Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Stomatol. Nov 20, 2015; 4(4): 141-145
Published online Nov 20, 2015. doi: 10.5321/wjs.v4.i4.141
Autotransplantation of a premolar to the maxillary anterior region in young children - how long should the donor root be? A case report
Uri Zilberman, Amram Zagury
Uri Zilberman, Department of the Pediatric Dental Unit, Barzilai University Medical Center, Ashkelon 7830604, Israel
Amram Zagury, Department of Maxillofacial Surgery, Barzilai University Medical Center, Ashkelon 7830604, Israel
Author contributions: Both authors contributed to the surgical and dental treatment, writing and revision of the manuscript.
Institutional review board statement: This case report was exempt from the Institutional Review Board standards at Barzilai Medical University Center, Ashkelon.
Informed consent statement: The patient’s parents gave their written informed consent authorizing use and disclosure of his protected information.
Conflict-of-interest statement: Both authors have no conflict of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Uri Zilberman, DMD, PhD, Head, Department of the Pediatric Dental Unit, Barzilai University Medical Center, 2nd Haatzmaut St, Ashkelon 7830604, Israel.
Telephone: +972-8-6745854 Fax: +972-8-6745238
Received: June 16, 2015
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.

Keywords: Autotransplantation, Dental trauma, Donor tooth root length

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.