Guided Osteotomy and Guided Autotransplantation for Treatment of Severely Impacted Teeth: A Proof of Concept Report

Abstract Introduction The aim was to present a novel surgical technique using virtually pre-planned 3D printed templates for guided osteotomies . These were to ensure atraumatic uncovering of a severely impacted donor tooth including guided drilling of the recipient alveolus followed by a secure autotransplantation procedure. Methods This report presents an autotransplantation procedure of a 14-year old patient with severely impacted second premolar and extensive contact to roots of adjacent teeth and inferior alveolar nerve. Autotransplantation of the impacted premolar was virtually performed using modified methods from guided implant surgery in order to pre-fabricate 3D printed templates with the aid of a fully digital workflow. Results Satisfactory treatment could be achieved using surgical templates for guided osteotomies of surgical access, guided drilling of recipient site and occlusal reference template ensuring autotransplantation in appropriate 3D location of the graft. An atraumatic approach could be ensured with an extraoral time of 46 seconds by one fitting attempt, no injuries or altered sensation of the inferior alveolar nerve were present. A vital natural tooth could be observed. Conclusions This innovative technique uses for the first time a fully implemented digital work flow for guided osteotomies, guided drilling and guided autotransplantation of a severely impacted tooth. 3D printed templates could ensure a guided atraumatic approach and facilitate highly complex treatments by virtually implementing recommended guidelines in future autotransplantations.