성공적인 자가치아이식을 위한 이식 전후 교정적 접근

Comprehensive Orthodontic Management for Successful Tooth Autotransplantation

Autotransplantation is an effective treatment option for replacing missing teeth in adolescents, particularly when dental implants are contraindicated due to ongoing skeletal growth. Orthodontic planning, both before and after transplantation can significantly enhances surgical precision, healing, and long-term outcomes. A 14-year-old female presented with congenital absence of the mandibular left second premolar (#35). Given her age, autotransplantation was selected as the optimal treatment. The maxillary left first premolar (#24) was chosen as the donor tooth due to its favorable root morphology, allowing for minimally traumatic extraction. Pre-transplant orthodontic preparation included bracketing the donor tooth to assist in controlled mobilization and placing a separating ring to ease atraumatic removal. A CBCT-guided approach was used to fabricate a 3D replica of the donor tooth, enabling accurate recipient site preparation and reducing extraoral time. On the day of surgery, tooth #24 was transplanted into the #35 site and stabilized using orthodontic brackets and a passively bent 0.019 × 0.025-inch stainless steel wire. Infraocclusion was maintained to prevent occlusal interference. Two weeks postoperatively, stable healing was observed with no inflammation or mobility, allowing for the initiation of light orthodontic alignment. During the nine-month follow-up, radiographs confirmed progressive bone healing, periodontal ligament regeneration, and lamina dura formation. Functionally, the transplanted tooth showed physiological mobility and maintained periodontal health. Esthetically, the anterior overjet improved from 6 mm to 3 mm, and upper incisor display was reduced. This case demonstrates the importance of interdisciplinary planning in achieving successful autotransplantation outcomes in young patients.