Allotransplant to replace avulsed mandibular central incisors using mesiodens

Parameswarappa Poornima; Suryakanth Motilal Pai; Mahesh Tirakappa Bajantri; Indavara Eregowda Neena

doi:10.4103/0976-433X.156223

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CASE REPORT

Year : 2015 | Volume : 6 | Issue : 3 | Page : 191-193

Allotransplant to replace avulsed mandibular central incisors using mesiodens

Parameswarappa Poornima, Suryakanth Motilal Pai, Mahesh Tirakappa Bajantri, Indavara Eregowda Neena
Department of Pedodontics and Preventive Dentistry, College of Dental Sciences, Davangere, Karnataka, India

Date of Web Publication

4-Aug-2015

Correspondence Address:
Parameswarappa Poornima
Department of Pedodontics and Preventive Dentistry, College of Dental Sciences, Davangere, Karnataka
India

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DOI: 10.4103/0976-433X.156223

Abstract

Tooth transplantation has attracted great interests since ancient times. A successful case of tooth allotransplantation is presented in this article. Teeth from two different donors was implanted into the socket of the mandibular central incisors. Follow-up of 1-year indicated good periapical healing with no resorption. Clinically, the transplantation site was free of symptoms and there was no evidence of periodontal disease or tooth mobility. This article suggests tooth transplantation as an alternative to other restorative options in children.

Keywords: Allotransplantation, implants, tooth

How to cite this article:
Poornima P, Pai SM, Bajantri MT, Neena IE. Allotransplant to replace avulsed mandibular central incisors using mesiodens. SRM J Res Dent Sci 2015;6:191-3

How to cite this URL:
Poornima P, Pai SM, Bajantri MT, Neena IE. Allotransplant to replace avulsed mandibular central incisors using mesiodens. SRM J Res Dent Sci [serial online] 2015 [cited 2020 Jul 13];6:191-3. Available from: http://www.srmjrds.in/text.asp?2015/6/3/191/156223

Introduction

Dental avulsion is the complete displacement of a tooth from its socket in alveolar bone owing to trauma. Immediate replantation ensures the best possible prognosis, but is not always possible for the teeth to be found in the site of accident. Allotransplant can be considered as the treatment option to maintain the functional matrix in the arch during the period of growth. Allotransplantation is the transplantation of tooth or teeth from one person to another. One of the earliest references in dental literature describing tooth allotransplantation relates to Reade, ^[1] a French surgeon dating back to the 16 ^th century. The long-term success of an allotransplanted tooth has been influenced by a number of factors such as surgical trauma, damage to periodontal ligament or the cemental layer of the root surface, the effect of splinting, developmental stage of the graft, immune reactions against the donor histocompatibility antigens etc. Many authors suggest a low success rate of tooth allografts and attribute this to lack of histocompatibility. ^[2],[3] However, Unno et al. ^[4] demonstrated that even after an immunological rejection occurs to delete the donor cells the periodontal tissue could regenerate whereas the pulp tissue could transform into the sparse connective tissue. With the introduction of dental implants, allotransplantation of teeth is being gradually sidelined as an alternative. However, placement of implant in the growing child is not a widely accepted treatment option and also considering other aspects such as cost of implants, allotransplantation of teeth could still be an effective alternative. This case report is one year follow-up of tooth allotransplantation of two mesiodens from two different donors in place of Avulsed mandibular right and left central incisor.

Case Report

A 9-year-old boy reported to the Department of Pedodontics a day after trauma with the chief complaint of missing lower front tooth. Extra oral examination revealed there was a laceration of upper and lower lip, for which the patient had taken first aid treatment in a local hospital as well tetanus prophylaxis. On examination, the permanent lower right and left mandibular incisors were avulsed and the sockets were filled with blood clot, no other signs and symptoms of alveolar fracture were seen [Figure 1]a and b. As the patient reported day after trauma teeth were not recovered from the site by accident, and hence replantation was not possible. To maintain the functional matrix in the arch during growth period, allotransplant was planned as treatment. Two patients who had reported for the extraction of the mesiodens for esthetic reasons were recalled to the department [Figure 1]c and d. These donors were investigated for hepatitis B, C and HIV which turned out to be negative. Informed consents were obtained from both the donors and the recipient. Under local anesthesia the teeth were carefully extracted with minimal trauma and placed immediately in a chilled solution of 2% chlorhexidine. Holding the tooth by the crown, the root surface was thoroughly cleaned off all the blood with the same solution using syringe. Throughout the procedure, care was taken to ensure that the root surfaces of these teeth were left undisturbed. This was to ensure minimal damage to the periodontal fibers. The teeth were then transplanted to the recipient's site within 10 min of extraction and was splinted with acid-etch resin composite splint [Figure 2]a. Before transplantation the socket was irrigated with saline to clean off debris following which fresh bleeding was induced by forceful irrigation. Intra oral periapical radiograph was taken to confirm the position of transplanted teeth in the socket after splinting [Figure 2]b.

Figure 1: (a) Pretreatment photograph (b) Pretreatment panoramic radiograph (c and d) Allograft

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Figure 2: (a) Post transplantation photograph (b) Post transplantation intraoral periapical (IOPA) (c) One year follow-up photograph (d) One year follow-up IOPA

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The wound healed uneventfully and the teeth had become stable in 2 weeks time. The splint was removed and the teeth were allowed to stabilize for a further period of 4weeks. Subsequently composite resin was built up. Periodic 1-year follow-up showed that the allograft is clinically firm and radiographically no inflammation or replacement resorption [Figure 2]c and d. This case is being continuously monitored to detect any future resorptive activity.

Discussion

Despite a progressive replacement resorption, which is a frequent complication of a transplanted tooth, allografts function effectively, symptomless often with clinically normal gingiva for many years. The mean functional time of the allografts was 6.8 years, with the teeth remaining free of symptoms. ^[5] Although Iványi and Komínek demonstrated a significant increase in the function time of allografts only up to 2 years after matching histocompatibility antigens, a long-term function time of allotransplanted teeth (10-16 years) has been described in a series of allografts carried out even before the discovery of human leukocyte antigen system in man. ^[6] Schwartz and Andreasen regarded the pulp as the major source of allogeneic donor tissue eliciting immune rejection reaction in the recipient and aggravates root resorption. Endodontic treatment reduces the inflammatory resorption to minimal levels in allografts. However, the prognosis of allotransplant is limited due to replacement resorption as periodontal ligament (PDL) seems to elicit immune response and rejection. ^[7] The donor tooth has been treated appropriately in an attempt to prolong the survival. Use of chlorhexidine solution, short handling time of the transplant undoubtedly would contribute to the survival of periodontal ligament cells. The tooth allografts could have a naturally prolonged survival rate based on a number of factors ^[8] such as the weak antigenicity of teeth; the fact that the tooth transplants are a special type of allografts-they do not have to stay alive to continue to function as do allovital kidney transplants; their acellularity; high density and low resorbability; and their capacity to function asymptomatically in spite of extensive resorption.

Conclusion

In case of nonavailability of autotransplant and the use as of implants being contraindicated in young children, allotransplant could be a better alternative in children. It has certain advantages over prosthetic substitute such as; it acts as a functional matrix during growth period, better esthetic and reduces the psychological trauma. Even if it survives for a few years the alveolar anatomy will maintain for future implant therapy.

References

1.	Reade P. Host reactions to tooth transplants. Aust Dent J 1970;15:172-8. [PUBMED]
2.	Mezrow RR. Homologous viable tooth transplantation. A clinical, immunologic, and histologic study. Oral Surg Oral Med Oral Pathol 1964;17:375-88. [PUBMED]
3.	Nordenram A. Allogeneic tooth transplantation with an observation time of 16 years. Clinical report of 32 cases. Swed Dent J 1982;6:149-56. [PUBMED]
4.	Unno H, Suzuki H, Nakakura-Ohshima K, Jung HS, Ohshima H. Pulpal regeneration following allogenic tooth transplantation into mouse maxilla. Anat Rec (Hoboken) 2009;292:570-9.
5.	Schwartz O, Frederiksen K, Klausen B. Allotransplantation of human teeth. A retrospective study of 73 transplantations over a period of 28 years. Int J Oral Maxillofac Surg 1987;16:285-301. [PUBMED]
6.	Iványi D, Komínek J. Tooth allografts in children matched for HLA. Transplantation 1977;23:255-60.
7.	Schwartz O, Andreasen JO. Allotransplantation and autotransplantation of mature teeth in monkeys: The influence of endodontic treatment. J Oral Maxillofac Surg 1988;46:672-81.
8.	Guralnick WC. Autogenous and allogeneic transplantation of teeth. J Oral Surg 1970;28:575-7. [PUBMED]