Açık Apeksli Gömülü Malpoze Daimi Dişlerde Cerrahi Yeniden Konumlandırma ve Ototransplantasyon
Synopsis
The management of impacted and malpositioned permanent teeth with open apices requires a multidisciplinary approach that integrates dental arch alignment with preservation of pulpal and periodontal tissues. This chapter examines surgical repositioning, in situ surgical rotation, and tooth autotransplantation, focusing on their biological foundations, indications, limitations, and integration with orthodontic treatment. It explains the importance of preserving the periodontal ligament, dental follicle, apical papilla, and Hertwig’s epithelial root sheath for pulpal revascularization, periodontal healing, and continued root development. Patient selection and treatment planning are discussed in relation to clinical and radiographic findings, root development stage, three-dimensional anatomical relationships, and recipient site characteristics. The contributions of cone-beam computed tomography and three-dimensional tooth replicas to treatment planning are also considered. Particular attention is given to preoperative orthodontic preparation, atraumatic surgical principles, stabilization, the timing and biomechanics of orthodontic tooth movement, and long-term follow-up. The chapter emphasizes individualized treatment decisions based on biological healing potential and the combined assessment of functional, periodontal, and aesthetic outcomes.
References
Plotino G, Abella Sans F, Duggal MS, et al. Present status and future directions: Surgical extrusion, intentional replantation, and tooth autotransplantation. Int Endod J. 2022;55(Suppl 3):827–842. doi:10.1111/iej.13723.
Tsukiboshi M, Tsukiboshi C, Levin L. A step-by-step guide for autotransplantation of teeth. Dent Traumatol. 2023;39(Suppl 1):70–80. doi:10.1111/edt.12819.
Cremona M, Bister D, Sherriff M, Abela S. Prognostic factors, outcomes, and complications for dental autotransplantation: An umbrella review. Eur J Orthod. 2024;46(1):cjad067. doi:10.1093/ejo/cjad067.
Dokova AF, Lee JY, Mason M, et al. Advancements in tooth autotransplantation. J Am Dent Assoc. 2024;155(6):476–482. doi:10.1016/j.adaj.2024.01.006.
Lee KJ, Hur J, Kim H, Seo MH. Surgical repositioning of inverted maxillary central incisors in children: A long-term retrospective case series analysis. Eur Arch Paediatr Dent. 2026;27(2):619–629. doi:10.1007/s40368-025-01076-9.
Murray PE. Review of guidance for the selection of regenerative endodontics, apexogenesis, apexification, pulpotomy, and other endodontic treatments for immature permanent teeth. Int Endod J. 2023;56(Suppl 2):188–199. doi:10.1111/iej.13809.
Shi R, Zhou Z, Li P, et al. In situ rotation surgery for correction of growing, inversely impacted maxillary central incisors. Am J Orthod Dentofacial Orthop. 2021;159(4):536–544. doi:10.1016/j.ajodo.2020.10.023.
Bai Y, Cui J, Sun H, et al. The enhanced conservation of vital pulp and apical tissues by the application of crown rotation surgery for inversely impacted central incisors: A follow-up analysis of two patients over four years. Int Endod J. 2022;55(8):882–888. doi:10.1111/iej.13761.
Keightley A, Cross DL, McKerlie R, et al. Autotransplantation of an immature premolar, with the aid of cone beam CT and computer-aided prototyping: A case report. Dent Traumatol. 2010;26(2):195–199. doi:10.1111/j.1600-9657.2009.00851.x.
Holland DJ. The surgical positioning of unerupted, impacted teeth (surgical orthodontics). Oral Surg Oral Med Oral Pathol. 1956;9(2):130–140. doi:10.1016/0030-4220(56)90096-2.
Andreasen JO, Paulsen HU, Yu Z, et al. A long-term study of 370 autotransplanted premolars. Part II. Tooth survival and pulp healing subsequent to transplantation. Eur J Orthod. 1990;12(1):14–24. doi:10.1093/ejo/12.1.14.
Andreasen JO, Paulsen HU, Yu Z, et al. A long-term study of 370 autotransplanted premolars. Part IV. Root development subsequent to transplantation. Eur J Orthod. 1990;12(1):38–50. doi:10.1093/ejo/12.1.38.
Paulsen HU, Andreasen JO, Schwartz O. Pulp and periodontal healing, root development and root resorption subsequent to transplantation and orthodontic rotation: A long-term study of autotransplanted premolars. Am J Orthod Dentofacial Orthop. 1995;108(6):630–640. doi:10.1016/S0889-5406(95)70009-9.
Tsai TP. Surgical repositioning of an impacted dilacerated incisor in mixed dentition. J Am Dent Assoc. 2002;133(1):61–66. doi:10.14219/jada.archive.2002.0022.
Kuroe K, Tomonari H, Soejima K, et al. Surgical repositioning of a developing maxillary permanent central incisor in a horizontal position: Spontaneous eruption and root formation. Eur J Orthod. 2005;27(3):206–209. doi:10.1093/ejo/cji099.
Kim S, Kim J, Song JS, et al. Continued root development of a surgically repositioned human incisor tooth germ. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;115(5):e11–e15. doi:10.1016/j.oooo.2011.10.033.
Agrait EM, Levy D, Gil M, Singh GD. Repositioning an inverted maxillary central incisor using a combination of replantation and orthodontic movement: A clinical case report. Pediatr Dent. 2003;25(2):157–160.
Song JS, Choi BJ, Choi HJ, Kim SO, Son HK, Lee JH. Arrest of root development after surgical repositioning of the inverted maxillary central incisor: Case report. J Korean Acad Pediatr Dent. 2007;34(1):162–168.
Becker A, Chaushu G, Casap-Caspi N. Cone-beam computed tomography and the orthosurgical management of impacted teeth. J Am Dent Assoc. 2010;141(Suppl 3):14S–18S. doi:10.14219/jada.archive.2010.0360.
Žarovienė A, et al. Post-treatment status of impacted maxillary central incisors following surgical-orthodontic treatment: A systematic review. Medicina (Kaunas). 2021;57(8):783. doi:10.3390/medicina57080783.
Moorrees CFA, Fanning EA, Hunt EE Jr. Age variation of formation stages for ten permanent teeth. J Dent Res. 1963;42:1490–1502. doi:10.1177/00220345630420062701.
Nolla CM. The development of the permanent teeth. J Dent Child. 1960;27:254–266.
Plakwicz P, Czochrowska EM. The prospective study of autotransplanted severely impacted developing premolars: Periodontal status and the long-term outcome. J Clin Periodontol. 2014;41(5):489–496. doi:10.1111/jcpe.12243.
Atala-Acevedo C, Abarca J, Martínez-Zapata MJ, et al. Success rate of autotransplantation of teeth with an open apex: Systematic review and meta-analysis. J Oral Maxillofac Surg. 2017;75(1):35–50. doi:10.1016/j.joms.2016.09.010.
Rohof ECM, Kerdijk W, Jansma J, et al. Autotransplantation of teeth with incomplete root formation: A systematic review and meta-analysis. Clin Oral Investig. 2018;22(4):1613–1624. doi:10.1007/s00784-018-2408-z.
Tan BL, Tong HJ, Narashimhan S, et al. Tooth autotransplantation: An umbrella review. Dent Traumatol. 2023;39(Suppl 1):2–29. doi:10.1111/edt.12836.
Czochrowska EM, Stenvik A, Bjercke B, Zachrisson BU. Outcome of tooth transplantation: Survival and success rates 17–41 years posttreatment. Am J Orthod Dentofacial Orthop. 2002;121(2):110–119. doi:10.1067/mod.2002.119979.
Wu Y, Chen J, Xie F, Liu H, Niu G, Zhou L. Autotransplantation of mature impacted tooth to a fresh molar socket using a 3D replica and guided bone regeneration: Two-year retrospective case series. BMC Oral Health. 2019;19(1):248. doi:10.1186/s12903-019-0945-8.
Grisar K, Smeets M, Ezeldeen M, Shaheen E, De Kock L, Politis C, et al. Survival and success of autotransplanted impacted maxillary canines during short-term follow-up: A prospective case-control study. Orthod Craniofac Res. 2021;24(2):222–232. doi:10.1111/ocr.12422.
Tirali RE, Sar C, Ates U, Kizilkaya M, Cehreli SB. Autotransplantation of a supernumerary tooth to replace a misaligned incisor with abnormal dimensions and morphology: 2-year follow-up. Case Rep Dent. 2013;2013:146343. doi:10.1155/2013/146343.
Chaushu S, Becker T, Becker A. Impacted central incisors: Factors affecting prognosis and treatment duration. Am J Orthod Dentofacial Orthop. 2015;148(3):355–362. doi:10.1016/j.ajodo.2014.11.019.
Bhikoo C, Xu J, Sun H, et al. Factors affecting treatment duration of labial inversely impacted maxillary central incisors. Am J Orthod Dentofacial Orthop. 2018;153(5):708–715. doi:10.1016/j.ajodo.2017.09.017.
Kokai S, Kanno Z, Koike S, et al. Retrospective study of 100 autotransplanted teeth with complete root formation and subsequent orthodontic treatment. Am J Orthod Dentofacial Orthop. 2015;148(6):982–989. doi:10.1016/j.ajodo.2015.06.018.
Kvint S, Lindsten R, Magnusson A, et al. Autotransplantation of teeth in 215 patients: A follow-up study. Angle Orthod. 2010;80(3):446–451. doi:10.2319/062509-354.1.
