Autotransplanation of immature premolars to replace a severely traumatized maxillary central incisor in young patients: Orthodontic and surgical cooperation

Young patients with a severely traumatized maxillary central incisor have limited possibilities to restore its loss. Autotransplantation of immature premolars has been documented as a predictable long-term outcome with the potential for preservation and regeneration of alveolar bone. They can also be successfully reshaped to the central incisor's morphology using direct composite build-ups. However, tooth transplantation is a technique sensitive procedure and requires good case selection, an understanding of relevant tooth transplantation biological principles and careful execution of the optimal surgical and follow-up protocols. Orthodontists play an important role in cooperation with the surgeon before and after surgery. This includes selection of suitable candidates based on orthodontic evaluation of occlusion and indications for premolar extraction, opening adequate space before transplantation and post-surgical alignment of the transplant for an optimal reshaping and establishing a stable occlusion. The aim of the paper is to present clinical application of autotransplanation of immature premolars to replace a traumatized central incisor in growing patients and to discuss the role of an orthodontist in the interdisciplinary team.