Metal tooth-like surgical templates for tooth autotransplantation in adolescents Malka Ashkenazi 1 , Liran Levin 2,3,4 1 Pediatric Dentistry, Private Practice, Petach- Tikva, Israel; 2 Faculty of Medicine, Technion IIT, Israel; 3 Department of Periodontology, Rambam Health Care Campus, Haifa, Israel; 4 Harvard School of Dental Medicine, Boston, MA, USA Key words: trauma; tooth loss; ankylosis; dental trauma; replantation Correspondence to: Malka Ashkenazi, 7A Haim Gilad St. Petach-Tikva 49377, Israel Tel.: +972 544326075 Fax: +972 3 9326075 e-mail: Malka.ashkenazi@gmail.com Accepted 25 May, 2013 Abstract – Objectives: The aim of this study was to suggest a way to fabri- cate surgical templates to assist the surgeon in preparing the recipient socket when performing premolar autotransplantation. Methods: Premo- lars used previously for extractions of periodontal ligament (PDL) fibro- blasts were used in this study as archetype of models for tooth transplantation. Eighty-four mandibular and maxillary first and second extracted premolars were reviewed. All teeth were extracted for orthodon- tic reasons. From these teeth, eight teeth were selected to serve as arche- type of models in which all the other teeth were at equal size or smaller in maximum 2 mm in M-D or B-L dimension. These teeth were sent to dental technician to perform identical archetype stainless steel templates. During autotransplantation immediately following donor tooth extraction, the appropriate template is chosen out of the toothlike stainless steel surgical templates and the donor tooth is then immediately replaced in its socket. This enables the surgeon to prepare the recipient site without manipulating the donor tooth and thus preventing damage to the PDL cells of the donor tooth. Only after the recipient site had been prepared to the appropriate size and shape according to the template, the donor tooth is removed from its socket, immediately placed at the recipient site and splinted as recom- mended. Conclusions: The advantage of the presented metal tooth-like surgical templates described in this study is that a set of stents has been produced by replicating different common shape adolescent premolars that reflect the biological variation in size and shape of these teeth. Tooth autotransplantation is the surgical transposition of a donor tooth from one site to another recipient site within the same individual. During autotransplanta- tion, a donor tooth is transplanted into either an extraction site or a surgically prepared artificial socket at the recipient site (1). Autotransplantation is a well- recognized technique for restoration of missing anterior teeth resulted from developmental disturbances or from traumatic injuries (2, 3). Recent reports have shown high success rates for this procedure over time (4–6). One of the most prevalent and important applications of this technique is to transplant premolar tooth to the maxillary anterior region to replace an incisor after loss due to trauma (7, 8). There are several proposed surgical techniques for autotransplantation, all based on a-traumatic handling of the donor tooth. Immediately after extraction, the extracted root should be evaluated for its size and shape and preserved in appropriate storage medium or preferably in its original socket. The recipient site is then prepared to appropriate dimensions to accommo- date the donor tooth in the best possible position, with- out applying pressure on the periodontal ligament of the donor tooth. The donor tooth is then tested in the recipient socket with light pressure to examine whether the socket was prepared to an appropriate size (9–11). The use of a surgical template instead of the transplanted tooth itself, during the preparation of the socket, might minimize the unnecessary additional peri- odontal ligament (PDL) trauma caused by the adjust- ment of the donor tooth in the artificial recipient socket (9). Day et al. have proposed and produced rounded surgical templates, which resemble the different sizes of premolar transplant roots (9). They suggested that fabri- cation of these surgical stents will improve the surgeon’s skill and minimize the trauma to the PDL of the donor tooth and reduce the extra-alveolar time of transplanted tooth, thus increasing the success rate of the transplanta- tion. Clokie et al. reported the use of an acrylic replica of the donor tooth, and its dimension was determined according to presurgery radiograph (12). Others sug- gested the use of computed tomography (CT) for indi- vidual tooth template preparation (13, 14), although this method required additional radiation as well as high cost for the patient. The aim of this study is to describe and suggest a simple and cost-effective method of fabricating metal tooth-like surgical templates for tooth autotransplanta- tion in adolescents. Metal tooth-like surgical templates fabrication Premolar teeth used in previous studies for extraction of PDL fibroblasts were stored at À16°C and used as © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd 1 Dental Traumatology 2013; doi: 10.1111/edt.12053