The outcomes of auto-transplanted premolars into the anterior maxilla following traumatic dental injuries

Background/ Aims

Tooth auto-transplantation is a treatment option which is often not considered to replace anterior maxillary incisors in children and adolescents. There are multiple prognostic factors that may influence the outcomes of premolar auto-transplantation but there is limited evidence from human studies. The aim of this study was to report the outcomes of auto-transplanted premolars in the anterior maxilla following traumatic dental injuries (TDI) and to identify their prognostic factors.

Materials and Methods

The clinical records of patients who had premolars transplanted in the anterior maxilla following TDI, with appropriate radiographs and a minimal of one year follow up, were reviewed retrospectively. A specific data extraction form was developed, tested, and used to collect information for the prognostic factors and outcomes.

Results

The cohort included 120 patients with 144 auto-transplanted premolars. The mean age was 12.2 years (+ 2.0), and the mean observation period was 3.7 years (+ 1.8). The success rate was 80% and the survival rate was 93%. Unfavourable outcomes included external replacement resorption in 12.5%, uncontrolled external inflammatory resorption in 2.7% and both resorption types in 4.9% of teeth. Periodontal healing was significantly associated with donor tooth root maturity, graft handling at the time of surgery including ease of donor tooth extraction and placement at the recipient sites, recipient site alveolar bone status and post-operative transplant mobility. Seventy four teeth (53.4%) were immature at the time of transplantation where pulp revascularisation was anticipated and 52 (70%) of those had radiographic and clinical signs of pulp healing. Pulp healing was significantly related to donor tooth eruption stage, ease of extraction of donor tooth and ease of placement in the recipient site.

Conclusions

Good outcomes were observed for premolar teeth auto-transplanted in the anterior maxilla. The main prognostic factors were ease extraction of donor tooth and ease of placement in the recipient sites and donor tooth root maturity.