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The practical aspects of pre-operative assessment and surgical procedure for autotransplantation are discussed in this part of the series. The success of tooth transplantation is dependent on case selection, careful planning and a surgical procedure that maintains viable periodontal ligament cells and intact cementum of the transplanted teeth. A thorough assessment of the donor tooth and recipient site is vital for successful planning and execution of tooth autotransplantation. The surgical procedure involves atraumatic extraction of the donor tooth, socket preparation and splinting of the transplanted tooth. Post-surgical procedures include monitoring of pulp and periodontal healing and restorative camouflage of the donor tooth.
CPD/Clinical Relevance: Surgical planning and procedures are vital to the success of autotransplantation. Orthodontists should be aware of these factors and bear them in mind when preparing patients for autotransplantation to optimize surgical success.
Surgical planning and technique are vital aspects to the success of autotransplantation. A number of key factors relating to the donor tooth and recipient site are considered during assessment and planning for autotransplantation.
Donor tooth assessment is usually considered in terms of assessment of the crown and roots. A donor tooth crown should be assessed for dental caries, crown anomalies and crown dimension. One of the main considerations, when assessing the recipient site, is whether adequate space exists for the donor tooth. It is therefore essential that the donor tooth size is measured accurately at maximum bulbosity including the maximum bulbosity and cervical dimension of the crown. The mesio-distal widths of upper and lower premolars are usually only 1.5 mm smaller than that of upper central incisors (7 mm compared to 8.5 mm at maximum bulbosity), although the cervical areas are usually considerably smaller. To manage this discrepancy it has been suggested that rotating the donor premolar tooth approximately 90 degrees improves the emergence profile when transplanted into the upper central incisor region (Figure 1).
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