Interdisciplinary orthodontic treatment with digitally-guided autotransplantation in a patient with a missing permanent maxillary left lateral incisor and a supernumerary mandibular incisor

This case report describes the interdisciplinary orthodontic treatment of a patient with a congenitally missing and a supernumerary tooth. A 15-year-old boy presented with a retrognathic convex profile, generalized maxillary and mandibular dental spacing, deep overbite, peg-shaped maxillary right permanent lateral incisor, missing permanent maxillary left lateral incisor, and a supernumerary mandibular incisor. The permanent maxillary left canine had ectopically erupted in the missing lateral incisor position, and the primary maxillary left canine was retained. Fixed orthodontic treatment with miniscrew implant-facilitated anchorage and extraction of the primary maxillary left canine was performed to bodily distalize the maxillary left permanent canine into Class I position while creating space for restoration of the missing permanent maxillary left lateral incisor. Cone-beam computed tomography was used for digitally-planned autotransplantation of the mandibular supernumerary incisor to the space of the congenitally missing lateral incisor. Root canal treatment of the donor tooth was performed the week before the extraction because of the complete root development of the tooth. A 3-dimensional printed surgical guide and tooth replica were used for socket preparation in the edentulous space. After 6 weeks of semirigid fixation of the transplanted tooth, a composite build-up of the peg-shaped and transplanted tooth was performed, and orthodontic treatment resumed to close residual spaces and detail the occlusion. Acceptable occlusion and facial esthetics were achieved with no adverse outcomes up to 1 year and 9 months after autotransplantation.