|Year : 2014 | Volume
| Issue : 2 | Page : 110-113
Intra-alveolar auto-transplantation to correct a single tooth rotation: A case report with four years of follow-up
Sunil Babu Kotha
Department of Preventive Dentistry, Riyadh Colleges of Dentistry and Pharmacy, Riyadh 11681, Kingdom of Saudi Arabia
|Date of Web Publication||12-Aug-2014|
Dr. Sunil Babu Kotha
Department of Preventive Dentistry, Riyadh Colleges of Dentistry and Pharmacy, P.O. Box 84891, Riyadh 11681
Kingdom of Saudi Arabia
Source of Support: None, Conflict of Interest: None
It is uncommon for children or young adults to have rotated central incisors. The restorative options are to carry out an orthodontic treatment or root canal treatment followed by crown placement for their correction. Often overlooked and misunderstood, another treatment option in the intra-alveolar auto-transplantation where the tooth is rotated within the same socket to an appropriate position. This article highlights the overview of intra-alveolar auto-transplantation along with a case of rotated central incisor. A 12-year-old complaining of rotated tooth and wanted it to be corrected. On clinical examination, there was rotation of maxillary left central incisor with no history of any gingival and periodontal involvement. After obtaining the consent from the patient and his parent, intra-alveolar auto-transplantation procedure was carried out. After a four-year follow-up, the concerned tooth, had retained its vitality and showed no signs of relapse.
Keywords: Auto-transplantation, intentional re-implantation, intra-alveolar tooth transplantation, re-implantation, surgical reposition
|How to cite this article:|
Kotha SB. Intra-alveolar auto-transplantation to correct a single tooth rotation: A case report with four years of follow-up. Saudi J Oral Sci 2014;1:110-3
|How to cite this URL:|
Kotha SB. Intra-alveolar auto-transplantation to correct a single tooth rotation: A case report with four years of follow-up. Saudi J Oral Sci [serial online] 2014 [cited 2020 Jan 25];1:110-3. Available from: http://www.saudijos.org/text.asp?2014/1/2/110/138485
| Introduction|| |
Maintaining the integrity of the natural dentition is the central goal of dentistry. Single tooth rotation has been a problem from antiquity.  Attempts to correct have included two traditional approaches; root canal treatment followed by crown placement or orthodontic correction. In spite of having better predictability, these two approaches can result in a compromise of esthetics, symmetry, occlusal function, periodontal stability. Furthermore, the time and cost of orthodontic treatment has often made patients look for alternatives. 
Intra-alveolar transplantation refers to extraction of a tooth and changing the position of a tooth within the same socket.  It has been used in cases where restoration or preservation of a tooth is difficult because of deep caries or crown fracture and has included cases of change in position of the tooth or extrusion by replantation, surgical up righting, or extrusion without complete extraction.  This procedure opens-up new avenues of treatment maintaining the integrity and improvement of the esthetics. However, there have been few reported cases of its use in the correction of the rotation of a single tooth. This paper reports a clinical case of intra-alveolar tooth transplantation to correct the rotation of single tooth rotation and documents the clinical and radiographic success of the procedure four years after the procedure.
| Case Report and Clinical Procedure|| |
A 12-year-old boy reported to the Department of Pedodontics and Preventive Dentistry, Government Dental College and Hospital, Hyderabad, Andhra Pradesh, India in April 2009 complaining of a "twisted" tooth. On clinical examination, there was rotation of maxillary left central incisor [Figure 1] with no history of gingival or periodontal involvement. Examination revealed no tenderness to percussion, swelling in the associated gingiva or mobility of the tooth. An intra-oral periapical radiograph showed rotated incisor with intact lamina dura [Figure 2]. No occlusal interferences were observed with the tooth.
|Figure 2: Preoperative radiograph of rotated of maxillary left central incisor|
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After evaluating both the clinical and radiographic examination, the patient and parents were given the options of orthodontic correction, intentional root canal treatment followed by crown placement or intra-alveolar tooth transplantation. The parents chose intra-alveolar transplantation citing cost and the absence of any other "crooked" teeth. Before the extraction and re-implantation procedure, the patient was informed of the possible complications. Informed consent was obtained from the patient and the parents which the father signed.
After the tooth was completely anesthetized, the tooth was extracted with gentle rotation motions in order to avoid pressing the periodontal ligament against the wall of socket. After stopping bleeding, the tooth was rotated into the correct position and replaced in the socket. A splint made of a medium rigidity wire was bonded to the labial surfaces of tooth no. 11 and 21 and left in place for 10 days.
The patient was placed on analgesics and antibiotics for a period of 5 days. The patient was recalled after 5 days for a regular check-up. Clinical and radiographic examination showed good prognosis [Figure 3] and [Figure 4]. The patient was placed on recall and was to be evaluated every 6 months for the 1 st year and every year for the next 3 years.
After 4 years of follow-up, there has been no clinical or radiographic evidence of failure. However, there was a mild overlap of the incisors [Figure 5] and [Figure 6]. Both patient and parents reported satisfaction with the outcome of the treatment.
|Figure 6: Recall radiograph approximately 4 years following intra-alveolar tooth transplantation|
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| Discussion|| |
Bittencourt et al.  attributed the first intentional replantation (IRR) to some investigators who performed the procedure in 1978. Although, there have been reports of IRR being used in the treatment of traumatized central incisors, , there has been little documentation of the use of this technique in patients who did not have a history of trauma.
The field of auto-transplantation includes a variety of procedures. Tsukiboshi summarized these into three categories [Table 1].
Success of auto-transplantation has been shown to depend on the presence of a conical root.  In this case the fact that neither the root nor the alveolar socket needed reshaping confirmed the advantage that a tooth with a conical root offers in cases of auto-transplantation the advantages that a tooth with a conical root offers in cases of auto-transplantation.
Tsukiboshi has stated that the successful transplant must show no evidence of ankylosis, resorption or inflammation.  The picture and radiographs seen in this case clearly demonstrated absence of any closure of the periodontal ligament space, root resorption or inflammation even after 4 years. Success of any re-implantation requires the maintenance of the viability of the periodontal ligament fibers.  The tooth was splinted for 10 days which was in line with the 2007 guidelines of the International Association for Dental Traumatology (IADT) for avulsed teeth.  It is interesting to note that in 2012 the IADT reduced the time suggested for splinting such teeth to 1-week. 
Nonrigid splinting was done to allow for physiologic tooth mobility which provided proper healing of the periodontium, and promoted fibrous instead of osseous junction with the alveolar socket.
The success achieved in this case after rotation of the incisor by approximately 90° has been achieved before in traumatized teeth. , Clokie et al.  pointed out that inﬂammatory resorption may become evident after 3 or 4 weeks, while replacement resorption may not become evident until 3 or 4 months after transplantation. In the current case, the absence of signs of resorption after 4 years was a clear sign of successful re-implantation. The 4 year survival is a good sign, as Czochrowska et al. have reported success of up to 10 years in an auto-transplanted tooth. 
It must be remembered that unlike previous reports that involved traumatized teeth, in this case an intentional extraction and re-implantation was carried out on an otherwise healthy tooth. It has been pointed out that economic factors often play a role in the type of treatment chosen by patients. , In this case, both the alternate choices; orthodontic treatment and intentional root canal treatment, were not acceptable to the parent. While several case-reports on the use of autotranplantation in traumatized teeth success of this treatment as a viable option, ,,, clinical trial or meta-analyses on the viability of intra-alveolar auto-transplantation in otherwise healthy teeth is lacking.
| Conclusion|| |
Intra-alveolar auto-transplantation can be considered as an alternative approach in oral rehabilitation for some clinical situations (especially in young patients). However, despite its relatively low cost compared to the traditional methods of correction (such as orthodontic treatment) and high success rates, it requires careful case selection, professional skill, and patient and parent collaboration. Although intra-alveolar tooth transplantation has not been confirmed as a traditional means of correcting the position of the tooth, the procedure needs more consideration and future clinical studies in order to obtain predictable long-term results.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]