Autotransplantation of Third Molars with Platelet Rich Plasma for Immediate Replacement of Extracted Non-Restorable Teeth

Problem: Pubertal patients (10-17 yrs) often present or are referred for extraction of a non-restorable tooth, normally a 1st or 2nd molar. At the time of evaluation, most patients possess impacted/non-functional, sometimes symptomatic 3rd molars indicated for extraction. This study takes advantage of the unique situation and timing where the patient requires removal of two teeth for different indications: one tooth can replace the other and become functional. The purpose of this study is to validate tooth autotransplantation using PRP as a successful and predictable technique. Autotransplantation provides immediate tooth structure for space maintenance and masticatory function. This approach to tooth replacement is also cost saving or neutral compared to other alternatives. Tooth autotransplantation from a third molar site to a first or second molar site with the adjunct of PRP may promote earlier healing thus improving the predictability and success rate of autotransplantation.

Materials and Methods: Ten patients underwent IV sedation for extraction of wisdom teeth and simultaneous removal of a non-restorable tooth. One of the third molars was used to replace the extracted tooth immediately during the same surgery. The third molar was atraumatically extracted and transplanted. PRP was injected into the new socket after socket adaptation.The tooth was then stabilized utilizing orthodontic wires and dental composite for one month. Patients were followed up for one year using a standard autotransplantion protocol similar to that of tooth avulsions. 

Data Analysis: Overall success was measured by tooth maintenance for one year without symptoms. Periapical x-rays were used to measure root development and formation. These were obtained at the following intervals: one, four weeks, three, six months, and one year. Periodontal probing, vitality and occlusal tests were also obtained at post-operative intervals.

Results: To date, none of the patients have failed or lost the transplanted tooth. More data will be available at the time of presentation.

Conclusions: Tooth autotransplantation has been reported in literature as a successful technique for replacing non-restorable teeth, it has been associated with promoting alveolar bone formation and maintaining normal gingival contour. Patients that undergo successful treatment benefit from maintaining a dental space with their own tooth structure. Patients also maintain masticatory functions without any restrictions or limitations. In other words, we are able to replace a non-restorable tooth with an impacted third molar, making it functional for daily chewing activities. With the use of platelet rich plasma (PRP), patients experience minimal pain, reduced infection rates, and improved overall healing, making future root canal treatment unnecessary for the transplanted teeth. Throughout this study, we showed that the use of PRP enhances the healing and recovery of the conventional tooth autotransplantation technique. When considered viable, this alternative option should be presented to patients that are in need of extraction of a posterior tooth and possess impacted/non-functional 3rd molars.

References: 

1.)   Tsukiboshi M. Autotransplantation of teeth: requirements for predictable success. Dent Traumatol 2002; 18: 157-180

2.)   Tatli, U. Kurkcu, M. Cam, O. Buyukyilmaz, T. Autotransplantation of impacted teeth: A report of 3 cases and review of literature. Quintessence International 2009. Volume 40, No. 7