Autogenous Tooth Transplantation: Aesthetic Dental Restoration Through the Transplantation of Wisdom Teeth and Ectopic Teeth

The stability and functionality of the human dentition depend on a complex balance. The health of your teeth largely depends on whether they support one another and whether they have opposing teeth in the upper and lower jaws during chewing and biting.

If a gap develops, this has far-reaching consequences for the entire dentition. In dentistry, it is often observed in such cases that the adjacent teeth tilt into the empty space, which compromises the stability of the entire dental arch.

At the same time, the opposing tooth in the opposite jaw tends to grow into the gap (elongation) to restore the missing contact when biting down. Over the long term, the jawbone in the area of the gap recedes due to the lack of stimulating chewing pressure.

To preserve the aesthetics of the dentition and prevent functional disorders of the temporomandibular joint, prompt closure of the gap is essential. 

This can be done as follows:

• With orthodontic gap closure (braces)
• With a prosthetic restoration (bridge or implant)
• With a tooth transplant as an alternative for a purely biological solution

Tooth transplants make it possible to replace missing teeth biologically. @ Alexandre / AdobeStock

A tooth transplant is usually considered when premature tooth loss occurs that would be difficult to treat using conventional methods. 
Other common causes include severe trauma, such as a dental injury during sports, or deep caries or bacterial apical periodontitis, which leads to the destruction of tooth structure.

Oral surgery for tooth transplantation is also indicated in cases of genetically determined agenesis or multiple agenesis of permanent teeth. In these cases, the baby tooth is often retained in the mouth for too long because the permanent teeth are missing.

Another indication is ankylosis, a pathological fusion of the tooth root with the surrounding bone that prevents normal tooth movement. Even when an important canine or molar is displaced within the jaw and cannot be successfully exposed and positioned within the dental arch despite surgical efforts, tooth transplantation offers an excellent solution. Especially during the mixed dentition phase, this procedure allows the dentition to continue developing harmoniously.

In modern dental practices today, autogenous tooth transplantation is performed almost exclusively. This means that the donor tooth and the recipient site belong to the same individual. This autogenous transplantation prevents immunological rejection reactions, as the immune system recognizes the tooth as the body’s own tissue. A special case is autogenous primary tooth transplantation, which can be used for young patients.

Depending on where your dentist removes the tooth and where he transplants it, he distinguishes between the following types of transplantation:

• Autogenous tooth transplantation: In autogenous tooth transplantation, the tooth is transplanted to a different location within the patient’s mouth.
• Isogenic tooth transplantation: The patient receives a tooth from a genetically identical person, e.g., an identical twin.
• Allogeneic tooth transplantation: The patient receives a tooth from a person who is not genetically identical.

Autogenous dental transplantation is now an integral part of dentistry. @ ViDi Studio / AdobeStock

Oral and maxillofacial surgeons today perform exclusively autogenous tooth transplants because they do not expect any immune reactions. The body’s own material is not classified as foreign by the immune system and is therefore not rejected (unlike materials such as metals and alloys). 

The greatest advantage of a transplant over an artificial implant lies in the preservation of the periodontium (the structures that support the tooth). A transplant has a living periodontal ligament with Sharpey’s fibers, which establish a physiologically correct connection to the jawbone. This preserves proprioception (the sense of bite pressure). While an implant is rigidly anchored in the bone, a transplanted tooth can move along with jaw growth in young patients. 

This is particularly crucial in the anterior maxilla to maintain a natural appearance. The surrounding tissue and bone are stimulated by the tooth, which counteracts bone resorption. Experts such as Filippi and Dirk Nolte have demonstrated in numerous studies that, when indicated correctly, the success rates are on par with those of implants, with significantly better biological integration.

For a successful tooth transplant, your oral surgeon will use:

• Wisdom teeth
• Premolars (small molars)
• Milk teeth

Tooth transplants have the best chances of success in children and adolescents, since root development is not yet complete. Because root development is still ongoing, the tooth can be reconnected to the blood and nervous systems after transplantation.

However, your dentist can also perform transplants on fully developed teeth with a good chance of success.

In many cases, the orthodontic transplantation of a wisdom tooth is the first choice.

Teeth 18, 38, and 48 are often used as donor teeth to replace lost molars (large back teeth).

Even a small molar (=premolar) can be used to replace an incisor or a canine, with the crown later being adjusted through aesthetic restoration. 

Prior to surgery, a comprehensive diagnostic evaluation is conducted at the practice clinic. Using modern imaging techniques, the root length and shape of the donor tooth are measured radiologically. In specialized cases, such as at Prof. Dirk Nolte’s MKG-MUC dental clinic, an orthodontist often performs 3D planning to prepare the transplant site with millimeter precision. 

When the tooth transplant is performed, it is usually done under local anesthesia; twilight sedation is also available upon request. The surgeon extracts the donor tooth as gently as possible to avoid damaging the sensitive periodontal ligament. At the same time, the recipient site is prepared with orthodontic precision. If a tooth that cannot be preserved is still present there, it is extracted. The tooth graft is then carefully inserted and secured to the adjacent teeth using a flexible splint. This splint stabilizes the tooth during the initial critical phase of healing. 

Strict compliance on the part of the patient is required postoperatively:

• Do not drink hot beverages
• Do not smoke
• Avoid physical exertion
• Use ice packs or cold compresses to reduce swelling
• Take medications that relieve inflammation and pain
• Keep your mouth very clean and use mouthwashes that kill germs.

In addition, you must not put excessive strain on the transplanted tooth during the healing period. After about 7 to 10 days, your dentist will remove the stitches and the splint. 

Poor oral hygiene and the resulting infections are one of the main reasons for the procedure to fail. In the following months, the orthodontist monitors the process with X-rays. Special attention is paid to preventing resorption (root resorption).

Two months after the transplant, the orthodontist checks the healing progress using a Periotest. After about eight weeks, the pulp of a young tooth has already regenerated, and the tooth has regained its sensitivity. In adults, this takes a little longer.

After transplants of immature teeth, your oral surgeon will also monitor the integration of the transplanted tooth at least once a quarter during the first year following the procedure using X-rays, and every six months in the following year.

Start applying cold compresses immediately after surgery to prevent swelling. @ absolutimages / AdobeStock

Today, tooth transplants represent a good and well-established alternative to dental implants and replace lost or missing teeth in a natural way.

Dentists perform these transplants with great success, especially in young people. Since the jaw is still growing, the transplanted teeth take root well and continue to develop like natural teeth.

What is the difference between a tooth transplant and an implant?

In a transplant, a natural tooth from the patient’s own body—one that has a living periodontal ligament—is transplanted. An implant, on the other hand, is an artificial screw made of titanium or ceramic. A transplant is biologically more advantageous because the tooth can grow along with the jaw, which is particularly important for children and adolescents.

What are the success rates for this procedure?

When performed correctly, the success rates are very high, exceeding 90% when performed by experienced specialists. The chances of success are particularly high for adolescents whose root growth is not yet complete.

Does health insurance cover the costs of a tooth transplant?

For children and adolescents undergoing orthodontic treatment, the costs are often covered by public health insurance, provided that medical necessity is demonstrated. For adults, this is usually a private service; however, it can often be more affordable than a complex implant procedure that includes bone grafting.

How painful is the procedure?

The procedure is performed under local anesthesia and is pain-free during the operation. Postoperative swelling is normal and can be effectively managed with common pain relievers and cold compresses.