(TC39) Autotransplantation of a Maxillary Premolar to the Anterior Zone: A 10-year Follow-up

Autotransplantation of partially developed premolars is a favorable treatment for tooth replacement when dental implants are contraindicated due to age. This case describes a nine-year-old female referred to the postgraduate endodontic clinic at the Universitat Internacional de Catalunya (Spain) after an avulsion and delayed replantation of tooth #9. Clinically, #9 revealed reduced mobility, infraocclusion, and high-pitched percussion sound. Radiographic examination showed no periodontal space surrounding #9, while a cone beam computed tomography confirmed an advanced degree of root resorption. A diagnosis of replacement root resorption was made on tooth #9. We discussed several treatment options knowing that ankylosis-related root resorption will lead to loss of the affected tooth and disturbance of the alveolar bone growth. An autotransplantation of #4 in site #9 was consented. After extraction of #9, the alveolus was prepared to fit the donor tooth at low speed and cooled with saline. Subsequently, #4 was atraumatically removed and immediately positioned into the recipient site. The primary stability was supported with a cross-suture technique. At nine months #4 was reshaped to resemble a maxillary central incisor, and a direct composite restoration was placed to provide an acceptable aesthetic appearance. Recall exams have been continuously performed throughout the last 10 years, and it has remained functional as it continues to erupt according to the patient’s age. This case demonstrates that premolar autotransplantation can be a beneficial long-term treatment alternative, particularly suitable when extractions are planned for orthodontics reasons. It supports continuing dentoalveolar growth, offering appropriate aesthetics and function.