Multiple traumatised upper incisors in children treated by autotransplantation and orthodontics - a 4-year follow-up

Objective: To present two young patients treated by the autotransplantation of developing premolars and subsequent orthodontic space closure and to report a 4-year follow-up result.Case and method: Two 11-year-old patients suffered traumatic anterior dental injuries resulting in ankylosis and subsequent extractions. After consulting the multidisciplinary team, the developing lower second permanent premolars with immature root apices were chosen to replace the injured upper incisors using autotransplantation.Results: Six months after autotransplantation, orthodontic treatment was initiated to close the upper arch spaces, correct the dental midline deviation and to camouflage the transplanted teeth. Normal overbite and overjet were achieved and Class I canine and molar relationships were obtained. After the removal of the orthodontic appliances, composite resin restorations were placed on the upper anterior teeth. During a 4-year follow-up, the pulp vitality of the transplanted teeth was normal with no periodontal nor pathological findings. Pulp canal obliteration with adequate apical length was observed in all the teeth.Conclusion: In children presenting with upper incisors lost to trauma, autotransplantation of developing lower premolars into the upper anterior region followed by orthodontic space closure can be a viable treatment modality producing satisfactory aesthetics and function.