The two-phase transplantation concept for rehabilitation of jaw growth after traumatic tooth loss in childhood and adolescence

Introduction: The clinical management of traumatic tooth loss in infant and adolescent denture poses a particular challenge for the surgical treatment due to the resulting local bone and soft tissue deficit. The "two-phase transplantation concept" (TPTX) has been developed to account for adequate recovery of aesthetics and function by reliably maintaining the growth of the youthful jaw up to early adulthood. Material and Method: In the primary and early mixed dentitions (age 4 to 10) the not yet exfoliated primary canines are used as tooth substitutes for the upper lost permanent incisor (phase I). Exfoliation of the transplanted primary canines occurs either spontaneously or due to the growth of the adjacent erupting teeth. In phase II (> 10 years of age), premolar transplantation can be applied for long-term rehabilitation of the adolescent jaw. Results: Autogenous transplantation (autoTX) of primary canines reliably stimulates the growth of local bone in the anterior upper jaw. Mean 5-year survival rate for primary canines autoTX assessed by Kaplan-Meier estimator was 87% (n=14). The survival rate of premolar autoTX is reported in the literature to be over 90% after 33 years which is supported by our own data (mean 3-year survival rate: 100%, n=24). Patient satisfaction, assessed by a questionnaire, resulted in excellent school grades for both primary canine (1.5) and premolar autotransplantation (1.7), respectively. Conclusion: This biological therapeutic approach to dental trauma is new by basing on the natural exfoliation of the primary tooth transplant in the early phase I and, if necessary, on premolar autotransplantation in the later phase II of therapy, thus allowing the rapid rehabilitation of children and adolescents with avulsed upper central incisors. Keywords: Dental trauma, autogenous tooth transplantation, autogenous primary tooth transplantation, physiological resorption, mixed dentition, soft tissue management