How Successful Is Autotransplantation and What Do Patients Think?

 Orthodontics - September 30, 2013 - Vol. 27 - No. 9

Autotransplantation is a technique that, when performed with established protocols, is a highly successful procedure that is well-accepted by the patient.

Article Reviewed: Survival and Success Rates of Autotransplanted Premolars: A Prospective Study of the Protocol for Developing Teeth. Plakwicz P, Wojtowicz A, et al: Am J Orthod Dentofacial Orthop; 2013;144 (August): 229-237.

Objective: To examine the predictability of the protocol for premolar autotransplantation when applied by an inexperienced surgeon.

Participants: 19 patients with 23 consecutively transplanted developing premolars.

Methods: In addition to the main objective, the hard and soft tissues of the transplanted teeth were compared to control premolars. Patients' perceptions of the procedure were also assessed following the surgical procedure. Mean patients age at surgery was 12 years 8 months (range, 9 years 10 months to 17 years). Mean observation time was 35 months (range, 6 to 78 months). Plaque accumulation, pocket depth, gingival recession, mobility, and pulp sensitivity were recorded for the transplanted and control teeth. Standardized radiographs were used to examine hard tissues and crown-to-root ratios. Questionnaires were used to register each patient's opinion about the treatment and its outcome.

Results: Survival rate of the transplanted premolars was 100%, and the success rate was 91.3%. Of transplanted teeth, 2 were categorized as not successful with 1 having a less than ideal crown-to-root ratio and the other was ankylosed. No significant differences in plaque accumulation, gingival height, mobility, and pocket depths were recorded between the autotransplanted teeth and controls. Electronic pulp testing the teeth did not find a significant difference between samples. Crown-to-root ratios were found to be 11% smaller in transplanted teeth than controls. Transplanted teeth generally exhibited various degrees of pulp obliteration and normal lamina duras on post-surgical evaluation. Patients' perceptions of the surgical management and treatment outcomes were favorable.

Conclusions: The protocol for autotransplantation of developing premolars in growing patients was successfully adopted. Soft and hard tissues of transplanted premolars were generally not significantly different than controls. Patients who had the procedure generally responded favorably when surveyed about the surgery and outcome.

Reviewer's Comments: Autotransplantation is a highly successful procedure provided proper established protocols are followed. The technique is not utilized as extensively in the U.S. as in Europe. The article did not elaborate on the protocols although they are referenced in the article. With a mean observation time of 35 months (range, 6 to 78 months) it would be interesting to evaluate these patients at longer intervals to determine if any differences between controls develop in time.(Reviewer–John Kanyusik, DDS, MSD).

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