Clinical procedures and outcome of surgical extrusion, intentional replantation and tooth autotransplantation – a narrative review

Abstract

Surgical extrusion is defined as the procedure in which the remaining tooth structure is repositioned at a more coronal/supragingival position in the same socket in which the tooth was located originally. Intentional replantation is defined as the deliberate extraction of a tooth and after evaluation of root surfaces, endodontic manipulation and repair, placement of the tooth back into its original position. Tooth autotransplantation is defined as the transplantation of an unerupted or erupted tooth in the same individual, from one site to another extraction site or a new surgically prepared socket. The advent of titanium implant rehabilitation has reduced the use of these treatments in day‐by‐day clinical practice; however, the re‐emerging trend to conserve and preserve natural sound tissues has led to a rediscovery of these treatments. All three distinct surgical methods are closely related, as they act to treat teeth that cannot be predictably treated using other more conventional procedures in endodontics, periodontics and restorative dentistry. Furthermore, these procedures share the same treatment approach and include the atraumatic extraction of a tooth, visual inspection of the tooth/root and its subsequent replantation. The clinical procedures for surgical extrusion, intentional replantation and tooth autotransplantation treatment have undergone several changes in recent years, and currently, there are no clear clinical treatment protocols/guidelines available. The clinician should be aware of the outcome of these treatments. Hence, the aim of this narrative review is to provide the background, clinical procedures and outcomes of surgical extrusion, intentional replantation and tooth autotransplantation.

Guided tooth autotransplantation in edentulous areas post‐orthodontic treatment

“…A 4.1 mm sleeve guide was designed to prepare the autotransplant site, leaving the sleeve space diameter 200 microns wider than the non‐active side of the burs (Figure 5). The recipient site was planned to be slightly larger than the dimensions of the donor tooth STL to avoid mechanical trauma to the PDL fibers 16 …”

“…Endodontic treatment was completed 2 weeks post‐surgery to avoid infection‐related root resorption 16 . After anesthesia delivery and rubber dam isolation (Nic‐tone, MDC, Mexico), a conservative access cavity was performed.…”

“…By leaving the donor tooth in a slight infraposition during autotransplantation of mature teeth, the clinician usually has to perform an adhesive indirect restoration 16 . This allows an excellent control of the contact points, an adequate emergence profile, and the possibility of evaluating occlusion with an articulator.…”

“…However, the patient may present with early tooth loss or congenitally missing teeth, for which the recipient site needs to be created surgically for autotransplantation 16 . The chief difference between this technique and transplantation to existing sockets lies in a lack of PDL fibers on the walls of the surgically prepared sockets 16 . The trauma triggered by the preparation of a new socket defers revascularization and increases the possibility of thermal bone damage 16 .…”

“…The chief difference between this technique and transplantation to existing sockets lies in a lack of PDL fibers on the walls of the surgically prepared sockets 16 . The trauma triggered by the preparation of a new socket defers revascularization and increases the possibility of thermal bone damage 16 . Notwithstanding, satisfactory healing also occurs in autotransplantation to surgically prepared alveolar sockets 9 …”