A New Home for a
Streetless Occupant:
A Case Report
Ayush Pokhriyal , Preeti Dhawan2, Shivangi Chandra , Avantika Tu, Shalini Tomar
International Journal of Clinical Pediatric Dentistry, Volume 12 Issue 6
contents
O Introduction
O Case report
O Discussion
O Conclusion
O References
INTRODUCTION
O Allotransplantation- is the transplantation of tooth
sourced from a genetically nonidentical member of
the same species as the recipient.
(Pokhriyal A et al)
O It has developed to be a safe treatment procedure.
O Success rate varies widely with reported results
from 0% to near 100%.
O Earliest reports of tooth transplantation involve
slaves in ancient egypt who were forced to give
their teeth to their pharaohs.*
*Schwartz O, Bergmann P, et al. Autotransplantation of human teeth. A life-table
analysis of prognostic factors. Int J Oral Surg 1985;14(2): 45–58
O Long-term success of an allotransplanted tooth has
been influenced by a number of factors such as:-
O Periodontal ligament or the cemental layer of
the root surface,
O Effect of splinting,
O Developmental stage of the graft,
O Immune reactions against the donor
histocompatibility antigens.
Poornima M. Allotransplant of mandibular teeth. SRM J Res Dent Sci
2015;6(3):45–58.
Indications
O Replacement of unrestorable tooth
O Tooth lost due to trauma
O Congenitally missing tooth
O Surgical repositioning of impacted
tooth
Pai SM, Patil PS, et al. Mesiodens used for allotransplantation. Eur J Gen Dent
2013;2(2):35–40.
Advantages
O Act as functional matrix during
growth period
O Better esthetics and masticatory
balance
O Reduces pschological trauma
O Maintain alveolar anatomy for
future implant therapy
O Preserve the volume and
morpohology of alveolar bone
Pai SM, Patil PS, et al. Mesiodens used for allotransplantation. Eur J Gen Dent
2013;2(2):35–40.
Disadvantages
O Immunological rejection
O Lack of histocompatibility
O Transmission of infection
O Replacement resorption
O Many authors suggest a low success rate of tooth
allografts and attribute this to lack of
histocompatibility.
O Unno et al. demonstrated that even after an
immunological rejection occurs to delete the donor
cells the periodontal tissue could regenerate
whereas the pulp tissue could transform into the
sparse connective tissue.
Unno H, Suzuki H, et al. Pulpal regeneration following allogenic tooth
transplantation into mouse maxilla. Anat Rec (Hoboken) 2009;292:
O Recent development of implant in the field of
dentistry has made the transplant of the tooth a
story of past.
O But placement of implant in the young child is not a
widely accepted treatment.
O Allotransplantation of teeth could still be an
effective alternative to implant.
This case report is a follow-up of tooth
allotransplantation of mandibular 1st premolar from
different donors in place of unrestorable mandibular
right second premolar.
Case report
O 14-year-old girl was referred.
O After a failed attempt to extract the
mandibular right premolar.
O Intra oral examination- nothing
was visible.
O Extra oral examination- swelling
was seen on right side due to
periapical lesion wrt 46.
Intraoral periapical (IOPA)
radiograph
A noninfected broken root was diagnosed in relation to
right lower second premolar
Treatment
To maintain the functional matrix in the arch during
growth period
Allotransplant was planned as treatment after the
extraction of root.
O Patients who had reported for the extraction of the
mandibular right premolar for orthodontic reasons
were recalled to the department.
O Donor was investigated for hepatitis B, C and HIV
tests which turned out to be negative.
O Informed consents were obtained from both the
donors and the recipient.
O After completing an endodontic treatment
O Under local anesthesia the teeth of donor was
carefully extracted with minimal trauma.
PROCEDURE
Tooth was placed immediately in
a chilled solution of 2%
chlorhexidine.
Holding the tooth by the crown, all
the blood from the root surface
was thoroughly cleaned off with
the same solution using syringe.
The apical end of tooth was
closed by the biodentine.
Care was taken to ensure minimal
damage to the periodontal fibers
After the extraction of root stem
Teeth were then transplanted to the
recipient’s site
Before transplantation the socket was irrigated with
saline to clean off debris
Following which fresh bleeding was induced by
forceful irrigation.
IOPA was taken to confirm the position of
transplanted teeth in the socket.
Procedure was done within 10 minutes of extraction
Tooth was splinted with splint
Post transplantation photographs after spliting
After 4 weeks
Wound healed uneventfully and Periodic follow-up showed that the
prosthesis porcelain crown was given allograft is clinically firm and
on the tooth. radiographically no inflammation or
replacement resorption was seen
Discussion
O Autotransplant has proven to be more efficient then
allotransplant.
O Schwartz et al. has reported that despite a
progressive replacement resorption, allografts
function effectively, symptomless often with
clinically normal gingiva for many years.
Schwartz O, Bergmann P, et al. Autotransplantation of human teeth. A life-table analysis of
prognostic factors. Int J Oral Surg 1985;14(2): 45–58.
O Mean functional time of the allografts was 6.8
years, with the teeth remaining free of symptoms.
O Ivanyi and Komínek demonstrated a significant
increase in the function time of allografts only up to
2 years after matching histocompatibility antigens,
O Long term function time of allotransplanted teeth
(10–16 years) has been described in a series of
allografts carried out.
Iványi D, Komínek J. Tooth allografts in children matched for HLA. Transplantation
1977;23:255–260. DOI: 10.1097/00007890- 197703000-00008.
O Complications includes :
Pulp necrosis
Progressive root resorption
Ankylosis/infraocclusion
O Jeopardize the long-term result of the
allotransplant.
O In the present case :
First complication was eliminated as root canal
treatment was done for the donor tooth prior to
its extraction.
Other two are not seen as the follow-up
radiograph shows normal periodontal ligament
space.
O Prognosis of allotransplant is limited due to
replacement resorption as periodontal ligament
seems to elicit immune response and rejection.
O Donor tooth has been treated to prolong the
survival.
O Use of chlorhexidine solution, short handling time of
the transplant would contribute to the survival of
periodontal ligament cells.
Conclusion
O As implant being contraindicated below the age of
18 years, allotransplant is one of the alternative in
young patient.
O Although it survive for few years, the alveolar height
is maintained by the allotransplanted tooth which is
not possible by any other prosthetic mean other
then implant
O Patient can receive the implant on a the respective
site after he/she complete their growth phase.
Case report
Poornima P et al. uses allotransplant to replace avulsed mandibular
central incisors using mesiodens
Pretreatment photographs of two donor patients having mesiodens
Post transplantation photographs after
spliting
I year follow up
REFERENCES
O Pai SM, Patil PS, et al. Mesiodens used for
allotransplantation. Eur J Gen Dent 2013;2(2):35–40.
O Schwartz O, Bergmann P, et al. Autotransplantation of
human teeth. A life-table analysis of prognostic factors. Int
J Oral Surg 1985;14(2): 45–58.
O Schwartz O, Frederiksen K, et al. Allotransplantation of
human teeth. A retrospective study of 73 transplantations
over a period of 28 years. Int J Oral Maxillofac Surg
1987;16:285–301.
O Poornima M. Allotransplant of mandibular teeth. SRM J
Res Dent Sci 2015;6(3):45–58.
O Unno H, Suzuki H, et al. Pulpal regeneration following
allogenic tooth transplantation into mouse maxilla. Anat
Rec (Hoboken) 2009;292:570–579.
O Park JH, Tai K, et al. Tooth autotransplantation as a
treatment option: A review. J ClinPediatr Dent
2010;35:129–135.
