PMC10257542_01
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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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)).
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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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)).
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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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).
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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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)).
Periapical radiograph of immediate post-operative obturation of tooth #20.
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The final post-operative radiograph was exposed (Figure 5). The patient was referred to his orthodontist for continued care.
Periapical radiograph of tooth #20 at 8-month post-operative follow-up.
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The patient has remained asymptomatic after the completion of NSRCT; a radiographic exam revealed complete healing of periapical pathosis (Figure 6).