SA3 - Is Root Treating Autotransplanted Teeth an Outdated Precaution? A Laser Doppler Study

Abstract: Dental autotransplantation of teeth, also known as autogenous transplantation, is the movement of one tooth from one position to another within the same person (Hale, 1965). Currently the protocol after transplantation of teeth with closed apices is to prophylactically root treat the teeth to prevent root resorption. However, we are finding that many autotransplanted teeth are maintaining vitality many years post operation and root canal treatment is rarely required. We closely monitored patients we had treated at Guy’s Hospital (London) in the Oral Surgery Department up to 6 years after their operation to monitor the vitality of their transplanted teeth using laser doppler flowmetry (LDF) and see if prophylactic root canal treatment is becoming an outdated precaution.We collected details of 15 patients with an overall total of 21 autotransplanted teeth. We closely monitored whether these teeth maintained a good position and gingival contour, whether they discoloured, underwent resorption, and tested pulpal blood flow using LDF. None of the teeth were root canal treated as a precautionary measure shortly after surgery.62% of the transplanted teeth were canines, 24% were first premolars and 14% were second premolars. Overall, only 10% (n = 2) of the teeth that were autotransplanted required root canal treatment post-surgery due to external resorption. Both of these teeth had closed apices at transplantation. Two teeth developed a sclerosed pulp without the need for RCT. All teeth had good gingival contour, did not discolour and maintained good positioning in the arch.When LDF was used to test the pulpal flow, the transplanted and adjacent untreated teeth had similar readings up to 6 years post-surgery. The untransplanted teeth had flux results ranging from 4-15 PU and the transplanted teeth results varied from 4-20 PU. LDF has no standard clinical reference range for dental pulp and studies have shown significant interindiviual differences due to tooth morphotype (Cholakova, 2019). Therefore, direct comparison is difficult, however all transplanted teeth had values lying in the expected ranges. Showing that blood flow is maintained with both open and closed apicies. The remaining 19 teeth that we continue to monitor have remained vital and healthy without the need for root canal treatment. Therefore, we are seeing high success rates of teeth remaining vital post transplantation without resorption and root canal treatment is rarely required. This saves, what is often a child, prolonged additional dental treatment which requires good patient compliance. Our laser doppler readings show positive results for our transplanted teeth, but further studies compiling larger patient numbers would be beneficial. References1. Hale, M.L. (1965) “Autogenous transplants.” Br J Oral Surg. Nov;3(2):109-13. Available at: https://doi.org/10.1016/s0007-117x(65)80016-6. 2. Cholakova, R. (2019) “Laser Doppler Flowmetry in Permanent Teeth.” Journal of IMAB. Dec;24(4):2751-2754. Available at: https://doi.org/10.5272/jimab.2019254.2751

Pre and post surgery OPG's of a patient undergoing LL4 LR4 autotransplantation into UL4 UR4 spaces and bilateral sinus lifts