Published online Nov 20, 2015. doi: 10.5321/wjs.v4.i4.141
Peer-review started: June 20, 2015
First decision: July 27, 2015
Revised: September 25, 2015
Accepted: October 16, 2015
Article in press: October 19, 2015
Published online: November 20, 2015
Autotransplantation of premolars to anterior region after incisor loss due to trauma is accepted as the best restoration procedure with very long follow-ups. There are two main protocols: Premolars with only two thirds of the root or premolars with complete root development. Premolars with two thirds of the root completed remain vital and show complete pulp obliteration while premolars with closed apex require root canal treatment. The problem arises when the child is very young and the root of the donor premolar is developed for only one third. This case report describes the outcome of an autotransplantation of a lower first premolar with only a third of developed root to the anterior region. The donor tooth was extracted with his follicle and placed instead of tooth No. 21. For the first month esthetics was restored with a glass-fibers ribbon attached to tooth No. 11 and composite material. After a month, the crown erupted and was reshaped to mimic an incisor with composite. Orthodontic movement was performed after 5 mo, in order to alleviate the gingival contour. The final restoration was performed after 15 mo. Follow up showed full root development with normal mobility, continuous periodontal ligament and complete pulp obliteration. A multidisciplinary approach and meticulous preparation are necessary for a positive result in autotransplantation of premolars with only a third of root development to the anterior region and this case report show that this method can be performed in very young children.
Core tip: Autotransplantation of a premolar to the anterior region has a success rate of more than 90% if the donor tooth has a developing root and pulp healing occurs. The only negative outcome is total obliteration of the pulp. This case report describe an autotransplantation of a lower first premolar with only a third of root length to the incisor area after a dental trauma that caused root resorption of a permanent upper left incisor, in a 8-year-old boy. Follow up of 15 mo showed full root growth and periodontal healing with normal mobility and obliteration of the pulp. The crown was restored using composite material to resemble the adjacent incisor. This case report shows that even with very short donor root length, autotransplantation to the anterior region can be performed in young children.