Autotransplantation of an impacted tooth accompanied with dentigerous cyst has rarely been reported.
The patient was a 17-year-old girl.
Her oral manifestation indicated a loss of the upper right second premolar, and the region had no space for tooth growth.
Findings of panoramic radiograph and CT scan revealed an impacted tooth with a cyst in the right maxillary sinus.
Clinical diagnosis was dentigerous cyst.
Under general anaesthesia, the impacted second premolar and the dentigerous cyst were removed from the right maxillary sinus, and the tooth was autotransplanted to the prepared recipient site where the upper left second premolar had already been lost.
The cystic cavity was filled with green-yellowish pus. It was considered that the infection was caused by apical periodontitis of the right upper first premolar.
Microscopically, the cystic wall revealed edema, marked inflammation and partial lining of the squamous epithelium. The histopathological diagnosis was dentigerous cyst.
On the 3 rd day after transplantation, the transplant was pulpectomied, and on the 8 th day, root canal filling of the transplant was done. On the 39 th day after transplantation, the fixation of the transplant was removed. Six months after transplantation, a metal crown was set to the transplant as a bridge from lateral inciser to the transplant of the left maxilla.
About two years after transplantation, there was no particular change related to the transplant, and the periodontal tissues were fairly good. Three years after transplantation, however, the radiographic examination revealed a slight root resorption of the transplant and pus discharged from the periodontal pocket of the transplant.
It was suggested that the root resorption of the transplant was caused by the long extraalveolar period (90 minutes) and extended inflammation into the periodontium of the transplant.
It was thus considered that the pus-discharge was resulted from local marginal periodontitis.
The autotransplantation in this case was tried under unfavorable condition, but it seemed that the postoperative course was comparatively good.