(20) Dental Autotransplantation in Adolescents with 3D-Printed Aids: A Mini Case Series

Abstract:

Background: Adolescents beginning orthodontic treatment are occasionally found to have dental agenesis, missing teeth, or ectopically positioned anterior teeth, leading to significant esthetic and functional concerns. This presents a treatment challenge, as dental implants are contraindicated at this age due to ongoing craniofacial growth. Moreover, the loss of a permanent anterior tooth often results in progressive alveolar bone atrophy, potentially compromising future restorative options. In this population, dental autotransplantation (DAT), transplantation of a tooth from one site to another in the same individual, provides a biologically favorable, cost-effective, and growth-compatible alternative.
Studies report 5-year success and survival rates of 85–95% for DAT involving donor teeth with incomplete root formation, with complications such as ankylosis, inflammatory root resorption, pulpal necrosis, and hypermobility occurring in less than 5% of cases. We believe careful case selection is key to achieving these outcomes.

Purpose: This mini case series showcases our evidence-based protocol incorporating digital planning and 3D-printed surgical aids to enhance the precision and predictability of DAT in adolescent patients. We also highlight key clinical insights and technical considerations.
Methods and

Results: We present two cases of DAT in adolescents aged 9 and 10 years. One case involved a supernumerary tooth transplanted to the maxillary central incisor site (#9), while the other involved a premolar (#5) transplanted to the contralateral premolar site (#12). Both donor teeth exhibited incomplete root formation.
Cone-beam CT (CBCT) data were used to fabricate 3D-printed replicas of the donor teeth using biocompatible resin, each designed with custom handles for ease of manipulation. Recipient site preparation included staged extraction of non-salvageable teeth and socket preservation with bone grafting to optimize bone volume. At the time of transplantation, printed replicas were used intraoperatively to prepare the recipient sockets, minimizing extraoral time and trauma to the periodontal ligament (PDL) and Hertwig’s epithelial root sheath (HERS).
Both DATs were successfully implanted using an atraumatic technique and stabilized using flexible composite splints. Success was defined as physiologic mobility, absence of inflammatory resorption, and continuation of root formation. Clinical and radiographic follow-up at 2–12 months showed successful outcomes. Orthodontic treatment was subsequently carried out in these cases, with no difficulties observed in moving the transplanted tooth into its desired position.
Two additional cases involving impacted canines with previously failed exposure and bonding were also examined. In these cases, the impacted tooth was atraumatically avulsed, repositioned into the desired site, and fixated. These cases also demonstrated successful outcomes with follow-up ranging from 1.5 to 6 months.

Conclusion: Autotransplantation offers significant advantages over delayed implant placement in adolescents, including preservation of alveolar bone and support for ongoing growth. Our technique demonstrates how digital planning and 3D-printed aids can improve precision and surgical outcomes, reinforcing DAT as a viable treatment modality in carefully selected pediatric patients. Additionally, we demonstrate that tooth repositioning, guided by the same biologic principles, can serve as a viable treatment alternative for impacted teeth unresponsive to traditional exposure and bonding techniques.
Figure. 1. Case 1 – Preoperative Presentation. A) Panoramic radiograph at the time of the patient’s initial presentation. B) Clinical examination demonstrating a geminated tooth #9 and a supernumerary tooth #8a. C) Panoramic radiograph following stage 1 surgery, including extraction of teeth C, H, and #9, with subsequent bone grafting.Figure 2. Case 1 – Intraoperative Photographs. A) Site #9 following osteotomy preparation with B) 3D-printed donor tooth replica used for surgical planning. C) Extraction site of the partially erupted tooth #8a and D) Donor tooth fixated into site #9 with a composite splint.Figure 3. Case 1 – Postoperative Presentation. A) Panoramic radiograph at 6 weeks postoperatively, demonstrating appropriate positioning of tooth #8a in site #9. B) Clinical image following Phase I orthodontics at 12 months, showing favorable movement of the anterior dentition, appropriate space closure, and correction of asymmetry.