Combined Application of Virtual Simulation Technology and 3-Dimensional-Printed Computer-Aided Rapid Prototyping in Autotransplantation of a Mature Third Molar

Abstract

The use of computer-aided rapid prototyping (CARP) models was considered to reduce surgical trauma and improve outcomes when autotransplantation of teeth (ATT) became a viable alternative for dental rehabilitation. However, ATT is considered technique-sensitive due to its series of complicated surgical procedures and unfavorable outcomes in complex cases. This study reported a novel autotransplantation technique of a 28-year-old patient with an unrestorable lower first molar (#36) with double roots. Regardless of a large shape deviation, a lower third molar (#38) with a completely single root formation was used as the donor tooth. ATT was performed with a combined use of virtual simulation, CARP model-based rehearsed surgery, and tooth replica-guided surgery. A 3D virtual model of the donor and recipient site was generated from cone-beam computed tomographic (CBCT) radiographs prior to surgery for direct virtual superimposition simulation and CARP model fabrication. The virtual simulation indicated that it was necessary to retain cervical alveolar bone during the surgical socket preparation, and an intensive surgical rehearsal was performed on the CARP models. The donor tooth replica was used during the procedure to guide precise socket preparation and avoid periodontal ligament injury. Without an additional fitting trial and extra-alveolar storage, the donor tooth settled naturally into the recipient socket within 30 s. The transplanted tooth showed excellent stability and received routine root canal treatment three weeks post-surgery, and the one-year follow-up examination verified the PDL healing outcome and normal functioning. Patient was satisfied with the transplanted tooth. This cutting-edge technology combines virtual simulation, digital surgery planning, and guided surgery implementation to ensure predictable and minimally invasive therapy in complex cases.

Dental autotransplantation

“…Among the factors to be taken into account for success are that the periodontal ligament of the donor tooth is intact, the degree of maturity of the dental organ, the extraoral time, the experience of the operator and the use and knowledge of all the necessary technological tools such as cone beam computed tomography (CBCT) and intraoral scanner to make 3D guides and replicas to obtain a simpler and more predictable procedure [9] . Nowadays there is no adequate justification about the benefits obtained from performing dental autotransplantation with advanced technology in combination with the use of tissue regeneration, therefore the aim is to analyze the literature about dental autotransplantation using 3D replicas of donor teeth, as well as the prognosis of the treatment in teeth with immature apex and complete apex, use of piezoelectric for the extraction of the donor tooth and use of tissue regeneration in transplanted teeth.…”