Autotransplantation & Implants to the Maxillary Anterior Region

Autotransplanation of developing teeth is an attractive treatment option to replace congenitally absent teeth and traumatically lost incisors as well as to upright ectopic teeth (trans-alveolar transplantation) in children and adolescents. Studies have shown, that autotransplanation of immature premolars resulted in over 90% long-term success rate. A comprehensive surgical and orthodontic treatment planning is mandatory whenever tooth transplantation is considered. It helps to select an optimal donor tooth, to plan pre- and post-surgical management of occlusion and to discuss other treatment options. The post-surgical orthodontic treatment plan is important not only to close the donor space and achieve a stable occlusion, but also to treat possible transplantation problems and to utilize other treatment options to replace the transplant in case of failure. The most common autotransplanation failures mainly include different types of root resorption such as internal (inflammatory and replacement) resorption/ or external (inflammatory, ankylosis and replacement or invasive) resorption. The description of complications following tooth transplantation in relation to the type of a donor tooth, surgical procedure and post-surgical handling of a donor will be presented during the lecture. Possible treatment options such as preservation of a non-successful transplant, management of ankylosis and cervical resorption, considering of another transplantation and orthodontic space closure will be discussed based on own clinical examples.

Autotransplantation & Implants to the Maxillary Anterior Region

The primary goals for successful treatment outcomes in implant dentistry include long-lasting function, esthetics, and inflammation-free tissues. Trauma-induced tooth loss in the esthetic zone is often associated with the loss of both bone and soft tissue. To meet expectations of today’s patients, as well as expectations of our own as healthcare professionals, increasing attention is being given to soft tissue management and pink esthetics. This presentation will provide a basic understanding of soft tissue around teeth and implants, which may be beneficial during emergency treatment to preserve tissue volume for better outcomes in the rehabilitation process. Surgical treatment strategies for augmenting tissue volume before, during, and after implant installation will be discussed to achieve favorable marginal soft tissue and papilla outcomes. Finally, follow-up and maintenance protocols will be covered

Networking

Autotransplantation & Implants to the Maxillary Anterior Region

Complex treatment plans in implant often include situations where the choices of autotransplantation of teeth (ATT) have been overlooked. If recipient sites are jeopardized for placing implants, more time, cost and techniques are required. However, if there is a good candidate as a donor tooth found in the same mouth, ATT can be the more appropriate option than implant. For example, the case where sinus lifting or ridge augmentation is indicated can be preferable and advantageous for ATT. If patients are younger than twenty, implant is hardly indicated. The indications, advantages and techniques for success in ATT will be discussed in this presentation. The lecture will be extensively illustrated with many clinical cases of ATT.

Networking

Autotransplantation & Implants to the Maxillary Anterior Region

Treatment with single anterior implants is predominantly used in younger individuals with a long remaining lifetime. Due to skeletal development and maturation along with passive eruption of adjacent teeth anterior implants tend to end up in infraposition with time. - How much infraposition can we expect? - What are the patients’ reactions to this phenomenon? - How do we plan our treatments to minimize the risk of making this a problem for our patients? - Are single implants the best treatment option for this group of patients? - Can resin-bonded bridges be considered a viable treatment option? Dr. Winitsky will, based on her research on single anterior implants and resin-bonded bridges, discuss this topic

Dialogue

Oral Presentation or Posters

Single missing teeth in the frontal segment of the maxilla are relatively common in children and adolescents and their solution is more a problem of aesthetics and psychosocial than of dental function. In contrast, multiple missing teeth are a very rare dental anomaly, with a prevalence of less than 1%. However, its occurrence represents a severe problem for the patient, because the management of multiple impacted or missing teeth in the dentition is not only a question of aesthetics, but also of function of occusion. A fundamental phase in the treatment of these cases is the determination of the ideal treatment plan, which in most patients must be interdisciplinary therapy. Orthodontic treatment may be an essential element or, conversely, form only a small, if necessary, part of the complete treatment. An important part of the treatment is the dental reconstruction, including autotransplantation with potential osteogenesis, orthodontic active tooth eruption (biologically driven treatment plan) and prosthetic reconstruction. The precise timing of the treatment is also very important, with respect to the age of the patient and the complete growth before implantation on the one hand, and the social handicap that the missing teeth represent for the patient on the other. The author uses several examples to demonstrate the diagnosis, treatment plan and therapeutic procedures for patients with relatively simple cases of missing single teeth to complex cases of multiple impacted teeth (ghost teeth) and presents various solutions, often very specific, but respecting the general rules valid for autotransplantation. The essential message of the lecture is that tooth autotransplantation is for us plan A and dental implant is plan B.

Dialogue

Networking