Ankylosis. Part V: Autotransplantation
Usually, in the treatment of ankylosed teeth in children, it is recommended to remove such teeth before intensive growth cycles so that the growth and subsequent teething do not create significant defects in hard and soft tissues. However, the difficulty in treating these patients is to temporarily replace missing teeth until growth ceases. This is especially true for male patients, when the injury occurs at an early age (i.e., aged 9 to 11 years) and when growth may not be completed by 21-22 years.
It may take a considerable amount of time to manage the toothless crest and create a temporary restoration that will not adversely affect the social aspect of life. Figure 1: A 10-year-old male patient with ankylosed tooth 21, with initial signs of asymmetry of the incisal incisal edge and gingival margin.
Ankliosis and autotransplantation
One option that I wrote about earlier is to use autotransplantation to treat these young patients. Autotransplantation is a procedure in which the patient’s own teeth, usually the second premolar of the lower jaw, are used as a replacement for missing front teeth by extraction and re-implantation. The transplanted tooth can then serve as an aesthetic and functional replacement for the patient. The main problem for most dentists is the following: how predictable is this treatment method?
The article “The result of tooth transplantation: survival and success for the period 17–41 years after surgery” (Am J Orthod Dentofacial Orthop 2002, Czochrowska EM, et al.), Showed a survival rate of 90% (with an average follow-up time of 26 years). Compared to other treatment options, this is an extremely favorable result. However, it should be noted that success rates are highly dependent on the skills and experience of the transplant surgeon. I was lucky to work with Dr. Jim Janakievski in Tacoma, WA, whom I consider to be one of the world’s experts in this field.
Requirements for Autotransplantation
In a transplanted tooth, the root length should be two-thirds until complete development and have an open apex. This will provide the most predictable transplantation to preserve the vitality of the tooth and continue root development. As a rule, the second lower jaw premolars in patients aged 10-12 years meet these criteria.
Therefore, this treatment option can be applied in a limited period of time. The transplanted teeth were moved while maintaining a teething profile. As a rule, the roots of such teeth continue their development and retain vitality.
The transplanted tooth can be restored from the composite, and the patient can proceed with orthodontic treatment.
Although this is not a treatment option that needs to be used every day, it’s enough to know that autotransplantation can provide predictable aesthetic and functional replacements for these patients, who otherwise would have to wait 10 to 12 years to complete growth before they could be an implant is installed.