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AUTOGENOUS TOOTH TRANSPLANTATION IN ADULT OROFACIAL CLEFTDEFORMITY: A CASE REPORT

*B. E. Edetanlen, C.C. Azodo, P.E. Egbor, O. Akpata

*Department of Oral and Maxillofacial Surgery, University of Benin Teaching Hospital

Benin City, Nigeria

Correspondence:Dr B. E. EdetanlenDepartment of Oral and Maxillofacial Surgery,University of Benin Teaching HospitalP.M.B. 1111 UgbowoBenin City, NigeriaEmail: [email protected]

ABSTRACTA case of autotransplantation of a

tooth in a 26 year old female Africancleft palate patient is reported.This case report emphasizes thepossibility and success of autotransplantation in our centre, italso emphasizes that transplantation isonly technique sensitive but lessequipment sensitive. It further stressesthat an otherwise extracted anddiscarded tooth can be used to makenatural functional unit.Keyword: autotransplantation, tooth,cleft palate, success, techniquesensitive, extraction.

INTRODUCTIONAutogenous tooth transplantation or autotransplantation is the surgicalmovement in one individual of a vital or endodontically treated tooth from itsoriginal location in the mouth toanother site.1 The earliest report of tooth transplantation involves slaves in

ancient Egypt who were forced to givetheir teeth to their pharaohs2.Autogenous tooth transplantation wasfirst well documented in 1954 by M.LHale.3 This technique seems superior to allotransplantation because of lessproblem of histocompatibility.2,4-8 Autotransplantation has previouslybeen viewed with uncertainty because

of lack of information on the topic andpoor clinical results of reported

cases.9-12 These poor results weredue to a lack of understanding of thebiological principles involved and poor clinical technique.9-12,13 Another barrier to the acceptance of the technique has been themisconception that autotransplantioncan only be successful whenimmature, developing teeth aretransplanted.14 Success of autotransplantion is viewedin terms of survival, with or without rootfilling.

PREOPERATIVE PHOTOGRAPH



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CASE REPORT A 26 year old black African femalepresenting to our oral and maxillofacialsurgery department of University of Benin Teaching Hospital Benin City

with complains of poor speech andnasal reflux of liquid and food. Sheadded that she had cleft lip repair 10years back but she is not comfortablewith the outcome of the repair becausethe upper lip is wider than the lower lip.She was also psychological disturbedon account of the arrangement of themaxillary anterior teeth.On examination, she had widenedupper lips with two vertical prominentphiltral scars. The lips were

incompetent. She had bilateral centricocclusion. In the anterior segment,there were asymmetric spacing,mesiobuccal displacement andmesiopalatal rotation of the leftmaxillary lateral incisor. The left centralincisor was also palatally displacedand mesiopalatally rotated. She alsohad midline shift.Preoperative periapical radiographwas taken to assess the roots of theleft maxillary central and lateralincisors but the root were normal andclosed.Orthodontic treatment was advised butshe opted for extraction due to cost.She further stressed that her upper lipsize is her prime concern.She was prepared for cleft lip revisitsurgery and cleft palate repair. Thecleft lip was repaired using Veau 111method and the cleft palate wasrepaired using Von Langerbeck

techniqueOn recall back, she was happy for theoutcome of the repair but opted for extraction of the malaligned anterior teeth. Then an option of autotransplantion was explained to the

patient and she agreed to undergonethe procedure.Using routine local anaesthesiainfiltration, and under aseptictechnique, the left maxillary central

and lateral incisors were extractedcarefully to avoid root fracture. Themaxillary central incisor was kept innormal saline as a storage medium.Then the alveoli socket was widenedusing surgical bur on a hand piececonnected to a rotor motor under jetspray using normal saline. Then thestored maxillary central incisor was re-implanted and held in place by acomposite splinting.She was then placed on saline mouth

bath with antibiotics.On recall visit, the implanted tooth wasexamined for mobility and this wasabsent. Then the composite splint wasremoved. Serial postoperativeperiapical radiograph were taken(6weeks and 6 months) and this showsnormal anatomy.

INITIAL POST OPERATIVEPHOTOGRAPH



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DISCUSSIONThis study shows that auto-transplantcan be done in all ages. It also showsthat auto transplant is a successfulprocedure if done under aseptic

condition and it can be a normalroutine procedure if required bypatient. More so, it is not equipmentsensitive procedure. It only requiresthat the recipient cavity is wide enoughnot to disturb the periodontal tissues. Itcan also be done in a tooth with closedapex unlike where previous reportsasserted that it is only successful in anopen apex tooth. It can also serve analternative for extraction andreplacement with prosthetics which is

known to have some limitations. Moreso, this case report just demonstratesthat the tooth that would otherwisehave been extracted or left within bonecan be used to make biologicallyfunctioning units.The factors that led to success havebeen extensively investigated. Themost significant determinant for survival of the transplant is thecontinued vitality of the periodontalmembrane15. Schwartz tried to link

loss of the graft to specific prognosticfactors and found that the successrates are higher when donor teeth areanterior teeth, have one-half to two-thirds root development, experienceminimal trauma and limited extra oraltime during surgery16. The experienceof the surgeons also affects thesuccess because this procedure istechnique but not equipment sensitive.Although retention of a tooth and

restoration of the edentulous space isthe desired outcome for patient, morespecific parameters have been used tomeasure the health of survivingtransplant 17. These parametersinclude marginal periodontalattachment mobility, pain, rootresorption, root development,

sensitivity to percussion, gingivalpocket depth, presence of gingivitisand presence of fistula18.

The most common cause of failure of auto transplant is chronic root

resorption19

. More specifically, thecauses of tooth loss followingtransplantation from most common toleast common are inflammatoryresorption, replacement resorption(ankylosis), marginal periodontitis,apical periodontitis, caries and trauma.Inflammatory resorption may becomeevident after 3 or 4 weeks whilereplacement resorption may notbecome evident until 3 or 4 monthafter transplant20. The incidence of

both types of resorption can bedecreased with atraumatic extractionof the donor tooth and immediatetransfer to the recipient site tominimize the risk of injury to theperiodontal ligament.21



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5. Andreasen JO, Paulsen HU, Yu Z,Bayer T, Schwartz O. A long-termstudy of 370 autotransplantedpremolars. Part II. Tooth survival

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8. Josefsson E, Brattstrom V, TegsjoU, Valerius-Olsson H. Treatment of lower second premolar agenesis byautotransplantation: four-year evaluation of eighty patients. ActaOdontol Scand 1999; 57(2):111-5.

9. Kahnberg KE. Autotransplantationof teeth: indications for transplantation with a follow-up of 51 cases. Int J Oral Maxillofac Surg1987; 16(5):577-85.

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11. Kristerson L, Lagerstrom L.Autotransplantation of teeth incases with agenesis or traumaticloss of maxillary incisors. Eur JOrthod 1991; 13(6):486-92.

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“state of the art”. Am J Orthod1980; 77(2):146-62.

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14. Akiyama Y, Fukuda H, HashimotoK. A clinical and radiographic studyof 25 autotransplanted third molars.J Oral Rehabil 1988; 25(8):640-4.

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specialties. St. Louis: C.V. MosbyCo.; 1980. p. 77-88.

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monitoring healing. Eur J Orthod1990; 12(1):3-13.

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22. Thomas S, Turner SR, Sandy R.Autotransplantation of teeth: isthere a role? Br J Orthod 1998;25(4):275-82.

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