ABSTRACT
Introduction:
Using three-dimensional printed duplicates of the donor teeth, three-dimensional auto-transplantation is a medical procedure that moves a tooth from one location inside a patient to another. The intraoperative practicability during 3D auto-transplantation of teeth was evaluated in the present study.
Material and Methods:
A prospective multicenter clinical study was done among the subjects. “Preoperative cone-beam computed tomography imaging,” “computer-assisted design (CAD),” and “computer-assisted manufacturing (CAM)” were used in all operations to make a 3D duplicate of the donor teeth. The clinical parameters that were evaluated were the time required for the fit, number of attempts to fit, and intra-operative experience.
Results:
Canines, premolars, molars, and one extra tooth were all transplanted during the 200 auto-transplantation surgeries among 152 subjects. An initial satisfactory fit of the donor tooth and an extra-alveolar time of less than one minute were achieved in 80% of the surgeries. The extra-alveolar time exceeded 3 minutes in ten teeth. Difficulties that were faced were related to the imaging, patient cooperation, and the bone quality.
Conclusions:
The application of the duplicate teeth by 3D printing of a donor tooth all through auto-transplantation techniques reduced the time the tooth stays extra-alveolar as well as the efforts at transplant fitting during implantation. This allowed for more challenging surgeries as well as a speedy and reliable therapy.
KEYWORDS: Auto-transplantation, extraction, printable, three dimensional, tooth replica
INTRODUCTION
Auto-transplantation of teeth is a typical approach that can be used to replace a single missing tooth. The donor tooth of a patient is extracted from one region (the donor site) and then implanted in either of the jaw’s quadrants at another location (the recipient site). Because the patient’s own teeth are used to create single-tooth replacements, dental rehabilitation can be tailored to the patient’s biology in a way that is both effective and comfortable.[1,2] It is essential to go by a few fundamental guidelines in order to achieve success that can be predicted.[3] When selecting an appropriate donor tooth prior to surgery, it is necessary to examine the root structure of the tooth in question and determine whether or not its apex is open or closed. It is possible to transplant teeth even if they have an open apex and incompletely grown roots (this occurs most frequently in premolars that are roughly two thirds of the root length). This procedure does not require any additional therapies.[3] If the development of the root is greater than 90 percent of the expected root length or if the apex has closed, an endodontic operation should be carried out within two weeks of the transplant. It is essential to avoid causing any harm to the periodontal ligament (PDL) when extracting teeth from the donor during the intraoperative procedure. The PDL or the cervical cementum should not come into contact with the extraction forceps; instead, the forceps should only come into contact with the enamel of the donor tooth. In addition, it is ideal to shorten the extra-alveolar interval as much as possible. This period refers to the time that passes between the extraction of the donor’s teeth and the installation of the new tooth in the replacement tooth socket. In order to establish a correct fit of the transplanted tooth without causing iatrogenic injury to the donor tooth, the dentist will need to build a new alveolus that comfortably seats the teeth of the donor. Imaging techniques such as “computer-aided design with computer-assisted manufacturing” (also known as “CAD/CAM”) and “cone-beam computed tomography,” or CBCT, make it possible to explore novel tooth auto-transplantation options.[4]
MATERIAL AND METHODS
To assess these 3D auto-transplantation techniques, a prospective multicenter clinical research was executed for the current study. Subjects among whom the 3D auto-transplantation was performed were selected. This may include one or more teeth in a single individual. The data was collected from between 2017 and 2022. The ethics clearance was obtained prior to the execution of the study. The design was explained elaborately to the subjects, and the consent was obtained. Eight CAD-CAM methods were used to prepare replicas of the donor teeth, which were later made in cobalt-chrome alloy using the 3D printing. In most cases, auto-transplantation was carried out using teeth of the donor that had an open apex and roots that had developed to between 50 and 75 percent of the projected total root length. Within two weeks following the transplant, an endodontic procedure should be carried out if the development of the root is greater than 90% of the estimated root length or if the apex closed. Care was taken during the auto-transplantation process to protect the donor tooth’s apex and periodontal ligament. The transplanted tooth was positioned at least 1 mm below the occlusal plane to avert postoperative occlusal stresses. Patients’ characteristics were obtained via medical records, radiographs, and case reports.
RESULTS
Patient characteristics
In this study, 152 patients who had 200 transplanted teeth were taken into account. Forty-eight molars (36 patients) made up the donor teeth, followed by 146 premolars (120 patients), 4 canines (4 patients), and 2 extra tooth (1 patient). Only a single tooth was transplanted into 120 subjects; two teeth into 30 patients; and three teeth into 2 patients simultaneously. Of the included teeth, 51 auto-transplantation procedures were carried out in the operating room, while 101 in the OPD, bringing the total number of transplanted teeth to 152 [Table 1].
Table 1.
Characteristics of included subjects
| Parameters | Value |
|---|---|
| Gender, n (%) | |
| Male | 86 (56.57) |
| Female | 66 (43.42) |
| Mean age (range) in years | |
| Canine | 13.9 (13.1-14.8) |
| Premolar | 13.1 (10.7-18.3) |
| Molar | 16.3 (10.9-20.9) |
| Supernumerary | 16.5 |
| Teeth (n) | |
| Canine | 4 |
| Molar | 48 |
| Premolar | 146 |
| Supernumerary | 2 |
| Stage of the root development (n) | |
| >90% | 23 |
| 50-75% | 147 |
| 75-90% | 30 |
| Surgical area (n) | |
| Mandibular | 184 |
| Maxillary | 16 |
Extra-alveolar time
The average extra-alveolar time during the 3D auto-transplantation technique was 51 ± 86 seconds. Ninety-seven teeth were transplanted in under a minute, 15 teeth in under two minutes, 30 in under three minutes, and 10 in over three minutes. The total procedure time for all the specimen was approximately 30 minutes [Table 2].
Table 2.
Evaluation of the extra-alveolar time in seconds
| Tooth type | Mean±SD | Average |
|---|---|---|
| Canine | 72±41 | 51±86 |
| Molar | 81±125 | |
| Premolar | 38±105 | |
| Supernumerary | 59±58 |
Number of trials to transplantation
In 160 cases of autotransplantation, 80% of the time, the transplanted teeth quickly fit in the new tooth sockets at the recipient sites, and there was no need for any extra fitting attempts. There were a total of 22 teeth that required one fitting attempt (11 percent), four teeth that required two fitting attempts (2 percent), 12 teeth that required three fitting attempts (6 percent), and two teeth that required more than three fitting attempts (1 percent) [Table 3].
Table 3.
Evaluation of number of trials to transplantation
| Number of attempts | ||||||
|---|---|---|---|---|---|---|
|
| ||||||
| Immediately | 1 | 2 | 3 | 4 | 5 | |
| Canine | 3 | 5 | ||||
| Premolar | 120 | 16 | 7 | 1 | ||
| Molar | 38 | 3 | 4 | 1 | ||
| Supernumerary | 2 | |||||
DISCUSSION
This prospective multicenter research was carried out for evaluating the current intraoperative knowledge with the 3D auto-transplantation procedures with a motive to examine the amount of time spent extra-alveolarly as well as the number of fitting attempts with the donor tooth. It was observed that by utilizing a 3D replica that is printed based of a donor tooth, it was possible to reduce the amount of time spent extra-alveolarly as well as the number of times the tooth was attempted to be fitted. This could assist reduce the likelihood of causing injury to the periodontal ligament, which would then prevent root ankylosis or resorption from occurring. The utilization of printed replicas that has been manufactured using a 3D printer may help to improve the predictability of the procedure, which may as well lead to an improved success as well as the survival.[4] The total amount of time spent extra-alveolarly did not exceed ten minutes at any point for almost all the subjects. This falls far within the acceptable range for the preservation of an important PDL.[5] For this reason, it is evident how important it is to evaluate not only how difficult the procedure is, but also how cooperative the patient is, in order to determine whether or not the procedure may be completed with only local anesthetic. No additional bone transplantations are needed if clinical bone levels were assessed prior to surgery.[6] The use of two-dimensional imaging, which cannot accurately calculate the root form of the donor tooth, is one of the most significant drawbacks of the alternative procedure that makes use of off-the-shelf templates. This drawback may result in more mistakes due to the fact that the root form of the donor tooth cannot be accurately calculated using two-dimensional radiography.[7] So, the shape of the root is determined intraoperatively after the extraction of this tooth, and the replacement tooth socket can only be made after the donor tooth has been extracted. This is because the shape of the root is dependent on the position of the tooth in the mouth. This is due to the fact that the position of the tooth within the mouth determines the shape of the root of the tooth.
CONCLUSION
In limits, the motive of this research was to determine the intraoperative experiences with the 3D auto-transplantation of teeth. To study the outcomes of 3D auto-transplantation methods after both short-term and long-term follow-up, additional research is required. The use of 3D procedures has the potential to improve these clinical outcomes since they reduce the amount of time spent extra-alveolarly as well as the number of attempts made intraoperatively to fit transplanted teeth.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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