The impasse of paediatric implantology: The use of autotransplantation

Oral rehabilitation in the growing patient imposes major biological constraints, the placement of dental implants being contraindicated before the end of skeletal maturation. Faced with complex clinical situations such as the impaction of mandibular molars, the practitioner must favour solutions capable of preserving alveolar bone stock and allowing for potential subsequent orthodontic movements.

This case report presents the management of a 13-year-old female patient suffering from impaction of teeth 46 and 47. Following the extraction of the first molar (46) and monitoring of the healing process, the second molar (47) was found in a horizontal position, rendering any natural eruption impossible. The objective of this study is to describe the surgical protocol for the dental autotransplantation (DAT) of tooth 47 into the socket of 46.

The authors test the hypothesis that an atraumatic surgical technique, focused on the rigorous preservation of the periodontal ligament, minimal extra-oral time and stabilisation in slight infraocclusion, can promote the biological integration of the transplant. The aim is to demonstrate that this functional and low-cost alternative constitutes a viable option to restore the integrity of the arch in the young patient.

Clinical approach and surgical protocol

This case report documents the management of a 13-year-old female patient (n=1) presenting with an impaction of teeth 46 and 47. The therapeutic protocol proceeded according to the following steps:

• Preparatory phase: extraction of tooth 46 and monitoring of initial bone healing. Diagnostic imaging revealed a horizontal position of tooth 47, with no prospect of physiological eruption.
• Surgical procedure: autotransplantation of tooth 47 (donor tooth) into the socket of 46 (recipient site). The procedure was performed via an atraumatic surgical technique to maximally preserve the periodontal ligament.
• Positioning and stabilisation: the tooth was placed in slight infra-occlusion to minimise early occlusal forces. Stabilisation was secured by sutures, with no mention of additional rigid splinting.
• Follow-up and evaluation: clinical and radiographic monitoring extended over a period of 19 months (1 year and 7 months).

The analysis parameters included the evaluation of dentoalveolar integration, the kinetics of new bone formation, the maintenance of pulp vitality and the assessment for signs of root resorption or infectious complications.

Clinical follow-up and biological integration at 19 months

The postoperative follow-up of the 13-year-old patient allowed the evaluation of the success of the autotransplantation of tooth 47 into the socket of tooth 46 over a total period of 19 months (one year and seven months). The clinical and radiographic observations made during the last follow-up visit confirm the stability of the dentoalveolar complex.

Clinically, the authors report satisfactory gingival healing, without any signs of infection, pain or pathological mobility. The transplanted tooth exhibits optimal functional adaptation within the arch. A critical point of this case lies in the preservation of pulp vitality, confirmed during follow-up tests, thus avoiding the need for post-transplantation endodontic treatment.

The radiographic analysis at 19 months reveals several indicators of biological success:

• Dentoalveolar integration: Absence of periradicular radiolucency, indicating healthy periodontal healing.
• Bone regeneration: Evidence of new bone formation filling the initial peri-implant spaces of the recipient socket.
• Root integrity: Complete absence of root resorption (internal or external) and signs of ankylosis.

Evaluated parameter	Observation at 19 months (Tooth 47)
Signs of infection	Absent
Pulpal vitality	Preserved
Root resorption	None
Bone formation	Present (complete integration)
Clinical stability	Satisfactory (initial infra-occlusion corrected)

These results highlight the efficacy of the technique when the donor tooth presents incomplete root formation, thereby promoting the potential for revascularisation and regeneration of the periodontal ligament.

Analysis of biological and functional integration

The success observed in this clinical case highlights the biological superiority of dental autotransplantation (DAT) over prosthetic or implant solutions in the growing patient. Unlike an implant, the transplanted element allows for the maintenance of the alveolar bone and the continued physiological development of the ridge. Clinically, the preservation of pulp vitality and the absence of root resorption after 19 months validate the atraumatic management of the periodontal ligament, a critical integration factor documented in the literature for teeth with incomplete root formation.

Determining factors and comparison with the literature

The success of this procedure on tooth 47 relies on a synergy of factors: precise imaging planning, extra-oral time kept to a minimum and positioning in slight infra-occlusion to avoid early occlusal trauma. These results corroborate data from recent reviews indicating that the survival rates of DATs are particularly high when the stage of root development is favourable (immature root), allowing predictable reinnervation and revascularisation of the graft.

Limitations and clinical scope

Although the results at one year and seven months are conclusive, this single case study (n=1) dictates caution regarding the systematic generalisation of the protocol. The 19-month follow-up, although significant, does not yet allow for the assessment of very long-term stability (over 5 years). Nevertheless, in the specific context of a 13-year-old female patient, ATD offers a rehabilitation that conventional implantology could not provide without the risk of infra-position associated with residual facial growth.

In practical terms, for the practitioner:

• Favour open apices: The potential for pulpal revascularisation is maximal when root formation is incomplete, often rendering post-operative endodontic treatment unnecessary.
• Master the extra-oral time: The survival of periodontal ligament fibroblasts is the critical success factor; every minute outside the socket increases the risk of resorption.
• Ensure flexible stabilisation: Unlike a fracture, the transplanted tooth requires some physiological mobility (via sutures or flexible wires) to promote functional periodontal healing rather than ankylosis.
• Consider orthodontics: A tooth transplanted with its ligament can be moved orthodontically, unlike an implant, offering essential therapeutic flexibility in young patients.

The case concerns a 13-year-old patient. Following the extraction of tooth 46 and a monitoring phase of bone healing, the examination revealed tooth 47 in a horizontal position, making any physiological eruption impossible. Faced with this situation, the clinical team opted for the autotransplantation of tooth 47 into the socket of tooth 46. The surgical methodology favoured an atraumatic approach to maximise cell survival. The protocol included the preparation of the recipient socket, the positioning of the donor tooth in slight infraocclusion and stabilisation by sutures. The authors emphasise critical success factors: the rigorous preservation of the periodontal ligament, the reduction of the extraoral time of the donor tooth and precise planning based on imaging. A decisive advantage in this case lay in the developmental stage of tooth 47, presenting incomplete root formation, a factor for a better prognosis for neurovascular integration. The clinical results, evaluated during a 19-month follow-up, confirm the relevance of the approach. The radiographic and clinical examination shows complete dentoalveolar integration, periradicular bone neoformation and a total absence of infectious signs. Notably: pulp vitality was preserved and no root resorption was detected, thus validating the long-term biological stability of the graft.

---

Information intended for healthcare professionals. This content may contain errors or truncated summaries. We recommend always checking against the original source article. Delynov disclaims all liability regarding the use of this information. This document is not intended for patients or the general public.