Autotransplantation of two maxillary premolars in a free vascularized fibula reconstructed mandible

doi:10.1016/j.ijom.2010.08.004

International Journal of Oral and Maxillofacial Surgery

Volume 40, Issue 2, February 2011, Pages 219-221

https://doi.org/10.1016/j.ijom.2010.08.004 Get rights and content

Abstract

A 10-year-old female patient with a fibula transplant in her left hemimandible due to ameloblastoma treatment was referred for combined orthodontic and surgical planning and treatment to observe and prevent expected asymmetric facial development and malocclusion, because the premolars and molars on the left side of the mandible were missing. The patient had an Angle Class II malocclusion and arch length discrepancy in the upper jaw. The two second premolars in the maxilla were transplanted into the neomandible to create occlusion on the left side and retention for orthodontic treatment. Clinical and radiological examination 3 months postoperatively showed good integration of both premolars without pocket formation. After 4 months, active orthodontic treatment with fixed appliances was started to create sufficient arch space in the upper jaw for both canines to erupt and to extrude and for the transplanted premolars in the lower jaw to rotate and align into the planned positions. This case report demonstrates that autotransplantation of premolars into a fibula transplant can be a successful dental rehabilitation procedure.

Section snippets

Case report

A 10-year-old female patient was referred with a fibula transplant on the left side of the mandible due to hemimandibulectomy and primary reconstruction with a free vascularized fibula graft, because of an ameloblastoma. The patient was referred to the combined orthodontic–surgical clinic for observation and treatment to prevent expected asymmetric facial development and malocclusion, because the premolars and molars on the left side of the mandible were missing. Extraction of the premolars to

Discussion

Autotransplantation of premolars is a routine procedure in cases with Class II occlusion and missing mandibular premolars1, 3, 5, 10. Autotransplantation in augmented areas of the alveolar process has been anecdotally documented7, 8. This case demonstrates uneventful healing of the autotransplanted maxillary premolars into a free vascularized fibula reconstructed area of the mandible.

The use of osseointegrated dental implants in adults is a successful treatment for the rehabilitation of missing

Competing interests

None declared.

Funding

None.

Ethical approval

Not required.

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There are more references available in the full text version of this article.

Cited by (3)

Pre-autotransplantation alveolar process augmentation and premolar autotransplantation as a treatment method for single tooth replacement in adolescents
2021, International Journal of Oral and Maxillofacial Surgery
Citation Excerpt :
Autotransplantation in previously augmented areas of the alveolar jaw has, however, been reported anecdotally11–13. Some authors have reported on autotransplantation of teeth in edentulous parts of the jaw or even a free vascularized fibula graft14,15. These results indicate that the absence of alveolar bone does not represent a contraindication for tooth autotransplantation.
The treatment of young patients with missing teeth and an atrophied alveolar process after trauma or agenesis of a tooth can be challenging. The aim of this study was to evaluate autotransplantation of a premolar after pre-autotransplantation alveolar process augmentation (PAPA) as a treatment option for these patients. A retrospective cohort study was implemented to analyse the PAPA procedure and subsequent autotransplantation procedure. Alveolar process augmentation was performed using different types of autologous bone grafts. Subsequent autotransplantation of one or more premolars was performed approximately 4 months later. Nine patients with a mean age of 12 years were included. Twelve premolars were transplanted after a PAPA procedure: seven in the maxillary incisor region, four in the mandibular premolar region, and one in the mandibular incisor region. Initially all transplanted teeth functioned well. However, one mandibular premolar that was transplanted in the maxillary incisor region was lost because of resorption after 6 years of follow-up. The other 11 transplanted teeth functioned well. The mean follow-up was 6 years (range 3–13 years). The results showed that autotransplantation can be facilitated by PAPA with a high chance of success. It can therefore be a valuable addition to other existing treatment options.
Premolar transplantation to replace a missing central incisor
2015, American Journal of Orthodontics and Dentofacial Orthopedics
Citation Excerpt :
In addition, the periodontal ligament provides undifferentiated progenitor cells that are capable of differentiating into fibroblasts, osteoblasts, and cementoblasts. The differentiated osteoblasts can generate bone around the transplants, filling the gap between the walls of the alveolus and the transplant, and causing osteogenesis.14,15 In this patient, there was bone formation in the vestibular region that could be easily observed in the computed tomography scan.
During childhood, the anterior maxilla is susceptible to injury, and the loss of incisors is one of the most serious injuries. In many cases, autotransplantation is the best alternative for children who lose an incisor during the growth phase. This case report describes the treatment of a boy who had a traumatic injury when he was 8 years old that resulted in avulsion of the maxillary right central incisor. When he sought treatment at age 10, the space was lost as was bone in the incisor region. Because he lacked space in the mandibular arch for proper tooth alignment, extractions were planned. One extracted premolar was transplanted into the space of the missing maxillary incisor area. The posttreatment results were good, and follow-up records 7 and 9 years after treatment showed healthy periodontal support and cortical bone gain in the transplanted tooth's buccal area.
Avulsed maxillary central incisors: The case for autotransplantation
2012, American Journal of Orthodontics and Dentofacial Orthopedics

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Case ReportOral RehabilitationAutotransplantation of two maxillary premolars in a free vascularized fibula reconstructed mandible

Abstract

Section snippets

Case report

Discussion

Competing interests

Funding

Ethical approval

J Oral maxillofac Surg

Am J Orthod Dentofacial Orthop

Int J Oral Maxillofac Surg

J Oral Maxillofac Surg

J Oral Maxillofac Surg

Case Report
Oral Rehabilitation
Autotransplantation of two maxillary premolars in a free vascularized fibula reconstructed mandible