|Year : 2014 | Volume
| Issue : 3 | Page : 196-199
Immediate autotransplantation of immature third molar with regeneration of recipient site using autologous platelet-rich fibrin
Takhellambam Premlata Devi1, Wahengbam Tulsidas Singh2, Ngairangbam Sanjeeta3, Nongthombam Rajesh Singh4
1 Department of Conservative and Endodontics, Dental College, Regional Institute of Medical Sciences, Imphal, Manipur, India
2 Department of Oral and Maxillofacial Surgery, Dental College, Regional Institute of Medical Sciences, Imphal, Manipur, India
3 Department of Oral Pathology and Oral Microbiology, Dental College, Regional Institute of Medical Sciences, Imphal, Manipur, India
4 Department of Prosthodontics, Dental College, Regional Institute of Medical Sciences, Imphal, Manipur, India
|Date of Web Publication||5-Jan-2015|
Wahengbam Tulsidas Singh
Department of Oral and Maxillofacial Surgery, Dental College, Regional Institute of Medical Sciences, Lamphelpat, Imphal - 795 004, Manipur
Source of Support: None, Conflict of Interest: None
Autotransplantation enabled the usage of natural tooth rather than prosthesis to replace a missing tooth. Autotransplantation of the mature tooth, incompletely formed root or an immature tooth bud can be done with variable success rate. Autotransplantation carried out within short duration in younger patient with immature tooth bud gives higher success rate. Platelet-rich fibrin (PRF) is a wonderful tissue engineering product and has gained much popularity due its promising results in wound healing. This case report illustrates the efficacy of PRF in the treatment of the autotransplantation of tooth bud.
Keywords: Growth factor, Periodontal ligament, Wound healing
|How to cite this article:|
Devi TP, Singh WT, Sanjeeta N, Singh NR. Immediate autotransplantation of immature third molar with regeneration of recipient site using autologous platelet-rich fibrin. J Med Soc 2014;28:196-9
|How to cite this URL:|
Devi TP, Singh WT, Sanjeeta N, Singh NR. Immediate autotransplantation of immature third molar with regeneration of recipient site using autologous platelet-rich fibrin. J Med Soc [serial online] 2014 [cited 2022 May 21];28:196-9. Available from: https://www.jmedsoc.org/text.asp?2014/28/3/196/148527
| Introduction|| |
Autotransplantation is the surgical transplantation of a vital or endodontically treated tooth from its original location in the mouth to another site in the same individual.  It is a viable treatment option for the replacement of extracted or missing mature permanent teeth as a result of carious destruction or traumatic injury bringing about early restoration of function and esthetics. Appropriate treatment planning and an atraumatic extraction are important factors that affect the success rate of autotransplanted teeth. Excellent success rate can be achieved if the donor third molar tooth is transplanted before complete root formation.  Favorable periodontal healing is a critical factor for a successful autotransplantation. This can be achieved if it is carried out immediately. Extremely good periodontal ligament (PDL) healing is expected when a donor tooth is immediately placed into the freshly extracted recipient socket. Continued root development after transplantation can be expected if the donor tooth is immature and Hertwig's epithelial root sheath is preserved around the apices. 
Autologous platelet-rich fibrin (PRF), a second generation platelet concentrate considered to be a healing biomaterial can be placed at the recipient site to enhance the speed of healing process and also to accelerate root formation of the immature donor third molar tooth. In this paper, a case of immediate mandibular third molar autotransplantation to replace a non-restorable mandibular second molar is presented. PRF was used for the enhancement of wound healing and to promote continued formation of the immature root of the donor tooth.
| Case Report|| |
A 16-year-old girl had reported with irreversible pulpitis irt 47 with poor prognosis, for which root canal treatment was ruled out. Adjoining the said tooth (i.e 48) an impacted tooth bud was present [Figure 1]. Considering the age of the patient an autotransplantation was planned. To accelerate the process of root formation and healing process PRF was placed in between the recipient tooth socket and the donor tooth bud.
|Figure 1 : Donor tooth bud 48 and recipient tooth 47 with irreversible pulpitis|
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PRF preparation: A blood sample was taken without anticoagulant in 10 ml tubes which were immediately centrifuged at 3000 rpm (approximately 400 g) for 10 minutes. A fibrin clot was then obtained in the middle of the tube, just between the red corpuscles at the bottom and acellular plasma at the top. A single spin produces three layers: Top is platelet poor plasma, middle is PRF, and bottom layer contains red blood cells (RBCs). The middle layer PRF is of clinical significance to us [Figure 2].
|Figure 2: Three layers: top is platelet poor plasma, middle is PRF, and bottom layer contains RBC|
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Surgical procedure: Under local anesthesia, Ward's incision was given to gain surgical access to impacted 3 rd molar tooth bud. Gilbes Moore's guttering technique was used to cut the bone under constant irrigation with saline [Figure 3]. Without making any purchase point the impacted tooth bud was luxated and atraumatic extraction of the adjacent recipient tooth (47) was done. Minimizing the working time, the donor tooth bud (48) was extracted. Simultaneously, the already prepared PRF harvested from the same patient was placed at the recipient extracted socket over which the donor impacted tooth bud was placed [Figure 4] and [Figure 5]. The entire manoeuvre was carried out within 15 minutes. Closure was done with 3-0 vicryl and was followed by splinting with 19 gauze wire and light cured composite resin [Figure 6] and [Figure 7]. Subsequent follow-up were done on 1 week, 2 week, 1month, 3 months, and 6 months. After completion of the 6 months, we can appreciate both radiographically and clinically the successful autotransplanted tooth bud 48 [Figure 8] and [Figure 9]. However, for the complete regeneration of the root to occur, the follow-up has to be continued for 2 and half years.
|Figure 6 : Autotransplanted 48 at recipient 47 socket secured by figure of 8 suturing|
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|Figure 9: Clinical photograph of the autotransplanted tooth after 6 months|
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| Discussion|| |
Transplanted teeth with incomplete root formation have a 96% rate of pulpal healing, compared with 15% for transplanted teeth with complete root formation. Although higher success rates are achieved with teeth that have immature roots, these teeth have less root growth after transplantation than other autografted teeth that have more mature, although not completely formed, apices. 
The success of the autotransplantation is critically determined by the favorable periodontal healing which is achieved if the donor tooth is immediately placed into the freshly extracted recipient socket. Continued root development after transplantation can be expected if the donor tooth is immature and Hertwig's epithelial root sheath is preserved.
The present case report evaluated the clinical efficacy of PRF in the treatment of autotransplantation of tooth bud. The main component of PRF is high concentration of growth factors present in the platelets which are required for wound healing. The PRF acts much like a fibrin bandage, serving as a matrix to accelerate the healing of wound. 
Among the various growth factors that PRF contains, platelet derived growth factor (PDGF), Transforming growth factor β (TGF β-1 and β-2), and insulin-like growth factor (IGF), epidermal growth factor, vascular endothelial factor, and fibroblast growth factors are believed to play a major role in bone metabolism and potential regulation of cell proliferation. PDGF is an activator of collagenase which promotes the strength of healed tissue. TGF-β activates fibroblasts to form procollagen which deposits collagen within the wound. PRF facilitates healing by controlling the local inflammatory response. 
The use of the platelet and immune concentrate promotes the integration of fibrin network into the regenerative site facilitating cellular migration, particularly for endothelial cells necessary for the neo-angiogenesis, vascularization, and survival of the graft.  The platelet cytokines (PDGF, TGF- α, IGF-1) are gradually released as the fibrin matrix is resorbed, thus creating a perpetual process of healing. Lastly, the presence of leukocytes and cytokines in the fibrin network can play a significant role in the self-regulation of inflammatory and infectious phenomena within the grafted material. 
Preparation of PRF is quite easy and fast and simplified processing minus artificial biochemical modification than PRP, which takes more time. The PRF preparation process creates a gel-like fibrin matrix polymerized in a tetra-molecular structure that incorporates platelets, leukocyte, and cytokines, and circulating stem cells. PRF is a by-product of the patient's own blood; therefore, chances of infectious disease transmission are rare. Since PRP harvesting is done with only 8-10 ml of blood, the patient need not bear the expense of the harvesting procedure in hospital or at the blood bank.
From the presented case, it can be concluded that PRF is efficacious clinically and radiographically in the treatment of autotransplantation. PRF is an autologous preparation and found to be clinically effective and economical than any other available regenerative materials. PRF with its beneficial outcomes will definitely revolutionize the surgical dentistry in the near future.
| References|| |
Cohen AS, Shen TC, Pogrel MA. Transplanting teeth successfully: Autografts and allografts that work. J Am Dent Assoc 1995;126:481-500.
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Proye MP, Polson AM. Repair in different zones of the periodontium after tooth reimplantation. J Periodontol 1982; 53:379-89.
Ustad F, Ali FM. Autotransplantation of teeth: A review. Am J Med Dent Sci 2013;1:25-30.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9]
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