Autotransplants Offer Hope for Teen Dental Injuries

Front teeth are not only essential for chewing and speaking but also play a significant role in aesthetics and self-confidence. Losing a front tooth, especially during adolescence, can be a traumatic experience. A recent case highlighted by The Straits Times demonstrates how dental autotransplantation can offer a viable solution for young patients facing this challenge.

The Case of Angela Chin

Angela Chin, a 19-year-old student, struggled with the emotional and social impact of losing a front tooth after a childhood accident. At the age of 10, she fell and broke her front tooth on a concrete floor. “It fell out, and I was rushed to CGH (Changi General Hospital), where it was placed back,” she recalled. However, she did not follow up with treatment to ensure the tooth’s long-term health.

Seven years later, in 2022, Miss Chin sought treatment at the National Dental Centre Singapore (NDCS) to address her deteriorating front tooth. She underwent orthodontic treatment to straighten her teeth and scheduled a dental autotransplant to replace the damaged tooth. However, in early 2023, her front tooth became loose and had to be extracted. “I had to live with a missing tooth for two months,” she said, noting that she was teased by friends at school. This experience strengthened her resolve to proceed with the autotransplant.

What Is Dental Autotransplantation?

Dental autotransplantation is a procedure where a healthy tooth, typically a premolar, is moved from one location in the mouth to replace a missing or damaged tooth. Dr. Wu Siwen, head of the endodontics unit at NDCS, explained, “The tooth is carefully positioned in the socket, and then the surrounding tissues are sutured to promote healing and reattachment.” In some cases, the transplanted tooth is stabilized with wires.

This procedure is particularly suitable for young patients whose jaws are still growing. Dr. Wu emphasized that dental implants are not an option for skeletally immature individuals, as they require a fully developed jawbone. “Replacement options like bridges may not be ideal because their jaws are still growing, and the teeth may move,” she added.

The Role of Advanced Technology

Dr. Lim Si Yu, an associate consultant at NDCS, highlighted the importance of 3D imaging in planning the procedure. “We can calculate the length of the root of the premolar that we want to transplant and try to match it as closely to the front tooth as possible,” she said. A 3D-printed replica of the tooth allows dentists to test the fit before extracting the actual tooth, increasing the procedure’s success rate. “That gives us a higher success rate – when we do not have to expose the transplanted tooth out of the mouth for a longer period of time,” Dr. Lim added.

Challenges and Limitations

While dental autotransplantation offers a promising solution, it is not suitable for everyone. Dr. Wu noted that the “perfect candidate” is someone who requires tooth extraction for orthodontic reasons or has a wisdom tooth available for transplantation. “Those two scenarios could be happening in the mouth of the same patient,” she said. Due to these specific requirements, only 12 autotransplants have been performed in Singapore over the past decade.

The success of the procedure also depends on the viability of periodontal cells on the tooth’s root surface. “Any delay would lead to a sub-optimal attachment when the tooth is transmitted to the recipient site,” Dr. Wu explained. Studies suggest that teeth left out of the socket for more than 30 to 60 minutes have reduced chances of successful transplantation.

Miss Chin’s Successful Outcome

Miss Chin’s autotransplant surgery, which took two to three hours, was performed in May 2023. “The dentist told me that they would remove the bad tooth in the front and replace it with one of my own teeth from the lower jaw,” she said. Despite initial apprehensions, she decided to proceed, motivated by the prospect of improved aesthetics and oral health. “Now I feel more confident and less scared (to show all) my teeth,” she shared.

Conclusion

Dental autotransplantation is a specialized procedure that can provide a lifeline for young patients dealing with front tooth loss. As demonstrated by Miss Chin’s case, the combination of advanced technology, skilled dental professionals, and careful patient selection can lead to successful outcomes. For more information, visit the original article on The Straits Times website.