Tuscan Academy of Dental Research (ATRO), Florence, Italy.
Department of Experimental and Clinical Medicine, The University of Florence, Florence, Italy.
Clin Adv Periodontics. 2024 Sep;14(3):165-171. doi: 10.1002/cap.10272. Epub 2023 Nov 20.
The aim of this case report was to present a translational approach to tooth autotransplantation using jiggling forces to enlarge the periodontal ligament (PDL) space before autotransplantation, with the goal of improving treatment success and long-term survival.
A 23-year-old patient, undergoing orthodontic therapy and with an unrestorable maxillary first molar, was proposed to have a healthy and fully-erupted maxillary third molar transplanted in the socket of the first molar. Jiggling forces were applied to the third molar to enlarge the PDL space and facilitate the preservation of PDL fibers on the root surfaces during the extraction.
Jiggling forces induced hypermobility and widened PDL space of the third molar. The autotransplantation was successful and the patient was followed regularly over a 27-year period. At the 27-year visit, the patient showed optimal chewing function, oral plaque control, and absence of gingivitis. The transplanted molar exhibited periodontal health and absence of mobility. Probing depth of 5 mm and radiographic external root resorption was noted on a localized area of the transplanted tooth which had experienced traumatic and unintentional removal of PDL fibers during the extraction.
A translational approach was proposed by integrating knowledge from the fields of orthodontics, trauma from occlusion, and replantation. It validated the crucial importance of maintaining healthy PDL fibers on the root surface and demonstrated clinically the successful autotransplantation of a fully formed third molar into the socket of a first molar with a retention of 27 years.
Why is this case new information? This case provided evidence of successful autotransplantation of a molar with complete root formation. It reported the longest-term follow-up (27 years) present in the literature. Most importantly, it used a translational medicine approach to apply concepts from the fields of orthodontics and traumatic occlusion to improve the success of the autotransplantation procedure. What are the keys to the successful management of this case? Jiggling forces induced tooth hypermobility and increased the PDL space of the tooth planned for autotransplantation. In turn, they facilitated the atraumatic extraction and preservation of the PDL fibers on the transplanted tooth, improving the success of the reattachment of periodontal fibers. What are the primary limitations to success in this case? Traumatic extraction resulting in the unintended removal of PDL fibers from the tooth planned for autotransplantation, or intentional removal of PDL fibers with root planing are expected to decrease the success rate of the autotransplantation procedure. This is due to the lack of viable PDL cells necessary for reattachment.
本病例报告旨在介绍一种通过摆动力量扩大牙周韧带（PDL）空间以促进牙自体移植的转化方法，目的是提高治疗成功率和长期存活率。
一名 23 岁的患者正在接受正畸治疗，有一颗不可修复的上颌第一磨牙，建议将一颗健康且完全萌出的上颌第三磨牙移植到第一磨牙的牙槽窝中。对第三磨牙施加摆动力量，以扩大 PDL 空间，并在拔牙过程中促进根面 PDL 纤维的保留。
摆动力量导致第三磨牙过度活动并扩大了 PDL 空间。自体移植成功，患者在 27 年内定期随访。在 27 年的随访中，患者表现出最佳的咀嚼功能、口腔菌斑控制和无牙龈炎。移植的磨牙表现出牙周健康且无松动。在移植牙的一个局部区域，探诊深度为 5 毫米，并有放射状根外吸收，该区域在拔牙过程中经历了 PDL 纤维的创伤性和非计划性去除。
通过整合正畸、咬合创伤和再植领域的知识，提出了一种转化方法。它验证了保持根面健康 PDL 纤维的重要性，并在临床上成功地将完全形成的第三磨牙自体移植到第一磨牙的牙槽窝中，保留了 27 年。
为什么这个病例是新信息？这个病例提供了成功自体移植完全根形成的磨牙的证据。它报告了文献中最长的随访时间（27 年）。最重要的是，它使用转化医学方法将正畸和咬合创伤领域的概念应用于提高自体移植程序的成功率。
成功管理这个病例的关键是什么？摆动力量导致牙齿过度活动并增加了计划自体移植的牙齿的 PDL 空间。反过来，它们促进了牙齿的微创提取和 PDL 纤维的保留，从而提高了牙周纤维重新附着的成功率。
这个病例的主要成功限制是什么？创伤性拔牙导致计划自体移植的牙齿的 PDL 纤维意外去除，或有意去除 PDL 纤维进行根面平整，预计会降低自体移植程序的成功率。这是因为缺乏重新附着所需的有活力的 PDL 细胞。
