Autotransplantation for the management of traumatic loss of a maxillary incisor in a growing pediatric patient

Abstract

This study presents the clinical management of a traumatic loss of a maxillary central incisor in a growing pediatric patient treated with autotransplantation. Dental trauma in children often involves maxillary incisors and poses significant challenges in rehabilitation due to ongoing craniofacial growth, which contraindicates implant therapy and fixed prosthetic solutions. Autotransplantation represents a valid alternative, allowing alveolar growth and orthodontic movement to be preserved. A 13-year-old male patient presented with a compromised maxillary left central incisor (2.1) following previous trauma and unsuccessful endodontic treatment. Clinical and radiographic examinations, including CBCT, revealed a vertical root fracture and extensive periapical lesion involving both 2.1 and 2.2, leading to a hopeless prognosis for 2.1. Treatment options considered included prosthetic replacement, orthodontic mesialization, and autotransplantation. Fixed provisional prostheses for further implant therapy were excluded because they would have interfered with maxillary growth; orthodontic mesialization was considered complex functionally and aesthetically. Therefore, autotransplantation was selected as the most favorable option. Following orthodontic pre-treatment of six weeks to mobilize and stimulate the donor tooth (2.5), surgical explantation of 2.1 was performed, and the recipient socket was prepared. Tooth 2.5, explanted atraumatically, was transplanted into the 2.1 site and stabilized passively with orthodontic splinting. Postoperative care included antibiotics, analgesics, and chlorhexidine rinses. Clinical follow-ups at 10 days and 4 weeks showed healthy periodontal tissues, and composite resin was used to reshape the transplanted premolar esthetically. Orthodontic treatment resumed after 8 weeks, and CBCT at 12 months confirmed complete healing without root resorption or periapical pathology. The contralateral premolar (1.5) was later extracted as part of the orthodontic plan, and a definitive composite restoration was performed at the end. Five-year follow-up demonstrated successful periodontal and pulp healing, with the transplanted tooth integrated functionally and esthetically, responding positively to thermal testing. This case supports autotransplantation as a reliable treatment option for pediatric patients. It should be considered the first-line approach when managing loss or compromise of permanent teeth in growing individuals.