Teeth can be transplanted, but the successful modern clinical procedure involves a specific method. The viable technique used today is called autogenous tooth transplantation, or autotransplantation. This procedure moves a tooth from one site in a patient’s mouth to a different site within the same mouth to replace a missing or unsalvageable tooth.
Autogenous Tooth Transplantation: Defining the Viable Option
Autogenous tooth transplantation involves surgically moving a tooth from its original position to another location in the same individual’s jaw. This method is successful because the relocated tooth is biologically compatible, bypassing the immune rejection issues associated with transplants between different people.
The ideal candidates are typically younger patients, often adolescents, whose jawbones are still developing. Their superior healing capacity and the specific developmental stage of their teeth contribute to the procedure’s success. Autotransplantation is indicated for replacing teeth lost to trauma, decay, or when teeth are congenitally missing.
Donor teeth are generally those that are supernumerary or scheduled for extraction for orthodontic reasons. Common donor teeth include impacted third molars (wisdom teeth) or premolars removed to create space in the dental arch. A suitable donor tooth must be healthy and have a root development stage that allows for optimal healing.
The Critical Surgical Steps and Healing Process
The success of a tooth transplant relies on a precise surgical technique that prioritizes the health of the periodontal ligament (PDL). The PDL is a delicate connective tissue surrounding the tooth root, and its cells are responsible for reattachment and healing. The donor tooth must be extracted with minimal trauma to preserve these PDL cells, which form the biological interface between the tooth and the bone.
After extraction, the surgeon prepares the recipient site to precisely match the donor root’s size and shape. Advanced tools, such as 3D-printed surgical guides, ensure the new socket is perfectly contoured. The extraoral time—the period the tooth spends outside the mouth—must be kept to a minimum, ideally under 15 to 20 minutes, to maintain PDL cell viability.
The tooth is immediately placed into the prepared socket and stabilized using a flexible splint for about one to two weeks. The healing process varies significantly depending on the maturity of the transplanted tooth’s root.
Immature Roots
Teeth with incomplete root formation and an open apex have the potential for pulp revascularization. This allows new blood and nerve supplies to grow back into the tooth’s pulp chamber.
Mature Roots
For mature teeth with a closed root apex, revascularization is highly unlikely because the opening is too narrow. These teeth require root canal treatment to remove the non-vital pulp tissue and prevent internal root resorption and failure. This endodontic procedure is performed within two to three weeks following transplantation to preserve the long-term health of the tooth.
Comparing Tooth Transplantation to Traditional Implants
Autogenous tooth transplantation offers distinct biological advantages over the traditional dental implant. The primary difference is the presence of the periodontal ligament (PDL), which survives with a successful transplant but is absent with an implant. The PDL allows the transplanted tooth to maintain sensory function, including the natural ability to feel biting pressure (proprioception).
Implants are titanium screws that fuse directly with the jawbone (osseointegration) and lack this natural sensory feedback. Furthermore, the transplanted tooth stimulates the surrounding bone, helping preserve bone volume and allowing the tooth to adapt to future jaw growth, which benefits young patients. Implants do not adapt to growth and can lead to infraocclusion in a growing jaw.
Implants offer greater predictability and broader applicability, as they do not require a suitable donor tooth. Autotransplantation success rates fall in the 80% to 95% range, while dental implants boast survival rates of 90% to 98% over a ten-year period. Transplantation is often a more cost-effective option, and if the transplant fails, the recipient site remains in excellent condition for subsequent implant placement.