Dr. Marco Bitto
Dr. Marco Bitto is an Oral Surgeon and Implantologist with a strong focus on digital dentistry, computer-guided surgery, and prosthetically driven implantology. He graduated in Dentistry and Dental Prosthetics from the University of Messina (Italy) in 2017 and completed his Specialty Diploma in Oral Surgery in 2024.
His clinical practice integrates advanced digital workflows, virtual surgical planning, CAD design, and fabrication of CAD/CAM surgical devices. He routinely combines applying digitally assisted protocols for implant placement, regenerative procedures, and oral surgery.
Dr. Bitto is the author and co-author of scientific publications focused on 3D-printed surgical templates, AI-supported surgical planning, digitally designed decompression devices for odontogenic cysts, and innovative workflows in oral surgery.
introduction
introduction
Tooth autotransplantation is the surgical repositioning of a tooth from one site to another within the same individual. When properly indicated, it represents a biological and conservative alternative to prosthetic replacement or implant therapy, particularly in growing patients where the other therapies may be contraindicated due to ongoing skeletal growth. However, tooth autotransplantation is highly sensitive to case selection and surgical technique. The presence of a healthy periodontal ligament, atraumatic extraction technique, short extraoral time, and a properly prepared recipient site are critical determinants of the outcome. The integration of digital technology has deeply changed the autotransplantation procedure. Cone beam computed tomography (CBCT), intraoral scanning, virtual planning, and the possibility of 3D-printing a replica of the donor element enable the clinician to previsualize anatomical relationships in three dimensions, plan the surgical procedure, and optimize recipient site preparation before the extraction of the autotransplant tooth. This approach minimizes surgical trauma while maximizing predictability.
The following case report presents the interdisciplinary treatment of a 14-year-old patient with bilateral impacted maxillary canines using a digital-assisted autotransplantation procedure.
clinical case
clinical case
A 14-year-old male patient was referred to our clinic (Policlinico “G. Martino” of Messina) for an evaluation of the delayed eruption of both maxillary permanent canines. The patient was in good general health and reported no relevant medical history. Clinically, deciduous canines were still present in the arch, and permanent canines were not palpable. The initial radiographic analysis with panoramic imaging revealed bilateral impaction of the maxillary canines (Fig. 1). The orthodontic group at our clinic assessed the position and eruption potential using radiographic parameters, including angular measurements and sector classification.
Both canines were positioned unfavorably. CBCT provided a more detailed three-dimensional understanding of the situation. The impacted canines were positioned horizontally and rotated 180° around their long axes, in close proximity to adjacent roots, without significant resorption (Fig. 2). After interdisciplinary discussion between orthodontic and surgical teams, autotransplantation was selected as the most biologically advantageous treatment option. The therapeutic plan comprised preliminary orthodontic preparation, digital planning of the tooth transplantation, the surgical procedure, and follow-up.
Orthodontic treatment began with rapid maxillary expansion to improve the arch’s transverse dimension, followed by the extraction of deciduous canines to create and condition the recipient site. DICOM data from CBCT were imported into open-source software to segment the impacted tooth and generate a replica (Fig. 3).
After healing of the fresh socket, a digital impression was taken with an intraoral scanner. DICOM data from CBCT were merged with STL files from intraoral scanning in software for guided surgery planification. The tooth replica was virtually placed as a wax-up element in the optimal position in the dental arch. This strategy facilitated a precise preoperative evaluation of the bone volume occupied by the transplanted tooth. Furthermore, it enabled the accurate planning of the osteotomy phase using implant burs. Based on this virtual simulation, a surgical guide was created to guide the osteotomy and ensure the donor tooth’s correct 3D positioning in the predefined recipient site. Both the surgical guide and the donor tooth replica were subsequently produced using 3D printing technology.
The surgical steps were performed in two consecutive operative sessions.
After local anesthesia, a full-thickness mucoperiosteal flap was raised. Access to the donor tooth was gained using a combination of piezoelectric and rotary instruments to gain a controlled and minimally traumatic osteotomy. The donor tooth was carefully mobilized but not immediately removed, thus maintaining the neurovascular bundle for as long as possible during the preparation of the recipient site.
The recipient site was then prepared following the digitally planned dimensions (Fig. 4).
“This case illustrates how autotransplantation can be a conservative, biological solution for impacted maxillary canines in adolescent patients.”
After verifying the accuracy of the recipient site preparation using the tooth replica, the impacted donor tooth was completely extracted. The tooth was immediately transferred to the prepared recipient site and positioned according to the planned 3D alignment.
Stabilization was achieved using an orthodontic wire and composite resin during the first postoperative week (Fig. 5).
conclusion
conclusion
This case illustrates how autotransplantation can be a conservative, biological solution for impacted maxillary canines in adolescent patients. When performed under appropriate indications and with careful execution, this approach allows alveolar bone preservation, the maintenance of proprioceptive function, and harmonious integration within the developing dentition.
The incorporation of digital planning significantly enhances surgical control. The combined use of 3D visualization and virtual simulation reduces uncertainty, facilitates recipient site preparation, and helps minimize extra-oral time, which is one of the most critical variables influencing periodontal ligament survival. Rather than replacing surgical skill, the digital workflow acts as a supportive tool that increases precision and predictability. In young patients, where long‑term biological considerations are paramount, digital-assisted autotransplantation should be considered a valuable option within the therapeutic armamentarium.
NOTES
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