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Dental Autotrasplantation as a treatment alternative. A review of the literature

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EAO-2018

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Abstract

Universidad Internacional de Catalunya (UIC) Objective: The objective of this poster is to provide information and evidence about dental autotrasplantation through an extensive literature review in order to know its indications extensively, to discuss the different surgical or endodontic aspects of the current protocol, as well as to know what is its prognosis at short and long term. Material and methods: To carry out this work, a review of the literature was performed. A research of articles found in the electronic database of Medline PubMed, in the Cochrane Library and in the digital library of the International University of Catalonia (UIC) was carried out. Eight journals: Dental Traumatology, Endodontic topics, Journal of Endodontics (JOE), Japanese Society of Oral Implantology, Swedish Dental Journal, International Journal of Oral Surgery, European Journal of Endodontics, and Journal of Oral Rehabilitation, were also included. This search was carried during the months of July to October 2017 and included publications between the years 1970 and 2017. Subsequently, the following keywords were applied: "review", "dental journals", "written in English and / or Spanish", "human studies" and "academic publications and journals". The keywords are registered and included in the MeSH terms of the NCBI portal. Results: The initial search using the keyword "Tooth Autotransplantation" in the electronic databases available previously mentioned resulted in a total of 390 articles available since 1970. All titles and abstracts were analyzed, discarding those that referred to another type of transplants, seeking agreement and relationship with the research topic. Finally 99 articles were selected. A first evaluation of the articles was carried out to determine their content. After this approach, 36 articles were discarded since they were clinical case reports, another 11 articles were discarded as being systematic reviews of the literature, another 13 articles were discarded because they had another research objective and did not meet the inclusion criteria, 7 articles were discarded because they had an insufficient number of patients in their research and three more articles were discarded because they were in vivo / ex vivo studies. After this exclusion of articles, the 29 remaining articles that met the inclusion criteria for the exhaustive analysis were selected. In the 29 articles included in this review of the literature, 1393 dental transplants of teeth with open apex and 746 of closed apex are reported, of which 1232 and 597 were considered respectively successful in follow-up periods of more than one year. The overall success rate of dental autotransplants with open apex was 88.5% and that of dental transplants with closed apex was 80%, during a follow-up between 1 and 20 years. The percentage of total success of the dental autotrasplants of this review of the literature is 86.1%. Other aspects that were evaluated were the root formation of the autotransplanted teeth, the splinting materials, the endodontic realization and follow-up. 1393 teeth with open apex are reported, in which a higher success rate (88.5%) is registered with respect to teeth with closed apices (80%). Regarding the follow-up period of the autotransplants, the highest success rate was during the period of 10-15 years with (88%) and it is observed that decreases at 15-20 years with (74%). Conclusions: With this review of the literature we can conclude that dental autotransplantation is a predictable technique in the short and long term. Teeth with open apex show a success rate of 90,7%, while closed apex present 80%. We thus defined, through this review, that the autotransplantation of a tooth with open apex presents a better short and long term prognosis than a closed apex, revascularizing and allowing full root development of the donor tooth in its new alveolus. Closed apex autotransplants require further root canal treatment in order to avoid possible pulpal and periodontal complications and such treatment is best performed in the first two weeks post-operative. We discarded the null hypothesis of our work since it claimed the dental autotransplantation did not present a prognosis similar to that of the dental implant as an alternative to the replacement of lost teeth. Future expectations: Dental autotransplantation is a real and predictable alternative to implantology in replacing missing teeth. According to the latest reviews of the literature, dental implants present prevalence of peri-implant problems of between 20 and 50%, being now a real problem for all clinicians. The treatment through dental transplants seems to be a more biological and biocompatible treatment than the dental implant, based on the presence of the periodontal ligament and the healing of the pulp tissue, making it a treatment that may have minor technical and biological complications in the long-term.

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