The esthetic outcome of autotransplanted premolars replacing maxillary incisors

Autotransplantation of developing premolars to replace maxillary incisors has been documented to provide physiologically sound results, but comprehensive studies of the esthetic outcome have not been made previously. In order to assess the applicability of this approach and to identify factors important for planning of treatment, 22 autotransplanted premolars reshaped to incisor morphology were compared to their natural, contralateral maxillary incisors by scoring of features considered important for esthetics (color, soft tissue appearance, tooth morphology, and position). The sum of scores for each feature was used to place the reshaped transplant in one of three categories - Match, Deviate, Mismatch. The 22 patients were asked to fill in a questionnaire which addressed the same features that were examined professionally, and the responses were categorized as either Satisfied, Acceptable, or Dissatisfied. Eleven of the 22 patients had received orthodontic treatment with fixed appliances following the transplantation. Most of the transplanted premolars matched the contralateral incisor, and the majority of patients were satisfied with the appearance of the transplant. Fourteen percentage of the transplants were categorized as Mismatch and 18% of patients reported dissatisfaction. The distribution in categories assessed professionally and by the patients was not significantly different. The color and gingival width of the transplanted tooth were scored as different from the natural incisor in about half of the bilateral comparisons. For those teeth categorized professionally as Mismatch and by patients as Dissatisfied, a potential for esthetic improvement could be identified, as allocation to these categories was primarily due to suboptimal positioning and restorative build-up of the transplant. Inter-disciplinary planning is important for successful esthetic results.