival grafting</span>

Gingival grafting, also called gum grafting or periodontal plastic surgery, is a generic term for the performance of any of a number of periodontal surgical procedures in which the gum tissue is grafted. The aim may be to cover exposed root surfaces or merely to augment the band of keratinized tissue.

References

  1. 1 2 Natiella, Joseph R.; Armitage, Jack E.; Greene, George W. (March 1970). "The replantation and transplantation of teeth". Oral Surgery, Oral Medicine, Oral Pathology. 29 (3): 397–419. doi:10.1016/0030-4220(70)90143-x. ISSN   0030-4220. PMID   4983973.
  2. 1 2 3 "Transplanting of teeth". British Dental Association.
  3. 1 2 3 4 5 6 7 8 9 10 11 Nimčenko, Tatjana; Omerca, Gražvydas; Varinauskas, Vaidas; Bramanti, Ennio; Signorino, Fabrizio; Cicciù, Marco (March 2013). "Tooth auto-transplantation as an alternative treatment option: A literature review". Dental Research Journal. 10 (1): 1–6. doi: 10.4103/1735-3327.111756 (inactive 31 January 2024). PMC   3714809 . PMID   23878556.{{cite journal}}: CS1 maint: DOI inactive as of January 2024 (link) CC BY-SA icon.svg Material was copied from this source, which is available under a Creative Commons Attribution-ShareAlike 3.0 Unported license.
  4. ↑ Schwartz, Ole; Frederiksen, Kirsten; Klausen, Bjarne (1987). "Allotransplantation of human teeth. A retrospective study of 73 transplantations over a period of 28 years". International Journal of Oral and Maxillofacial Surgery. 16 (3): 285–301. doi:10.1016/s0901-5027(87)80149-2. ISSN   0901-5027. PMID   3112258.
  5. ↑ Cross, D; El-Angbawi, A; McLaughlin, P; Keightley, A; Brocklebank, L; Whitters, J; McKerlie, R; Cross, L; Welbury, R (Feb 2013). "Developments in autotransplantation of teeth". The Surgeon. 11 (1): 49–55. doi:10.1016/j.surge.2012.10.003. PMID   23142342.
  6. ↑ Jung, R.E.; Pjetursson, B.E.; Glauser, R.; Zembic, A.; Zwahlen, M.; Lang, N.P. (2008). "A systematic review of the 5-year survival and complication rates of implant-supported single crowns" (PDF). Clinical Oral Implants Research. 19 (2): 119–130. doi:10.1111/j.1600-0501.2007.01453.x. PMID   18067597. S2CID   13599504.
  7. ↑ Martin, K; Nathwani, S; Bunyan, R (June 2018). "Autotransplantation of teeth: an evidence-based approach". BDJ. 224 (11): 861–864. doi:10.1038/sj.bdj.2018.432. PMID   29855592. S2CID   46924344.
  8. ↑ Almpani, K.; Papageorgiou, S.N.; Papadopoulos, M.A. (April 2015). "Autotransplantation of teeth in humans: a systematic review and meta-analysis". Clinical Oral Investigations. 19 (6): 1157–1179. doi:10.1007/s00784-015-1473-9. PMID   25903060. S2CID   7915503.
  9. 1 2 3 4 Almpani, Konstantinia; Papageorgiou, Spyridon N.; Papadopoulos, Moschos A. (2015-04-24). "Autotransplantation of teeth in humans: a systematic review and meta-analysis". Clinical Oral Investigations. 19 (6): 1157–1179. doi:10.1007/s00784-015-1473-9. ISSN   1432-6981. PMID   25903060. S2CID   7915503.
  10. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Cross D.; El-Angbawi A.; McLaughlin P.; Keightley A.; Brocklebank L.; Whitters J.; McKerlie R.; Cross L.; Welbury R. (2013-02-01). "Developments in autotransplantation of teeth". The Surgeon. 11 (1): 49–55. doi:10.1016/j.surge.2012.10.003. ISSN   1479-666X. PMID   23142342.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  11. 1 2 Martin, K.; Nathwani, S.; Bunyan, R. (2018-06-01). "Autotransplantation of teeth: an evidence-based approach". BDJ. 224 (11): 861–864. doi:10.1038/sj.bdj.2018.432. ISSN   0007-0610. PMID   29855592. S2CID   46924344.
  12. 1 2 Weinberger, Bernhard Wolf (Jan 1931). "Charles Allen's "The Operator for the Teeth," York, 1685: The History of the First English Dental Publication, with Corrections". The Journal of the American Dental Association. 18 (1): 67–76. doi:10.14219/jada.archive.1931.0027. ISSN   1048-6364.
  13. 1 2 3 Noble, Henry W. (2002). "Tooth transplantation: a controversial story" (PDF). Henry Noble History of Dentistry Research Group.
  14. ↑ Fauchard, Pierre (1980). Le chirurgien dentiste, ou, Traité des dents / Pierre Fauchard; being a facsimile of the 1746 French edition, together with the Lindsay English translation of 1946. Birmingham, Ala.: Classics of Dentistry Library.
  15. ↑ "Treatise on The Teeth of the Human Body and Their Diseases". NYU College of Dentistry. 2017.
  16. ↑ Pfaff, Philipp (1756). Philipp Pfaffs, Königl. Preuß. Hof-Zahn-Arztes und privilegirten Chirurgi, Abhandlung von den Zähnen des menschlichen Körpers und deren Krankheiten: Mit Kupfern (in German). Bey Haude und Spener.
  17. 1 2 Hunter, John (1803). The natural history of the human teeth: explaining their structure, use, formation, growth, and diseases. To which is added A practical treatise on the diseases of the teeth / [John Hunter]. London: W. Spilsbury for J. Johnson.
  18. ↑ Bell, Benjamin (1785). A system of surgery. Edinburgh: Charles Elliott.
  19. ↑ Engelmeier, Robert L. (2003). "The history and development of posterior denture teeth[mdash ]introduction, part I". Journal of Prosthodontics: Implant, Esthetic, and Reconstructive Dentistry. 12 (3): 219–226. doi:10.1016/s1059-941x(03)00099-8. ISSN   1059-941X. PMID   14508746.
  20. ↑ "A French dentist showing his artificial teeth". bda.org. Retrieved 2018-11-26.
  21. 1 2 Tsukiboshi, Mitsuhiro (2001). Autotransplantation of teeth. Andreasen, J. O. Chicago: Quintessence Pub. Co. ISBN   978-0867153958. OCLC   46315308.
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