Autotransplantation of premolars to replace maxillary incisors: A comparison with natural incisors

The published literature contains no comprehensive studies that compare the outcome of premolar autotransplantation to the maxillary anterior region w ith natural incisors in the same patients. This article describes the gingi val and periodontal conditions around premolars transplanted to the maxilla ry incisor region, subsequent to restoration. Forty-five premolars autotran splanted to the maxillary incisor region in 40 adolescent patients were eva luated after a mean observation period of 4.0 years. Mean age at surgery wa s 11.0 years. Established clinical criteria were used to assess tooth mobil ity, plaque and gingival indexes, probing pocket depth, and percussion. Rec ession and hyperplasia of interproximal gingival papillae were assessed acc ording to a recently proposed index. Standardized radiography was used to e valuate presence of, pathosis, pulp obliteration, root length, and crown-ro ot ratios. Clinical variables for transplants did not differ from those of the natural incisors, except for increased mobility and more plaque in a fe w transplanted premolars. The interproximal gingival papillae adjacent to a ll transplanted teeth were normal or slightly hyperplastic. Radiographicall y, all transplants showed varying degrees of pulp obliteration, but no sign s of pathosis. Crown-root ratios were similar for natural and transplanted teeth as were distances from cementoenamel junction to marginal bone. The o verall status of the transplanted premolars and surrounding tissues indicat ed that this treatment modality may be recommended when maxillary incisors are missing in adolescents. In addition, tooth transplantation represents a n inherent potential for bone induction and reestablishment of a normal alv eolar process.