Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00161 Rome, Italy.
Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 04100 Latina, Italy.
Medicina (Kaunas). 2024 Mar 13;60(3):473. doi: 10.3390/medicina60030473.
Third molar extraction is the most common procedure in oral and maxillofacial surgery. Third molars are considered less functional than other teeth and are often extracted. Sometimes, they are also used for auto-transplantation for the benefit of oral rehabilitation. Since many biological factors are involved in this surgical approach, herein, we outline a review of the biological characteristics of medico-legal/forensic interest, in addition to presenting a successful clinical case. A scoping review of currently available research data (following the principles of PRISMA-ScR or the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) on third molar auto-transplantation was conducted by drawing upon the main databases (Scopus, PubMed, Google Scholar and LILACS) to evaluate biological and clinical characteristics possibly relatable to forensic issues. All the collected data were summarized and elaborated on for the purpose of this article. A patient underwent extraction of the right upper first molar and auto-transplantation of the unerupted ipsilateral third molar. Many biologic and clinical factors are involved in the success of this clinical procedure. Knowledge of third molar anatomy, of its development and viable surgical approaches are all essential elements; just as important are the treatment of the tooth before and after transplantation and the integrity of the periodontal ligament. Follow-up of the clinical case for 5 years made it possible to verify the stability of the procedure over time. Third molar auto-transplantation is feasible and cost-effective. However, the use of third molars as donor teeth in auto-transplantation may have medico-legal implications. The lack of official protocols and consistent evidence-based guidelines for operators still prevent such a procedure from becoming mainstream; therefore, it is viewed with suspicion by clinicians and patients, even though the biological factors herein detected point to a reasonably high degree of safety. The understanding of many specific biological and clinical factors involved in the stability of third molar auto-transplantation allows for a thorough understanding of the forensic implications relevant to clinical practice. Effective communication and information provision are therefore of utmost importance, in the interest of both patients and doctors.
第三磨牙拔除是口腔颌面外科最常见的手术。第三磨牙的功能比其他牙齿差，通常需要拔除。有时，它们也被用于自体移植，以促进口腔修复。由于这种手术方法涉及许多生物学因素，因此，除了介绍一个成功的临床病例外，我们还概述了与法医学/法医利益相关的生物特征的综述。通过参考主要数据库（Scopus、PubMed、Google Scholar 和 LILACS），对第三磨牙自体移植的现有研究数据（遵循 PRISMA-ScR 原则或系统评价和荟萃分析扩展的首选报告项目用于范围综述）进行了综述，以评估可能与法医学问题相关的生物学和临床特征。收集到的所有数据都进行了总结和阐述，以完成本文。一位患者接受了右上第一磨牙的拔除和同侧未萌出第三磨牙的自体移植。许多生物学和临床因素都与这一临床手术的成功有关。了解第三磨牙的解剖结构、其发育和可行的手术方法都是必不可少的要素；同样重要的是移植前后牙齿的处理以及牙周膜的完整性。对临床病例进行 5 年的随访，使我们能够随着时间的推移验证该程序的稳定性。第三磨牙自体移植是可行且具有成本效益的。然而，将第三磨牙用作自体移植的供体牙可能会涉及法医学问题。由于缺乏操作人员的官方协议和一致的循证指南，这种手术方法仍然无法成为主流；因此，尽管在此处检测到的生物学因素表明安全性相当高，但临床医生和患者仍然对此持怀疑态度。了解第三磨牙自体移植稳定性所涉及的许多特定生物学和临床因素，可以全面了解与临床实践相关的法医学意义。因此，为了患者和医生的利益，有效的沟通和信息提供至关重要。
