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An autogenous tooth transplant: report of case
A maxillary right molar was transplanted to the left mandibular quadrant in the mouth of a 22-year-old man.
An autogenous tooth transplant: report of case
Fred Danziger, DDS, Long Beach, NY ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■
The transplantation of teeth has been discussed as far back as the 17th century. Successful trans plants have been mentioned in the literature periodically but, for the most part, these cases were poorly documented. In this report of an autogenous transplant of a fully developed tooth, the criteria of success, both radiographically and clinically, will be elucidated.
Report of case In June 1974, a 22-year-old man had pain in the lower left dental quadrant. Clinical and radiographic examination showed a mesioangular im paction of the mandibular left third molar and a deep carious lesion in the distal aspect of the second molar (A). The patient was advised to have the impacted tooth removed immediately and to have the lesion filled. By his next visit on Jan 9, 1975, the impacted tooth had been successfully removed, but nothing had been done to correct the lesion in the second molar (B). At this time, a periapical radiograph
showed a lesion below the crest of the alveolar bone. Although the tooth might have been treated successfully endodontically, it would have been a difficult, traumatic, and, most likely, a com promised final restoration. Therefore, the deci sion was made to extract the tooth and replace it with the maxillary right third molar. On Jan 15, the mandibular left second molar was extracted, and the extraction site was curetted thoroughly. The mandibular right third molar was removed immediately and placed into the freshly prepared socket. A wire ligation and acrylic splint were fabricated and used to stabilize the transplanted tooth which was placed in infraocclusion (C). One week postoperatively, the transplant ap peared healthy, in spite of the patient’s poor oral hygiene. Subsequent postoperative examinations showed a great deal of improvement in home care. However, in a six-week postoperative radiograph (D) considerable deterioration of bone was seen, and at eight weeks there were no signs of im provement. The prognosis now became very questionable. The splint was removed to deter mine mobility and to test the tooth’s ability to JADA, Vol. 96, January 1978 ■ 105
An autogenous too th transplant: Im paction of m andibular third left m olar and deep carious lesion In second m olar (A); im pacted m olar removed, lesion below crest visible (B); stabilization of transplanted too th (C); six weeks after transplant bone d e terioration seen (D); sp lin t removed (E); ro ot canal therapy com pleted (F); fun ctiona l transplanted tooth (G, H, I).
w ith stan d n o rm al s tr e s s e s (E ). M o b ility w a s 1 + , p o c k e t d ep th s w e re 3 mm lin g u a lly , 5 m m b u c a lly ,
A lth o u g h th e s u c c e s s o f tra n sp la n te d te e th is n o t p re d ic ta b le , w ith p ro p e r c a s e s e le c tio n , c a r e
5 m m d is ta lly , and 4 m m m e sia lly . A t n ine w e e k s , p o sto p e ra tiv e a c tiv e b o n e lo ss a p p ea red to hav e a b a te d . N o fu rth e r ch a n g e s w ere n o ted by th e 13th w e e k ; h o w e v e r, th e p eria p ica l lesio n and th e m o b ility still p e rsiste d . A t th is tim e , ro o t ca n a l th e ra p y w as in itia te d . O n S e p t 2 7 , th e th e ra p y w as co m p le te d ( F ) . M o b ility w as re d u ce d to a + . S o ft tissu e q u a lity w as e x c e lle n t, a lth ou g h d ep th s o f th e p o c k e ts rem ain ed th e sa m e (G ). A s o f N o v 6 , 1976, th e tra n sp la n te d to o th w a s in o c c lu s io n and c o m p le te ly fu n c tio n a l. P o c k e t d ep th s w ere 4 m m m e sia lly , 3 m m b u c a lly , 3 mm
ful m a n ip u la tio n , and scru p u lo u s oral h y g ien e the p ro g n o sis o f su ch a p ro ce d u re is g re a tly e n h a n ced .
d is ta lly , and 3 m m ling u ally . T h e r e w as no in d ic a tio n o f p e riap ica l in fe c tio n , ro o t re s o rp tio n , or a n k y lo s is . M o b ility rem a in s le ss than 1 (H , I). A t a 2 1 -m o n th fo llo w -u p , th e tra n sp la n t a p p e a rs to b e d oing q u ite w ell and th e p a tie n t is c o m p le te ly c o m fo rta b le . 106 ■ JADA, Vol. 96, January 1978
The author acknow ledges the advice and assistance of Dr. Leon Schertzer.
AUTHOR
Dr. Danzlger is in private prac tice in Long Beach, NY, and Is chief of adult special care at the N orth Shore University Hospital, 300 C om m unity Dr, Manhasset, NY, 11030. DANZIGER
An autogenous tooth transplant: report of case
Fred Danziger, DDS, Long Beach, NY ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■
The transplantation of teeth has been discussed as far back as the 17th century. Successful trans plants have been mentioned in the literature periodically but, for the most part, these cases were poorly documented. In this report of an autogenous transplant of a fully developed tooth, the criteria of success, both radiographically and clinically, will be elucidated.
Report of case In June 1974, a 22-year-old man had pain in the lower left dental quadrant. Clinical and radiographic examination showed a mesioangular im paction of the mandibular left third molar and a deep carious lesion in the distal aspect of the second molar (A). The patient was advised to have the impacted tooth removed immediately and to have the lesion filled. By his next visit on Jan 9, 1975, the impacted tooth had been successfully removed, but nothing had been done to correct the lesion in the second molar (B). At this time, a periapical radiograph
showed a lesion below the crest of the alveolar bone. Although the tooth might have been treated successfully endodontically, it would have been a difficult, traumatic, and, most likely, a com promised final restoration. Therefore, the deci sion was made to extract the tooth and replace it with the maxillary right third molar. On Jan 15, the mandibular left second molar was extracted, and the extraction site was curetted thoroughly. The mandibular right third molar was removed immediately and placed into the freshly prepared socket. A wire ligation and acrylic splint were fabricated and used to stabilize the transplanted tooth which was placed in infraocclusion (C). One week postoperatively, the transplant ap peared healthy, in spite of the patient’s poor oral hygiene. Subsequent postoperative examinations showed a great deal of improvement in home care. However, in a six-week postoperative radiograph (D) considerable deterioration of bone was seen, and at eight weeks there were no signs of im provement. The prognosis now became very questionable. The splint was removed to deter mine mobility and to test the tooth’s ability to JADA, Vol. 96, January 1978 ■ 105
An autogenous too th transplant: Im paction of m andibular third left m olar and deep carious lesion In second m olar (A); im pacted m olar removed, lesion below crest visible (B); stabilization of transplanted too th (C); six weeks after transplant bone d e terioration seen (D); sp lin t removed (E); ro ot canal therapy com pleted (F); fun ctiona l transplanted tooth (G, H, I).
w ith stan d n o rm al s tr e s s e s (E ). M o b ility w a s 1 + , p o c k e t d ep th s w e re 3 mm lin g u a lly , 5 m m b u c a lly ,
A lth o u g h th e s u c c e s s o f tra n sp la n te d te e th is n o t p re d ic ta b le , w ith p ro p e r c a s e s e le c tio n , c a r e
5 m m d is ta lly , and 4 m m m e sia lly . A t n ine w e e k s , p o sto p e ra tiv e a c tiv e b o n e lo ss a p p ea red to hav e a b a te d . N o fu rth e r ch a n g e s w ere n o ted by th e 13th w e e k ; h o w e v e r, th e p eria p ica l lesio n and th e m o b ility still p e rsiste d . A t th is tim e , ro o t ca n a l th e ra p y w as in itia te d . O n S e p t 2 7 , th e th e ra p y w as co m p le te d ( F ) . M o b ility w as re d u ce d to a + . S o ft tissu e q u a lity w as e x c e lle n t, a lth ou g h d ep th s o f th e p o c k e ts rem ain ed th e sa m e (G ). A s o f N o v 6 , 1976, th e tra n sp la n te d to o th w a s in o c c lu s io n and c o m p le te ly fu n c tio n a l. P o c k e t d ep th s w ere 4 m m m e sia lly , 3 m m b u c a lly , 3 mm
ful m a n ip u la tio n , and scru p u lo u s oral h y g ien e the p ro g n o sis o f su ch a p ro ce d u re is g re a tly e n h a n ced .
d is ta lly , and 3 m m ling u ally . T h e r e w as no in d ic a tio n o f p e riap ica l in fe c tio n , ro o t re s o rp tio n , or a n k y lo s is . M o b ility rem a in s le ss than 1 (H , I). A t a 2 1 -m o n th fo llo w -u p , th e tra n sp la n t a p p e a rs to b e d oing q u ite w ell and th e p a tie n t is c o m p le te ly c o m fo rta b le . 106 ■ JADA, Vol. 96, January 1978
The author acknow ledges the advice and assistance of Dr. Leon Schertzer.
AUTHOR
Dr. Danzlger is in private prac tice in Long Beach, NY, and Is chief of adult special care at the N orth Shore University Hospital, 300 C om m unity Dr, Manhasset, NY, 11030. DANZIGER