Autotransplantation of Premolars to the Position of Central Maxillary Incisors: Evaluation After 10-Year Follow-up

Autotransplantation of premolars to replace lost maxillary incisors in young patients can ensure restoration of normal function and aesthetics. However, there is a need to evaluate the function and aesthetic appearance of the transplanted teeth after a long period. The purpose of this study was to evaluate the success of treatment and aesthetic appearance of transplanted premolars after follow-up of 9 to 13 years. The intention was also to assess whether the transplantation procedure can give predictable functional and aesthetic results after long-term intraoral use. The study was performed on 10 patients with teeth transplanted to the position of the upper central incisors. At the time of transplantation the patients were aged between 9 and 14 years (mean 12 years). They were all treated in the Department of Paediatric Dentistry, School of Dental Medicine. After transplantation all the teeth were immobilised with a wire-composite splint for two weeks, and reshaped with composite after three months. The reshaped teeth were compared with the contralateral incisors with regard to morphology, colour and overall aesthetics. Follow-up of the treatment ranged from 9 to 13 years (average 10.5 years). Transplantation outcome was assessed on the basis of clinical, radiographic and aesthetic criteria. Patients were given a visual analogous scale to assess their overall satisfaction with the treatment outcome. Aesthetic outcome was classified in three categories: 1. Match (difference less than 0.5 mm), 2. Deviation (difference from 0.5 to 1.5 mm) and 3. Mismatch (difference greater than 1.5 mm). The results showed that all the teeth survived without signs of root resorption and ankylosis, although endodontic treatment was performed in 70% of the teeth. Aesthetic appearance after the initial reshaping was classified as matched in all cases and in 80% of cases after 9 to 12.5 years. The study showed that the overall satisfaction of patients with the outcome of treatment was very high (VAS = 87.1). Transplantation of premolars to the position of incisors represents a safe method of treatment which gives highly predictable functional and aesthetic results.