Alveolar Bone Formation via Subperiosteal Storage of an Endodontically Treated Incisor for Periodontal Ligament Preservation Before Autotransplantation: A Case Report.

Abstract

Background: When patients accidentally lose or miss one or more teeth due to agenesis, the dentoalveolar complex is either destroyed or not formed. Replacing these teeth typically presents significant challenges This case report offers proof of principle that the periodontal ligament (PDL) of an endodontically treated tooth can form new alveolar bone in a previously non-existent location, offering a potential breakthrough in treating such cases.

Case description: A 15-year-old healthy Caucasian male presented for orthodontic treatment with lower right lateral incisor and canine transposition. To enable optimal canine positioning, extraction of the incisor was required. A decision was made to temporarily store the endodontically treated incisor in a subperiosteal pocket to preserve the viability of the PDL while the orthodontic repositioning of the canine was completed. The incisor was thoroughly debrided, extracted, and placed in a subperiosteal pocket created via a small incision and tunnel preparation in the buccal corridor. After 14 months, retrieval of the incisor revealed the formation of a nearly complete alveolus housing the incisor. The incisor was immediately transplanted into its final position. Favorable healing allowed functional loading with orthodontic extrusive force 3 weeks post-transplantation. Follow-up assessments were conducted at 3, 6, and 12 months, with annual evaluations extending up to 5 years.

Practical implications: The regenerative potential of PDL to reconstruct the dentoalveolar complex, including alveolar bone, provides an optimal pathway for tooth replacement. This approach, employed within an interdisciplinary treatment framework, broadens the range of techniques available to dental specialists for managing complex clinical cases involving substantial alveolar bone loss.