Part V: Autotransplantation

AUTOTRANSPLANTATION

ANKLYOSIS AND AUTOTRANSPLANTATION

One option that I have previously written about is the use of autotransplantation to manage these young patients. Autotransplantion is a procedure that utilizes the patient’s own teeth, typically the mandibular second premolar, as a replacement for missing anterior teeth by extraction and re-implantation. The transplanted tooth can then serve as an esthetic and functional replacement for the patient. The major concern for most dentists is: how predictable is this type of treatment?

A 2002 paper from the Am J Orthod Dentofacial Orthop (Czochrowska EM, et al.) entitled Outcome of Tooth Transplanation: Survival and Success Rates 17-41 Years Post-treatment showed a 90% survival rate (with a mean observation time of 26 years). By comparison with other treatment options, this is an extremely favorable outcome. However, it must be stated that the success rates is highly dependent on the skill and experience of the surgeon performing transplantations. I have been fortunate to work with Dr. Jim Janakievski in Tacoma, WA whom I consider to be one of the world experts in the area.

THE REQUIREMENTS NEEDED FOR AUTOTRANSPLANTATION?

The harvested tooth needs to have a root length that is two-thirds to fully developed and have an open apex. This will provide the most predictable transplant for retaining vitality as well as having continued root development. Generally, the patient that has a mandibular second premolar that meets these criteria is typically between the ages of 10-12. (Figure 2)

Figure 2

Hence, this treatment option has a narrow window of time where it is viable. The transplanted teeth placed in a similar position of eruption as they were in when harvested. (Figure 3) These teeth typically have continued root development and even maintain their vitality which can be attributed to their stage of root development at the time of harvest.

The transplant tooth can be built up with composite and the patient can continue on with orthodontic treatment. (Figures 4 and 5)

Although this is not a treatment option that needs to be utilized every day, it is wonderful to know that autotransplantion can provide a predictable esthetic and functional replacement for these patients that would otherwise have to wait 10 to 12 years, until the completion of growth, before the implant can be placed.

Figure 3

Figure 4

Figure 5

A B O U T T H E AUTHOR

A gifted academician and clinician, Dr. Kinzer’s interdisciplinary approach to dentistry is founded in empirical research and clinical experience. His unique ability to impart complex clinical processes in a logical, systematic and understandable way differentiates him from other dental educators of our time.

Committed to advancing the art and science of restorative dentistry, Dr. Kinzer continues to serve as an affiliate assistant professor in the graduate prosthodontic program at the University of Washington School of Dentistry. He also taught with Dr. Frank Spear at the Seattle Institute for Advanced Dental Education from 1998-2009 prior to joining Spear Resident Faculty.

In addition, Dr. Kinzer has written numerous articles and chapters for many dental publications and serves on the editorial review board for the Journal of Esthetics and Restorative Dentistry. He maintains a private practice in Seattle limited to comprehensive restorative and esthetic dentistry.

Dr. Kinzer received his D.D.S. from the University of Washington in 1995 and an M.S.D. and certificate in prosthodontics in 1998.

Greggory Kinzer, D.D.S., M.S.D.

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