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case_images: Pre-operative records of auto-transplantation. (a) Panoramic radiograph showing congenitally missing teeth #20 and #29. (b) Pre-operative periapical radiograph of tooth #13. (c) Clinical photo of mandibular arch showing congenitally missing teeth #20 and #29. (d) Pre-operative CBCT of the apical third of the root of tooth #13 (donor tooth). (e) Pre-operative CBCT of recipient site for transplanting tooth #20.
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case_images: The periodontic resident determined the auto-transplantation procedure by selecting donor teeth #4 and #13 and transplanting the teeth at recipient sites #29 and #20, respectively (Figures 1(a), 1(b), 1(c), 1(d), and 1(e)).
case_images: Post-operative records of auto-transplantation. (a) Post-operative periapical radiograph of immediate auto-transplantation of tooth #13 (donor tooth) to the socket of tooth #20 (recipient site). (b) Periapical radiograph 1-week follow-up of auto-transplantation of tooth #20. (c) Clinical photo 1-week post-operative of auto-transplantation of tooth #20. (d) Clinical photo 3-week post-operative of auto-transplantation of tooth #20. (e) Clinical photo 6-week post-operative of auto-transplantation of tooth #20. (f) Periapical radiograph showing 6-week post-operative follow-up of auto-transplantation of tooth #20. (g) Clinical photo 6-week post-operative of auto-transplantation: maxillary occlusal view. Teeth #4 and #13 were donor teeth, and spaces were closing. (h) Clinical photo 6-week post-operative of auto-transplantation: mandibular occlusal view. Teeth #20 and #29 were recipient sites, and spaces were closed.
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case_images: Therefore, after 6 weeks, the patient was referred to UNC-CH ASOD Graduate Endodontic Clinic for evaluation of #20 (Figures 2(a), 2(b), 2(c), 2(d), 2(e), 2(f), 2(g), and 2(h)). The radiographic examination revealed normal PDL space around teeth #19 and #21 but widening of the PDL space, loss of lamina dura, and localized loss of marginal bone on the mesial and distal of tooth #20 (Figure 2(f)).
case_images: Initial endodontic treatment. (a) Periapical radiograph of working length of tooth #20. (b) Periapical radiograph of calcium hydroxide placement of tooth #20.
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case_images: TN, USA) to a size #80 (Figure 3(a)). Copious irrigation of 2.5% sodium hypochlorite (NaOCl) (Henry Schein, Melville, NY, USA) was used during the cleaning and shaping process, followed by a final rinse of 17% ethylenediaminetetraacetic acid (EDTA) (Henry Schein, Melville, NY, USA) to remove the smear layer. The tooth was dried with medium endodontic paper points (Dentsply-Sirona, Johnson City, TN, USA) until the paper points were stiff. Calcium hydroxide (Sultan Healthcare, York, PA, USA) was mixed with 2.5% NaOCl and placed with an amalgam carrier 2 mm from the radiographic apex (Figure 3(b)). The tooth was then temporized with Teflon tape and Fuji TRIAGE (GC America, Alsip, IL, USA).
case_images: Obturation radiographs. (a) Periapical radiograph of endodontic plugger measurement of tooth #20. (b) Periapical radiograph of 4 mm apical plug of tooth #20.
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case_images: A nickel-titanium plugger (SybronEndo, Kerr, Brea, CA, USA) was selected to obtain an appropriate apical fit of 2 mm from the radiographic apex and working length (Figure 4(a)). A radiograph was exposed to ensure a proper 2-4 mm apical seal (Figure 4(b)).
case_images: Periapical radiograph of immediate post-operative obturation of tooth #20.
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case_images: The final post-operative radiograph was exposed (Figure 5). The patient was referred to his orthodontist for continued care.
case_images: Periapical radiograph of tooth #20 at 8-month post-operative follow-up.
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case_images: The patient has remained asymptomatic after the completion of NSRCT; a radiographic exam revealed complete healing of periapical pathosis (Figure 6).