Gómez Meda Ramón, Abella Sans Francesc, Esquivel Jonathan, Zufía Juan
Private practice, Ponferrada (León), Spain.
Department of Endodontics, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain.
J Endod. 2023 Mar;49(3):313-320. doi: 10.1016/j.joen.2022.12.014. Epub 2023 Jan 6.
Tooth replacement often leads to insufficient vertical volume in the recipient socket bone. The aim of this novel report is to present a successful fully guided autotransplantation of a maxillary right third molar (tooth #1) with its attached buccal plate. The procedure was combined with a palatal connective tissue graft to reconstruct a buccal hard and soft tissue defect of an irreparable maxillary right first molar (tooth #3).
A 45-year-old man complaining of pain in tooth #3 came to the clinic. Tooth #3 was non-restorable due to an extensive caries and a vertical root fracture of the mesiobuccal root, leading to a total loss of the buccal cortical plate. Guided autotransplantation of tooth #1 was completed by using 3-dimensional surgical templates for implant burs and a 3-dimensional-printed replica. After positioning the donor tooth, the cortical plate was fixed to the recipient socket with osteosynthesis screws. A connective tissue graft was also harvested to increase the band of keratinized gingiva and the thickness of the buccal soft tissue. At 6-month follow-up, the screws were removed, showing excellent regeneration throughout the buccal area.
At 3-year follow-up, the transplanted tooth was asymptomatic, with a natural bone level and no signs of replacement or inflammatory root resorption.
The use of a donor tooth and its attached bone cortical plate combined simultaneously with a connective tissue graft appears to improve hard and soft tissues in a single procedure.
牙齿替换常常导致受植牙槽骨的垂直骨量不足。本新报告的目的是介绍一例成功的上颌右侧第三磨牙（1号牙）及其附着颊侧骨板的全引导式自体移植病例。该手术联合了腭部结缔组织移植，以修复上颌右侧第一磨牙（3号牙）无法修复的颊侧软硬组织缺损。
一名45岁男性因3号牙疼痛前来就诊。3号牙因广泛龋坏及近中颊根垂直根折无法修复，导致颊侧皮质骨板完全缺失。使用种植钻的三维手术模板和三维打印模型完成了1号牙的引导式自体移植。将供牙就位后，用接骨螺钉将皮质骨板固定于受植牙槽窝。同时采集结缔组织移植片以增加角化龈宽度和颊侧软组织厚度。6个月随访时，取出螺钉，颊侧区域显示出良好的再生情况。
3年随访时，移植牙无症状，骨水平正常，无替代性或炎性牙根吸收迹象。
使用供牙及其附着的骨皮质板并同时联合结缔组织移植，似乎能在单一手术中改善软硬组织情况。
