Complex Impaction Case With Autotransplantation & Orthodontic Rehabilitation - Full Analysis

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Severity: 
Moderate

 FULL ANALYSIS & DIAGNOSIS

 Impacted Wisdom Teeth (18, 28, 38, 48)

All four third molars show full impaction.

  • 18 (upper left) – Vertically impacted, pushing against tooth 17.

  • 28 (upper left) – Fully impacted; removal recommended.

  • 38 (lower left) – Horizontally impacted, pushing forward into 37.

  • 48 (lower right) – Also horizontally impacted.

Risks if not removed:

  • Pericoronitis, cyst formation, root resorption of adjacent teeth, bone defects.

 Tooth 47 – Impacted Premolar/Molar

Tooth 47 is impacted and not in its proper occlusal position.

  • It’s tilted and trapped under the distal root of 46.

  • Requires surgical exposure + reposition (transalveolar transplantation).

 Tooth 16 – Large Restoration With Poor Prognosis

The large filling compromises tooth strength:

  • Possible fracture risk

  • Possible future infection

  • Poor long-term stability

Decision: Extract 16 and replace it using transplanted tooth 18 — a rare but effective alternative when executed by a skilled oral surgeon.

 TREATMENT PLAN (as provided by dentist)

✔ Extract the following teeth:

  • 16 (due to poor prognosis)

  • 28, 38, 48 (due to impaction risk & orthodontic necessity)

✔ Transalveolar Transplantation

  1. Tooth 18 → Position of tooth 16

    • 18 is a better candidate to replace the non-viable 16.

  2. Tooth 47 → Moved to its natural location

    • Prevents crowding

    • Allows proper orthodontic alignment

Autotransplantation success rate is 80–92% if proper technique + healing is followed.

 HEALING TIME FRAME

 First 14 Days (Critical Stage)

  • Primary soft tissue healing

  • Stabilization of the transplanted tooth

  • Avoid chewing on the area

  • Risk during this period:

    • Infection

    • Mobility of transplanted tooth

    • Graft failure if trauma occurs

 1–3 Months

  • Early periodontal ligament reattachment

  • Bone formation around transplanted tooth

  • Light occlusion allowed

 6–9 Months

  • Radiographic confirmation of full stabilization

  • Orthodontic treatment begins (as your dentist planned: ~9 months)

 1–2 Years

  • Full bone maturation

  • Final orthodontic correction

 What Problems Can “Scale Up” if Not Managed Properly

If the 14-day critical period is disturbed:

  • Root resorption of transplanted tooth

  • Ankylosis (tooth becomes fused to bone)

  • Pulp necrosis

  • Graft failure

  • Infection leading to extraction

  • Delayed orthodontic movement

Proper follow-ups are essential.

 COMMENTS / PROFESSIONAL NOTES

  • This is a high-complexity case, but well-planned.

  • Decision to use autotransplantation preserves natural tooth structure vs. implants.

  • Orthodontics will correct alignment once healing is stable.

  • Good prognosis if patient strictly follows post-op care.

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