Digital planning in intentional replantation and autotransplantation
Through the results of two in vivo investigations, as well as clinical cases and videos, we will teach the digital step by step to plan all types of cases.
In recent years, primary endodontic treatment, nonsurgical retreatment and microscopical surgery have achieved success rates of around 90%. However, there are situations in which the tooth cannot be saved using these techniques. The first part of this lecture will discuss intentional replantation. This is an accepted endodontic treatment procedure in which a tooth is extracted and treated outside the oral cavity and then reinserted into its socket to correct an obvious radiographic or clinical endodontic failure. It should not be considered a last-resort treatment prescribed only for unsalvageable teeth as proposed by Grossman. Although intentional replantation is not a frequently performed procedure, it yields a tooth survival rate of 88%, according to a recent meta-analysis. In addition, the new advances in computer-aided rapid prototyping (CARP) models (tooth replicas) and 3D-printed guiding templates allow us to apply this technique in a much more predictable way. In situations where the tooth cannot be saved, there is the option of performing an autotransplant (both open and closed apex). The complications observed in the past can be overcome thanks to advances in diagnostic and surgical techniques, particularly CARP models and 3D-printed guiding templates. The digital planning not only allows for the selection of the most suitable donor tooth according to tooth morphology, but also shows the ideal 3D position and the required dimensions of the alveolus during surgery. Moreover, the use of tooth replicas can reduce the additional socket time and possible donor tooth injury during the procedure.