Immediate Autotransplantation of Mature Third Molars to Bilateral Mandibular First Molars With Large Periapical Lesions: A Case Report

Previously reported protocols suggested that the transplantation of teeth should be delayed if the recipient site presents large periapical lesions. The presented case is a pioneering attempt to conduct mature third molar transplantation immediately after the extraction of mandibular first molars accompanied by large periradicular lesions with the guidance of computer-designed 3D-printed replicas and with the utilization of concentrated growth factor (CGF) so as to avoid the use of synthetic bone substitutes and secondary surgical procedures. A 24-year-old female patient in generally good health was presented with pain and swelling of bilateral mandibular first molars accompanied by a sinus tract. Cone-beam computed tomography (CBCT) revealed 16 * 10 mm and 13 * 7 mm low density, respectively, in the periapical area of #46 and #36. After confirmation of the feasibility of transplanting the mandibular third molars to the first molars with the evaluation by CBCT, patient's consent was obtained. Based on patient's CBCT, individual 3D-printed replicas of the mandibular third molars were fabricated and CGF was collected by centrifugation. Autogenous tooth transplantation (ATT) was performed immediately after the removal of the first molars and curettage of periapical lesions. The periapical bone defect was filled with CGF membranes. After the surgery, healing conditions were monitored. At 18-month follow-up, both transplanted teeth presented with stable healing without any clinical complications. Radiographically, periapical new bone healing at both recipient sites was observed. This case indicates that immediate transplantation of mature teeth to recipient sites with large periapical lesions can be a viable treatment option and can lead to optimistic results.