A Case of Autotransplantation of a Tooth with Curved and Hypertrophied Roots

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  • Katsutaka KUREMOTO
    Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry
  • Hazuki MAEZONO
    Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry
  • Ranna KITAGAWA
    Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry
  • Kahoru TAKEDA
    Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry
  • Yuko SHINNO
    Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry
  • Kenta MATSUSHITA
    Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry
  • Shosaku ITO
    Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry
  • Yuichiro NOIRI
    Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry
  • Mikako HAYASHI
    Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry

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Other Title
  • 歯根の肥大および湾曲を伴う上顎大臼歯の自家移植症例

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Abstract

 Purpose: Auto-transplantation of teeth is a viable treatment option for tooth loss because the transplanted tooth resembles a natural tooth histologically. Several studies have reported the advantages of this procedure. However, autotransplantation is often complicated by the size and shape of the donor tooth, thus necessitating careful consideration before implementation. Generally, donor teeth are single-rooted and almost straight, which makes transplantation and root canal treatment easier. However, in this report, we present the favorable results obtained after transplantation of a maxillary third molar with curved and hypertrophied roots in place of a maxillary second molar.<br> Case report: A 37-year-old man presented at the Osaka University Dental Hospital with gingival swelling around the left maxillary molars. At presentation, both buccal and palatal gingivae of the left maxillary second molar were swollen and had a fistula. Removal of the full cast crown resulted in a fracture of the pulpal floor, necessitating tooth extraction. The patient opted for autogenous transplantation of the right maxillary third molar (donor tooth) into the socket of the left maxillary second molar. We chose to proceed with the transplantation even though cone-beam computed tomography (CBCT) revealed that the donor tooth had hypertrophic curved roots. Following extraction of both teeth, endodontic treatment was performed extraorally on the donor tooth by using Ni-Ti rotary file systems. The resin-wire splint used for fixation was removed 1 month postoperatively, the tooth was built up with core materials, and a temporary crown was placed. Successful periodontal reattachment of the donor tooth was seen and prosthetic treatment was performed 6 months postoperatively.<br> Discussion: Hypercementosis and dilaceration of the roots make extraction of teeth difficult and increase the risk of periodontal ligament injury and rejection of the transplant by the recipient site, contributing to the low success rate of tooth transplantation. The shape of dilacerated teeth especially complicates root canal treatment. In general, the exposure time of the donor tooth to the extra-oral environment is correlated with the success rate; the prognosis is usually better when the exposure time is short. However, we opted to perform extraoral treatment taking into consideration the difficulty of root canal treatment in this case.<br> Conclusion: A careful examination of the recipient site with CBCT is recommended and the operative procedure should be chosen depending on the case, even if the donor teeth are curved and hypertrophied, so as to increase the success rate of autotransplantation.

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