Reimplant; Complications, Tooth Diseases, Tooth Loss
Conditions
Brief summary
Autogenous tooth transplantation (autotransplantation) represents a biologically valid alternative to implant therapy, particularly in young patients where implant placement is contraindicated due to ongoing skeletal growth. This approach preserves alveolar bone volume, maintains periodontal proprioception, and allows physiological adaptation over time.
Detailed description
One of the main limitations of autotransplantation in teeth with complete root formation is the absence of pulpal revascularization following apical closure, which frequently leads to pulp necrosis and the subsequent need for endodontic treatment. Root canal therapy may compromise the structural integrity of the tooth and negatively affect long-term outcomes. The combined use of simulated apical patency and autologous PRF is expected to enhance pulpal revascularization, reduce the incidence of pulp necrosis, and improve the biological and clinical outcomes of autogenous tooth transplantation in teeth with complete root formation. This protocol aims to expand the indications for autogenous tooth transplantation by introducing a biologically driven approach that combines surgical and regenerative techniques. The use of autologous PRF may represent a valuable adjunct in improving healing and long-term success in challenging clinical scenarios.
Interventions
PROCEDUREAutogenous Tooth Transplantation
After atraumatic extraction of the donor tooth, a simulated apical opening will be created using rotary instruments to induce apical patency and replicate the biological conditions of an open apex, potentially favoring pulpal revascularization.
PROCEDUREAlveolar Prf graft
To enhance clot formation and promote angiogenesis and tissue regeneration, autologous platelet-rich fibrin (PRF) will be used in the recipient site. PRF Collection and Preparation * Prior to surgery, peripheral venous blood will be collected from the patient using sterile tubes without anticoagulants. * The blood samples will be immediately processed using a standardized centrifugation protocol, allowing the separation of a fibrin matrix enriched with platelets and leukocytes. * After centrifugation, the PRF clot will be gently removed and prepared under sterile conditions for clinical use. PRF Placement * The autologous PRF will be placed directly into the recipient alveolus before positioning the donor tooth. * The PRF matrix will act as a biological scaffold, promoting clot stabilization, neovascularization, and early healing of the periodontal and pulpal tissues.
Sponsors
University of Bari Aldo Moro
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
10 Years to 80 Years
Healthy volunteers
Yes
Inclusion criteria
Autotransplantation will be performed in selected cases with favorable biological and functional prognosis, including: * Early loss of permanent teeth due to trauma, extensive caries, or agenesis. * Dental agenesis, particularly involving premolars or incisors, when a suitable donor tooth is available. * Replacement of non-restorable teeth (fractures or destructive caries). * Preservation of alveolar bone in growing patients where implant therapy is contraindicated. * Functional and aesthetic rehabilitation of anterior teeth in pediatric and adolescent patients. * Post-traumatic oral rehabilitation in young patients. * Good general and oral health. * Presence of a vital and intact periodontal ligament on the donor tooth. * Adequate recipient site dimensions and morphology, or surgically adaptable. * Absence of active infection at the recipient site. Donor Tooth Selection Criteria * Tooth extracted for orthodontic purposes. * Impacted or erupting third molars with compatible morphology. * Suitable supernumerary teeth.
Exclusion criteria
* Poor patient compliance. * Active infection at the recipient site. * Smoking of more than 15 cigarettes a day •. Untreated periodontal disease * Pregnancy or breastfeeding at date of inclusion * Acute infections
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Resporption | 1 month, 3 months, 6 months, 1 year, 2 years | Rx to evalue internal or external root resorption. Present or Not. |
| Vitality | 1 month, 3 months, 6 months, 1 year, 2 years | Pulp vitality will be assessed during follow-up using standardized sensibility tests. ( electric test). Vitality : Yes or None |
| Mobility | 1 month, 3 months, 6 months, 1 year, 2 years | Mobility Test. Grade I, Grade II or Grade III |
| Inflammation | 1 month, 3 months, 6 months, 1 year, 2 years | signs of inflammation will be monitored. Blood on Probing: Yes or None |
| periodontal health | 1 month, 3 months, 6 months, 1 year, 2 years | Periodontal Chart (mm). 6 point for each tooth. |
| bone remodeling | 1 month, 1 year, 2 years | Assess periodontal integration and bone remodeling by Rx. Comparing Rx. |
Countries
Italy
Contacts
CONTACTGiuseppe D'Albis, Dr.
CONTACTNicola De Giglio, Dr.
PRINCIPAL_INVESTIGATORGiuseppe D'Albis, Dr.
University of Bari Aldo Moro
PRINCIPAL_INVESTIGATORNicola De Giglio, Dr.
University of Bari Aldo Moro
STUDY_DIRECTORSaverio Capodiferro, Prof. Dr.
University of Bari Aldo Moro
Outcome results
None listed