Autotransplantation of Teeth Dr. Juri Kurol Summary by: Dr. John Kanyusik Dr. Kurol of Jonkoping, Sweden, presented a history of tooth transplantation in the literature and a current description of canine autotransplantation techniques and indications. He discussed a chronology of tooth transplantation from the Incas, through the early twentieth century Pare (1594). Hunter (1771), and Wideman (1915) were all cited. Later he described the current literature reports on autotransplantation, specifically Apfel (1950), Nordenram (1963), Slagsvold-Bjerke (1967-70), Oksula (1974), Kristerson (1985), Paulson (1999), Czochrowska (2003), and his article with Berglund and Kvint (1996). He discussion focused on canine autotransplantation, its indications and techniques. He referred to a recent JCO article by Zachrisson that listed the advantages of autotransplantation over implants. He concurred with the article that some of the advantages are: Not age specific, the patient does not have to finished with growth The transplanted tooth can continue to erupt Superior gingival appearance Gingival papilla is maintained Less supporting bone loss 95% success rate (for canines, 94% for premolars) Dr. Kurol also thoroughly described specifics about the technique of autotransplantation: The success of autotransplantation is very dependent on the surgical procedure The socket must be larger than the transplanted tooth (ideal 1 mm excess on each side) The tooth is extracted with gentle dissection The tooth should be transplanted as soon as possible after extraction Manual and instrument manipulation of the tooth must be kept to a minimum The cementum should not be squeezed The tooth is fixated out of occlusion Loose fixation with sutures for 10 days. Rigid fixation results in greater incidence of ankylosis. Soft diet for 1 week, with antibiotics for 10 days and a Chlorhexidene rinse It is ideal if the root of the tooth is 2/3 formed (Andreason - 1990) Orthodontic movement can be initiated at 3 months The pulp will usually obliterate in time, but typically the tooth does not require endodontics Dr. Kurol emphasized that early detection of impacted maxillary canines and adjacent incisor resorption are critical. By palpation and timely radiographs, a poorly erupting canine may be detected and acted upon. He recommends early extraction of the deciduous canines when there is evidence of canine eruption abnormalities. He also discussed orthodontic intervention to prepare a poorly erupting canine for autotransplantation. His 1996 EJO article, co-written with Berglund and Kvint, described the rational and technique of orthodontically moving canines that are in difficult positions to access surgically for transplantation. A rational for this technique is the potential reduction in treatment time to bring the canine into its proper position. Dr. Kurol presented a number of cases to illustrate canine autotransplantation. Interestingly the ages of the patients referred to ranged from 10 to 55 years.