Class II Treatment with Auto Transplantation at the Maxillary Central Site: Case Report

Abstract

Introduction: The loss of a permanent maxillary central incisor in a young patient presents a therapeutic challenge for the dental profession. Objective: To illustrate the treatment of an adolescent patient with skeletal Class II malocclusion, who had a history of trauma in the anterior maxillary region. Case Presentation: A 14-year-old male, apparently healthy, presented for consultation due to dissatisfaction with the different heights of his maxillary central incisors as a consequence of previous trauma and the lack of progress in his ongoing treatment. During the clinical and radiographic examination, a Class II skeletal pattern was determined, along with vertical growth, a retrusive chin, increased inter-labial distance, and bimaxillary protrusion. The right maxillary central incisor showed evidence of a previous inadequate endodontic treatment, in addition to external root resorption and localized periodontal disease, with an unfavorable prognosis for the tooth. The parents were informed about the therapeutic complexity and risks involved in resolving this issue. We proposed to initiate a new orthodontic treatment with fixed appliances, perform four premolar extractions, and extract the right maxillary central incisor. An autotransplant of the left lower first premolar was performed to replace the central incisor due to its poor prognosis. The treatment plan was accepted and executed as planned. The results, in terms of stability, functional permanence, and proper prosthetic characterization as the right maxillary central incisor, along with favorable radiographic control of endodontic treatment and periodontal health over 12 years, demonstrate the success of this case. Conclusions: The transplant favors function, aesthetics, and long-term stability. Monitoring the transplant of developing premolars is essential during follow-up appointments.