Dental Pulp Autotransplantation: A New Modality of Endodontic Regenerative Therapy — Follow-Up of 3 Clinical Cases

By Feitosa V, Mota M, Vieira L, Paula D, Gomes L, Solheiro L, Neto M, Carvalho D, Silvestre F

Date: 06/2023
Journal: JOE

Purpose: describe the clinical procedures (a novel method) for dental pulp autotransplantation and to conduct a clinical follow-up of 3 patients treated with this modality of regenerative endodontic treatment.

Materials and methods: 

  • Inclusion criteria: 18–40 Y/O with no gender predilection, requiring RCT of single rooted PM, with a periodontal pocket depth <3 mm, a 3rd molar prone to extraction without odontosection and without caries.
  • Initial Panoramic RG and CT imaging. All teeth Dx.: pulp necrosis.
  • 3rd molar Ex. Done with minimal injury then stored in sterilized saline solution. 
  • PM: isolated with RD, accessed, patency achieved with K-file size 10 (no bleeding performed),, canals instrumented with rotary files (WaveOne Gold), 
  • Irrigation: 1) triantibiotic solution (ciprofloxacin, minocycline, metronidazole) 2) saline 3)EDTA 17% for 5 min 4) saline. 
  •  3rd molar: cut with diamond saw in low speed hand piece to make a notch in M-D direction, which was pressed to section the tooth into 2 half’s to allow pulp removal with tweezer >> inserted into RC with disinfected GP to avoid tissue damage. 
  • DPC with Biodentine, RMGIC, selective enamel etching, adhesive, composite incrementally. 
  • Medications: 600mg ibuprofen q8 for 3 days. 
  • Follow up: 3-6-9-12 months (Evaluation with  CT, EPT, Pulp vitality testing, Doppler Ultrasound examination)

Results: 

  • At 3 months: no symptoms, no response to EPT ( slight twinges at PA region) 
  • At 6 months: reduction in PA RL in CT imaging, +ve to EPT
  • At 1 year: complete regression in Pt. 1+2, RL almost diminished in Pt. 3. +ve pulp vitality confirmed and revasc. Proved with Doppler imaging. No sings of Endo/Perio. 
  • Adv: lack of transplant rejection, completely mature connective tissue,neural and BV innervation, regeneration would be faster VS using only scaffolds, mesenchymal SC, and GF (all structures are already formed). no laboratory intervention is needed.
  • Triantibiotic solution was used only as irrigant, thereby diminishing the possibility of tooth staining.
  • all 3 patients presented PA RL initially which may possess lower blood circulation and likely bacterial contamination,, successful outcomes were attained
  • Limitation: if 3rd molar is not possible to be Ex. Without sectioning or teeth with abscess. 

Conclusion: 

  • The protocol discussed for pulp autotrasplantation highlighted a a feasible clinical application without the need for further experiments outside the office.