Transplantation of Premolars as an Approach for Replacing Avulsed Teeth 8/28/09

Resident: Murphy
Date: 8/28/09
Article title: Transplantation of Premolars as an Approach for Replacing Avulsed Teeth
Author(s): Andreason, Jens. Ole Shwartz, etc.Journal: Pediatric Dentistry, Vol. 31, #2, pg 129-132
Major topic: Treatment modalities for transplanting premolars Type of Article: Clinical Review

Findings: The anterior maxilla is the primary site for dental traumas, with the peak incidence being from between 8 and 12 years old. 7-8% of these injuries involve an avulsed tooth, or a tooth that was not able to be re-implanted. Filling the space left by a lost tooth can be accomplished in many ways. Orthodontic closure, Removable appliance, conventional fixed bridge, acid etched bridge, implant, autotransplantation of premolars, and no treatment. Aside from Orthodontic closure, transplantation of premolars is the most biological approach. The space is filled with a vital tooth that will erupt in harmony with other teeth, won’t compromise the health of adjacent teeth, and has a good prognosis.
The most decisive factor affecting successful transplantation is the stage of root development, with a root with ¾ formed being the best. Studies show that this stage of root development is optimal for pulpal and PDL healing. This method has a 90% success rate.
Maxillary second and mandibular first and second premolars are the teeth that are used (excluding maxillary firsts due to their two roots). Teeth that are used as grafts have to be shaped with restorative procedures.
Key factors for success of the transplantation include minimal trauma to hertwigs root sheath during harvesting and re-implanting, pre/post op antibiotics, and using a tooth that’s root is in the correct developmental stage. Standard tooth removal techniques should not be used, and only clinicians who are familiar with the proper technique should attempt the treatment.
Complications include pulpal necrosis, root resorption, infection, and ankylosis(the worst). Ankylosis prevents eruption and leads to the replacement of root with bone. One option is to separate the crown from the root, leaving the root in the socket to preserve the growth of the alvelolar process.

Conclusions:
-Premolar transplantation is an excellent alternative treatment plan to other conventional options.
-Minimize trauma as much as possible to HRS, dental pulp, and PDL.
-Reimplanted teeth can be shaped with restorative options.
-Only professionals who are adept at doing this procedure so attempt it.

Assessment of article: It was an interesting article to read. For a subject that I thought would have extensive explanation on how to/not to do it, why to/not do it, it was extremely short. I think there should have been more of a discussion on how to do the treatment. Also, the article made some vague statements about how “studies show” that this treatment option is excellent, but don’t list any reasons why. Good article, could have been great.