Autotransplantation of an immature premolar, with the aid of cone beam CT and computer-aided prototyping: a case report

Autotransplantation of immature teeth has good survival rates, and has benefits over ossointegrated implants in the growing child, but is very technique sensitive. Spiral CT imaging has been previously used in adult patients to enable computer-aided prototyping to produce a surgical template of the donor tooth, further increasing success rates. Case report: The case presented describes management of a 9-year-old girl with the combination of hypodontia affecting the upper lateral incisors as well as a severely ectopic maxillary canine. Cone beam CT was used in combination with computer-aided prototyping to produce a surgical template of an immature mandibular second premolar. The surgical template was used to prepare the transplant site before the donor tooth was extracted, greatly reducing the time from extraction to implantation. By 6 months posttransplant the tooth was clinically sound, and continued root development and laying down of dentine was visible radiographically. Discussion: This paper demonstrates the use of a novel technique to aid the surgical procedure of autotransplantation of immature premolar teeth. The use of autotransplantation in this case allowed the difficult situation of two missing units in the upper left quadrant to be reduced to one unit, while retaining symmetry in the upper arch. Compared to previous studies, the use of cone beam CT to create a 3D prototype reduced radiation dose compared to spiral CT and drastically reduced the extra-oral time of the donor tooth from extraction to transplantation.