There are a lot of dental procedures being utilized by consumers whether for aesthetic purposes or medical, and tooth transplantation is the most common one. Basically, this is done by moving a tooth from a site to another site of the mouth and rarely to another recipient.

Studies showed that implants utilized in filling gaps of missing front teeth are not the best alternative since this can cause a considerable amount of bone loss and abrasion on neighboring teeth and surrounding gums. Autotransplantation is considered a better alternative in certain cases.

Autotransplantation (Autogenous tooth transplantation) is a tooth surgical procedure in one location to another location within the same person. Before, this was considered experimental, but in present times auto-transplantation is a better alternative for tooth replacement with high success rate. Indication for clients opted for this procedure is narrow, and thorough patient selection added with appropriate technique leads to outstanding aesthetic and functional capabilities. One advantage of this procedure is that the placement of implant-supported prosthesis or other form of prosthetic tooth replacement is not essentially required.

Indications for auto-transplantation

Usually, autotransplantation is done because of tooth loss due to dental caries, predominantly in the first molars of the lower jaws. Early eruption of first molars is frequently restored. In this case, the third molar is then removed via autotransplantation and then transferred to the site of the first molar that is beyond saving.

Transplantation can also be opted in cases like tooth agenesis (premolars and lateral incisors), traumatic tooth loss, canine atopic eruption, root resorption (body of the cells attack and destroy a part of a tooth), large endodontic lesions, cervical root fractures, and localized juvenile periodontitis.

Transplant success depends primarily on the specified requirements from the client, donor tooth, and recipient site. Autotransplant success is based on how well the healing takes place after the procedure. A healthy tooth with undamaged periodontal ligament will have higher degree of success.

Before having this procedure, clients must have a good health and oral hygiene regimen. Most of all, a suitable donor tooth and recipient site are required so that tooth can be replanted appropriately.

The site should be well prepared in receiving the tooth donor. Size should accommodate a tooth, along with sufficient alveolar bone structure, which enables support. This should be free from inflammation and infection.

The replanted Donor Tooth (the tooth) should be positioned to assist in easy removal with minimum trauma possible. Mishapen teeth or abnormal root morphology are not used in transplants.

Tooth length and development stage is vital in determining the effectivity of a replantation wherein the tooth has between one-half to two-thirds complete root development. So, autotransplantation of the premolars where there is half to two thirds completed root development have higher chances of pulp survival, with minimum chances of necrosis (cell death).

Another factor influencing tooth development is the status of epithelial root sheath or the covering. HERS or Hertwig’s epithelial root sheath has a continuous production of cells that separates a pulp to a dental follicle. HERS determines the root growth by its degree of damage so the lesser the damage, the greater chance of root growth post transplantation.

Tooth cryopreservation

Teeth auto-transplantation with cryopreservation is an alternative currently utilized for clients in a few clinics.

With cryobiology, cells or whole tissues are preserved by cooling it to sub-zero temperature at around 77K or -196°C (boiling point of liquid nitrogen). Low temperatures leads to prevention of cell death (necrosis) and ceasing of biological activities along with its biochemical reactions. Experiments on mice showed effectivity of cryopreservation on the teeth, resulting to dental tissue survival even at below freezing point.

Teeth cryopreservation requires a wider understanding of cryoprotective mechanisms of cosolvents like dimethylsulfoxide (DMSO). Consequently, only a few clinics have the expertise to do tooth cryopreservation and make it available to their clients.

With cryopreservation, elevated numbers of healthy teeth extractions can be done for orthodontic purposes and it enables sufficient amounts of donor teeth in cases of extensive surgical reconstruction. Tissue banks for teeth tissues are regulated legally for quality control.

Surgical technique for tooth transplantation

The same amount of trauma is experienced by the client having a removal of impacted molars to that that underwent tooth transplantation. Sedation along with local anesthesia is utilized in this case. Once the effect of anesthesia is sufficient, then extraction of the tooth at the recipient site and recipient socket is prepared.

Replantation of an acrylic replica of a tooth is done after an x-ray and donor tooth scan. This replica will guide the tooth technician to prepare a donor site for its dimension, etc. Then, extraction of the donor tooth should have least damage on the periodontal ligament and positioned quickly on the recipient site.

Instructions and follow-ups given to post operative clients are similar in that of removal of tooth impaction. A soft diet is followed for several days post-surgery, and chewing on the transplant should be avoided. Clients should always maintain good oral hygiene.