case_images: PMC11772061_01
case_images: Preoperative panoramic radiograph and photographs. (a) Panoramic radiograph shows an unrestorable Tooth #19. The root of Tooth #32 is fused, making minimally invasive extraction available. (b) The preoperative clinical picture of Tooth #19. (c) The preoperative clinical picture of Tooth #32.
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case_images: fig1
case_images: A pretreatment panoramic radiograph was obtained (Figure 1(a)). The remaining crown was weak, especially at the root bifurcation and distal part of the crown (Figure 1(b)). Tooth #32 on the right mandible had caries on the occlusal surface with mesial inclination, but there was no redness or swelling of the gums (Figure 1(c)).
case_images: The clinical procedure. (a) Removal of dental caries on the mesial-occlusal part of Tooth #32 using a fissure bur. (b) Tooth #32 after removal of carious tissue. (c) Tooth #32 was extracted with a minimally invasive technique. (d) Tooth #32 was scanned digitally by a 3Shape scanner to obtain a highly accurate 3D image. (e) A custom 3D ultrasonic osteotome was designed. (f) A 3D-printed ultrasonic osteotome. (g) Occlusal view of recipient alveolar socket. (h) A 3D-printed individual ultrasonic osteotome was used to prepare the recipient's alveolar socket. (i) A CARP model was used to evaluate and prepare the receptor alveolus. (j) The root end of Tooth #32 was prepared and filled with iRoot BP. (k) The prepared Tooth #32 was transplanted into the recipient site. (l) Occlusal view of the transplanted tooth with suture 1 week after surgery. (m) Buccal view of the transplanted tooth with suture 1 week after surgery. (n) Periapical radiograph of the transplanted tooth 1 week after surgery. (o) Panoramic radiograph of the transplanted tooth 1 week after surgery.
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case_images: fig2
case_images: Tooth #32, caries on the tooth's occlusal surface were removed to minimize bacterial contamination and postoperative discomfort (Figure 2(a)). Caries was removed from the mesial-occlusal surfaces of Tooth #32 and the distal-occlusal surfaces of Tooth #31 (Figure 2(b)). Briefly, using maxillary premolar extraction forceps (Kohler, Mainz, Germany), gently separate the roots of the donor tooth from the surrounding bone tissue and carefully remove it from the alveolar bone to avoid damaging surrounding structures (Figure 2(c)). A chairside dental assistant used an R700 scanner (3Shape, Copenhagen, Denmark) to create 3D digital images of the tooth's shape (Figure 2(d)). Due to the presence of blood and periodontal membrane on the tooth root surface, the final personalized ultrasonic osteotome (Figure 2(e)) was designed to be about 1 mm larger than the tooth root. To prevent damage to local tissues and cells during alveolar socket preparation, the root-shaped osteotome had multiple water-cooled vents on its surface (Figure 2(f)). Additionally, we performed a root-splitting procedure without using tooth elevator or removing alveolar compartment (Figure 2(g)). Afterward, the 3D-printed osteotome in the shape of Tooth #32 was positioned at the location where it was needed (Figure 2(h)). Tooth #32 received an ex vivo apical surgery, and its apical part was sealed with iRoot BP (Innovative Bioceramix in Burnaby, Canada) (Figure 2(j)). The PDL was positioned about 1-2 mm above the alveolar ridge (Figure 2(k)). To prevent crown displacement, a figure-eight suspension suture was employed: the suture needle was inserted at the mesial buccal gingiva of the transplanted tooth, passed obliquely through the occlusal surface to the distal lingual gingiva, then through the mesial lingual gingiva, and crossed over the occlusal surface to enter the distal buccal gingiva (Figures 2(l) and 2(m)). Donor tooth stability was successfully achieved after transplantation (Figures 2(n) and 2(o)).
case_images: Timeline of the tooth autotransplantation procedure.
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case_images: fig3
case_images: The timeline of the tooth autotransplantation procedure is shown in the figure to enhance the readers' understanding (Figure 3).
case_images: Clinical follow-up at 2 years. (a) The periodontal probing depth of the transplanted tooth was normal, which meant that tooth autotransplantation obtained excellent epithelial attachment. (b) The buccal view of the transplanted tooth. (c) The occlusal view of the transplanted tooth. (d) Periapical radiograph 2 years after transplantation. (e) Panoramic radiograph 2 years after transplantation.
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case_images: fig4
case_images: Follow-up examinations at 1 week, 1 month, 6 months, 1 year, and 2 years posttransplant revealed no pain or other periapical pathologies associated with the transplanted tooth (Figures 4(a)-4(e)).