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PAOLO GENERALI
ENDODONTICS

AUTOTRANSPLANTATION OF THIRD MOLAR

MASTERING CLASS IV
RESTORATIONS
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The first permanent molars are very prone to caries because of their anatomical structure, with deep
pits and fissures, and early eruption in the mouth. They sometimes need to be restored very early,
and the standard of care is often sub-optimal. So, in adolescence, it may happen that they become
cronically infected and non-restorable. Extraction is mandatory in these cases, but the patient is often
too young for an implant or a three-unit FDP. Waiting means mesial migration of second and third
molars, and perhaps extrusion of maxillary molars. Even worst, space maintainers have an high failure
rate.
In these cases, tooth auto-transplantation can be an option, when a donor tooth is available.
Here is a protocol for wisdom tooth transplantation:

SHOP

First, case selection: Patient:good health, cooperative, comprehensive.

Recipient site:adequate bone and attached keratinized tissue.
Donor site: possible atraumatic extraction, best if 2/3 of root formation, compatible roots & dimension.
Second, technique: Anesthesia, extraction of hopeless tooth after sulcular incision with a scalpel in
order to prevent damage of the keratinized tissue, atraumatic extraction of wisdom tooth, immediate
replantation in the recipient site. Tooth must be in infraocclusion 1-2 mm. Stabilization with suture,
blocked with flowable composite on the occlusal surface. Antibiotic, pain killer, clx rinses. No chewing
on that side for a month.
Third, follow up: 1 week recall checking for suture stability;
2 weeks suture remotion;
2-3 months endodontic treatment.
Recall 6 months, 1 yr with x-ray, 2 yrs with x-ray.
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Walter Devoto
Dr. Walter Devoto Born in
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The first case refers to a 16 y/o patient with a non-restorable first mandibular molar, the second to a
45 y/o patient with vertical root fracture of first maxillary molar.
In the second case, pulp asportation was followed by histology. The pulpal tissue was substituted
by a dense fibrous tissue, without necrotic areas.
The literature reports excellent success rates following tooth transplantation when the appropriate
protocol is followed. Andreasen found 95% and 98% long-term survival rates for incomplete and
complete root formation of 370 transplanted premolars observed over 13 years.
Jens O. Andreasen, Atlas of Replantation and Transplantation of Teeth, W.B. Saunders, 1992; Tatjana
Nim?enko, Gravydas Omerca, Vaidas Varinauskas, Ennio Bramanti, Fabrizio Signorino, and Marco
Cicci Tooth auto-transplantation as an alternative treatment option: A literature review Dent Res J
(Isfahan). 2013 Jan-Feb; 10(1): 16.

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