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Replacing Premolars with Wisdom Teeth – Autotransplantation by a GDP! – PDP193

Clinician Development Tool: https://protrusive.co.uk/cdt

Did you know, there’s a cheaper, quicker and more natural treatment option than using Dental Implants, WITHOUT compromising on longevity? Sounds too good to be true right? 

You already know about it. You most likely studied it already at Dental School and just haven’t given it much thought in a clinical scenario.

Meet Dr Lukas Huber who will remind us of the power of Autotransplantation for such cases, which in turn can massively help our patients who have missing or hopeless teeth, all while keeping laboratory costs down and success rates up.

Watch PDP193 on Youtube

Need to Read it? Check out the Full Episode Transcript below!

Highlights of this Episode:
02:10 Clinician Development Tool
03:34 Introduction – Dr Lukas Huber
07:40 Autotransplantation Procedure
12:45 Example Autotransplantation
18:40 Step by Step Autotransplantation
26:35 Placing the Donor Tooth
30:15 Transplant Restorative Augmentation
35:00 Learn more from Lukas

I thought that Dr Lukas is an inspiration to all the general Dentists and am so grateful he is part of our Protrusive Community – thanks for sharing your entire protocol!

Don’t forget to claim CE Credits on Protrusive Guidance by completing the quiz.

Check out Dr Lukas Huber’s Instagram!

If you liked this episode, you will also like Atraumatic Extractions

Click below for full episode transcript:

Jaz's Introduction: You may already be familiar with an auto transplantation. Essentially, it's a scenario whereby, for example, you remove a pre molar from a patient, and on that same patient, you put that pre molar and you re implant that pre molar in to the central incisor socket. So for example, you've got a central incisor of poor prognosis, you remove that, and then you put this recently freshly extracted pre molar in to the central incisor.

Jaz’s Introduction:
And essentially you let nature do its thing, you let it heal. And literally you’ve kind of given this patient the best implant there is. You’ve given them a human tooth, their own human tooth. Another common scenario is replacing a premolar, for example, an upper premolar, with an upper wisdom tooth that’s potentially over rupted or non functional.

That’s another common indication. But all these things, we’ve all seen it in like an orthodontic lecture at dental school. And then it lives somewhere at the very far back of our minds. And it’s not really an option that we discuss with our patients very much. Or when we’re treating planning, we kind of have it in our blind spot.

It’s just not something that we see a lot of, which is why I’m very excited to welcome to you, Dr. Lukas Huber, a general dentist, ladies and gents, who has a few of these procedures up his sleeve and is happy to share the full protocol. Look, some of you will go away today and the stage of your career, where you’re at, you will probably be able to offer this treatment to your patients.

And you’ll actually remember that, ah, yes, this is an option. And if I follow the steps, I can get a good result. In fact, Lukas very kindly shared all the evidence space that he uses in his decision making. So I will put that in the Protrusive Vault on Protrusive Guidance app. Now, for the rest of us mere mortals, who may not feel confident despite the full protocol being shared with you on the podcast today, most of us will be like, you know what?

I’m actually just much more educated about this option now. I know what to say to a patient. I now know which kind of cases would be suitable for an auto transplantation and which ones are not suitable. And so now hopefully this option will not be living in the very back in the corners, deep dark areas of our mind somewhere. It’s come a little bit more to the front of our minds. So we can actually consider this as a realistic and actually damn right cool option.

Dental Pearl
Hello, Protruserati, I’m Jaz Gulati, and welcome back to your favorite dental podcast. Every PDP episode, I give you a Protrusive Dental Pearl. And so today’s pearl I’m sharing with you is a really cool tool that you can use online.

It is amazing for that scenario, for that stage of your career, where you’re just not sure what courses you should do next, or where should you start focusing? What are your weaknesses? Which disciplines or facets of dentistry Should you be focusing more time and energy on? It’s a question I get all the time from the Protruserati, which is why when I discovered the clinician development tool, I was really impressed.

This is really well curated by Ripe Global. And yes, it takes about five minutes, some deep thinking to answer this quiz. But I tell you the information and the detail that you get is the best I’ve seen from an online resource like this. It’s a really clever tool that assesses your confidence in the different disciplines and is very mindful of what your goals are and what stage of career you’re at.

And your current income level and your projected income level. And how much time you spend in the clinic and how much time you would like to spend at the clinic. How much restorative you do and how much complex restorative you want to do. And all these really key factors which makes this tool just the best.

I made a little short link for you so you can check it out. Go to protrusive.co.uk/cdt, that’s clinician development tool. So that’s /cdt, just three letters. I’ll put it on YouTube, the show links and Protrusive Guidance. I’ll put it everywhere. It is well worth doing. Even if you’ve got lots of experience behind you, you’ve got 15, 20 years experience behind you. It’s nice to see what this tool suggests is the next step for you. Hope you found that useful and outro.

Main Episode:
Dr. Lukas Huber, welcome to the Protrusive Dental Podcast. I am in awe of the work you do. And I just, before we hit the record button, I asked you, are you a specialist? Are you a general dentist? And you said general dentist and I celebrated, right? I celebrated so hard, right? So please tell us about yourself. Where do you practice and tell us about your career so far?

[Lukas]
Okay, so my name is Lukas Huber, originally I’m from Upper Austria, like a really, really small village. I think we have more cows than we have people. I then went to Vienna to study dentistry there. And afterwards I worked in a quite big insurance company. I recently thought of it because of you the Protrusive app about like burnout in dentistry. And this was quite a crazy time. I had like 20, 25, 30 patients in six hours, then started to looking for something else, you know?

[Jaz]
So can I just say this? So this was like a public funded system or?

[Lukas]
Yes. Yes. So I had like, most of them were just pain patients. Yes. And I decided to look for something else and then got great job offer here in Konstanz. Never been to Konstanz before. I asked my partner, she said, I know you’re crazy. We love Vienna. Why should we go then? We just tried. We said, okay, we will try it for six months. And if it’s good, it’s good. And it was crazy good.

[Jaz]
My geography is poor. How far is Konstanz from Vienna? Like how far is it?

[Lukas]
It’s like 600 kilometers, so it’s like a five hours car ride, which is quite a lot for an Austrian boy.

[Jaz]
Absolutely. And did you get headhunted, or like, how did you find this position?

[Lukas]
Facebook. It was crazy, yes. Yeah, we took a dog and we’re really happy here. We are like in Southern Germany, like the Southern part. We are near a big lake called the Bodensee. So if any Protruserati is ever here in Konstanz, let me know. I am more than happy to show you around.

[Jaz]
Amazing. And then what have you done in the additional, like a master’s degree? I see your work is like, it’s exceptional. Tell us about what led you there. What are the sort of career development steps that you took?

[Lukas]
So we are a general practice here. We are four dentists and we cover like nearly everything in dentistry. So we do aligners, we do ortho, resto, we do surgery. We don’t do like big stuff of surgery, like, I don’t know, external sinus lift, for example.

But we cover, I would say like 90 percent of dentistry and I really enjoy being there. So we are doing really high quality dentistry. My boss is really like letting me buy everything I want, everything I need. He’s always like, if you are happy, I am. And that’s just really, yeah, like a big chance for me to develop. I took a lot of courses in surgery because I’m really interested in this topic. Yes. And here I am.

[Jaz]
That’s amazing. And I love how you have such a supportive principal who is happy to help you get the toys. It’s not about the toys. I mean, it’s about the toys, but it’s also not about the toys. It’s about the mindset, right? It’s about the mindset, really, that I want to help support my associate, be the best they can be. And that kind of mindset goes a long way. Like, I do hear stories whereby associates buy things and they don’t use them. And that’s why some principals, they worry. But if you find the right person and it looks like you found the right team, but credit to you because a lot of people, if they got an offer that was almost too good to refuse, but it was 600 kilometers away. They would be like, you know what? It’s not for me. I’ll wait for something down the road. So, you took a massive action basically to make the create, to find the environment.

[Lukas]
Yeah. But I’m like exactly this person, and also my partner. So it was really, the deal was, okay, we do this for six months. We sub rented our apartment in Vienna, went here also into a sub rent and we were quite sure to leave again. But it was like fantastic. And here we are.

[Jaz]
And how long has it been now you’re in Konstanz?

[Lukas]
Two years.

[Jaz]
Two years. Okay, good. Well, thanks for telling us a little about yourself and the topic of today is auto transplantation. Now, autotransplantation is something that I got exposed to just from the orthodontic lectures. Like I did a diploma in ortho and at dental school. It was like something that was mentioned, but like you’d never ever, like you could pretty much go your entire career without ever seeing it, touching it, smelling it, like just a buzzword that every three years might just pop up.

Oh, that’s interesting. That’s cool. Right. And that’s it. How well you documented and share on Instagram. That really inspired me. Okay. And to know that you’re a general dentist who did that. I am just so, so happy to just learn from you and share with the Protruserati about how do you even get into this? So tell me, how did you even get into this? How much of the autotransplantation cases have you actually done?

[Lukas]
So it’s quite a rare indication. So you don’t do this on a weekly basis.

[Jaz]
Exactly.

[Lukas]
You have like, you don’t have these many cases where, where you can perform that. I got in touch with it at university. So we had a professor who is doing that, like I think one of the most cases in Austria, but even he is doing that, I don’t know, every one or two months, so it’s not something you do really often, but it is underestimated. I think it is not that widespread as is that, but it is a really good and really like it has a lot of advantages for the patients. So I’m more than happy to spread it around.

[Jaz]
Yeah. And it might be something that perhaps should be an option to consider, but because it’s like such a, the back of your mind somewhere, it doesn’t even come to the surface. And then you miss out some of those cases where actually this might be a good case.

And what you prove is that if you’d like a bit of surgery, then you don’t have to be a specialist to do this kind of work, basically. That’s what you’ve proven that. And so tell us about what is the ideal case for an autotransplantation and just for the students maybe listening just from the beginning, what is an autotransplantation?

[Lukas]
So, autotransplantation basically is when you transplant a tooth into another side of the mouth. Basically, you can transplant every tooth into every side you want, but a lot of that doesn’t make sense. So you have like the main indication and also like the beginner case is when you take the wisdom tooth and transplant it into another side where the tooth is totally destroyed and you cannot rescue that tooth anymore.

For example, the first or second molar if that is totally destroyed or if you have a genesis of the second premolar you can also transplant in there. And that’s the best case scenario because it’s so easy to explain to the patient, you tell the patient you have a tooth here that is totally destroyed, we cannot rescue that anymore, and you have your wisdom tooth that has to be extracted anyway.

I love the idea because it’s patient talk a little bit, a lot of patients tends to simplify dentistry, you’re telling them the tooth is probably like five millimeter beneath the gums and they are saying, Oh, just put a pin into it, do a crown over it. And that’s easy. And that’s like the talk you have, both tooth have to be extracted. We just take this one that’s good and put it there. And then patients love the idea and they are more than happy with it.

[Jaz]
So excuse me for diving into a nuance straight away, but really you just mentioned something interesting that’s piqued my interest. Like you just said a genesis of a second premolar, for example. In my mind, autotransplantation was like you remove the tooth. So now you have the socket and then you are able to put a different tooth, like a wisdom tooth, for example, into that socket. What you’re describing is you pretty much has to do an osteotomy, like for implants, right? And then you put the tooth there. Is that correct?

[Lukas]
Yeah, that’s totally correct. So you have two possibilities. So when there’s a disjoint tooth, as you say, you just have to extract it, but you can also have the possibility that there is no tooth anymore, maybe for a year, maybe five years, or anagenesis. And yes, you pretty much do as an implant surgery, you just do a osteotomy, you create space for the transplant. And that’s also a scenario which works as well as if you extract it out into it. So that’s no problem at all.

[Jaz]
Very fascinating. That’s good. That’s good to consider. And then therefore, what is the most common, like which is the most common donor tooth and which is the most common recipient tooth, if you like, which are the teeth that are more commonly restored by auto transplant and which tooth is sacrificing itself to move into different position.

[Lukas]
So mostly I will consider to take the wisdom tooth and transplant it into I would say mostly the first molar because everybody knows that that’s a really important tooth and you want to replace that one. That’s the most common thing, but what is also commonly done is you take the first pre molar and put it into the central incisor position.

I think that’s also the case what we learn at universities, which is done a lot. You can take like mandibular incisal if you have a lot of crowding, put it into agenesis of lateral incisor at the maxilla. You can do primary canine, put it into central incisor position in a child. So you have a lot of possibilities, but that are the most common indications.

[Jaz]
Okay, well, let’s go to the scenario whereby we’re considering removing an upper wisdom tooth and we want to put it into the upper first molar. So maybe the upper first molar is failing due to, I don’t know, resorption or a crack. And then therefore, because of a crack, we can’t restore this tooth anymore.

So what is the sort of success rate and predictability? Because really if you’re not going to be doing it, we’re either accepting a gap or maybe considering implants, for example. So let’s forget bridges and stuff. So when there is a toss up between implant and a wisdom tooth, what may sway us more towards an implant? What may sway us more towards an auto transplantation?

[Lukas]
That’s a really good question. Because like when you are performing out to transplantation, it has a lot of advantages by an implant. I mean, as you say, that’s like the most reasonable comparison. So that’s the most reasonable comparison. So when you’re doing implants, I think, what many of us don’t consider or don’t have in mind that the implant is like an ankylose tooth. Everybody knows, but our natural teeth passively erupting a whole life. The alveolar process is like growing a whole life and over 50 percent of the implants are in intraposition after some time, even if we are like over 18.

So that’s the most common age where people start to perform implants and the tooth itself, the PDL. It’s like, osteoinductive, that’s what we all want. We want it osteoinductive sources. So that’s the best thing that can happen to us. When we perform auto transplantation, we have proprioception, so the tooth is still maintaining a healthy alveolar process, a healthy alveolar bone.

We have a really good aesthetic outcome, so it has a lot of advantages. It is really cost effective. You can move this tooth orthodontically afterwards. You don’t have any complications with that. So that are the main advantages. But frankly, if I have a patient who is like 40, 50, 60 years, most often we don’t have the chance to extract a third molar because it is already extracted.

And it really makes sense to put an implant because the implant has really high success rates, but so does the autotransplantation. So we have survival rates over 90 percent even after 10 years, we have really long term data. So we know that it works. We know that it works really predictably. So it has a lot of advantages and therefore, yeah, it should be like more in our minds when educating patients. Yes.

[Jaz]
And hopefully after our chat today, people will consider it as another option. Now in that scenario, we are essentially avulsing you’re like kind of doing an avulsion. You’re doing a trauma, a guided trauma to avulse the wisdom tooth, right?

And then you’re moving it over to the first premolar and I’ll get you to talk through it a bit more scientifically. But sometimes when you experienced an avulsion, sometimes you are committed to perhaps doing a root canal, 10 days, two weeks later, basically, I imagine because of how sterile or how quick everything is. And the cells are still alive that perhaps is root canal always there is? Is it part of the protocol?

[Lukas]
That’s a good question. If the apex is still open so if the apex is like more than one millimeter you don’t have to do root canal treatment at all. Over 95 percent of the cases are showing revascularization, so you have a vital tooth there, but if the apex is already closed, if the root formation is completely finished, root canal treatment has to be performed.

The cases where we have revascularization are really seldomly, it’s like, around 10 percent of the cases. So you should not wait, you should perform root canal treatment if the root formation has already finished and if the apex is already closed. Yes.

[Jaz]
Okay. So, and then what about when trauma cases, the most long term complication we warn our patients about when re implanting an evolved tooth is resorption and ankylosis and that kind of stuff. So, how prevalent is that amongst auto transplantation cases?

[Lukas]
That’s a good question, because that’s like, we always learn from the failures of others, but hopefully not of ourselves, but that are the most common complications. So you can have, as you said, it can have root disruption and you can have encloses, you have that in a round 5 percent of the cases so it’s quite comparable to an implant actually. Because when you are looking at the data of peri implantitis, you have like crazy crazy numbers going from I don’t know 10 percent to 100 percent. That are like a crazy variation of numbers depending on the study. But when you are doing autotransplantation these failures are about 5 percent. But if you have root disruption, what you have left is bone.

So perfect situation for a healthy alveolar process later and a good site for an implant. So that’s actually not a big deal. If you have ankylosis, what you have is basically a tooth implant there. I mean, you can perform the coronation if it’s like an aesthetic issue or not an aesthetic issues.

If it’s like a functional issue there, if you need the bone, if it doesn’t grow, you can perform like surgical extrusion or you just let it be and like perform the restorative in a restorative way and just build it up. So that are the two complications you can have. They are quite certain if you are having a good protocol and we will talk about the protocol. Then we are talking about like three to 5%. Okay. So it’s really, it’s like something which is quite handable.

[Jaz]
And exactly what I was gonna ask you next was about the protocol. And I think to make it more specific and make it tangible for everyone, that case I saw of yours recently on Instagram just beautifully executed.

I really enjoyed watching that. And I’ll put the link for everyone to check it out. Just talk about that specific case and then use that case example to describe the whole thing about getting the 3d printed tooth and everything and the sequence and the protocol of it.

[Lukas]
Okay. So the case was like a 20 year old boy or man, and he had like a fracture around 2mm and beneath the gums at the second premolar, and the tooth was completely destroyed. So we couldn’t rescue that tooth anymore. We talked about orthodontic extrusion, but that would also just be a temporary approach. So we have no chance to rescue that tooth. We talked about implants. I have a genesis of my second premolar as well. So, kind of related with the patient.

[Jaz]
You connected with him.

[Lukas]
I told him that. And I said, you’re 20 years old. We can do an implant. Normally, I will never do implants before the age of 25 in the aesthetic zone here, they’re like a real broad smile, so it was the aesthetic zone for him, and I told him I wouldn’t do implant there, I would never do that, so I started 25 in the aesthetic zone where we do implants.

And I said, what we can do is just take your wisdom tooth, which has no sense there anyway, because at the opposite, there was no tooth at all. So he couldn’t chew with that. That tooth made-

[Jaz]
It was a non functional wisdom.

[Lukas]
It was non functional. It was already extruded. So it had no sense that anyway, it was just a shoe trap. And I said, we can just take the tooth and transplant it into that site. So there was this root which we had to extract anyway, there was this wisdom tooth non functioning and patient said, yes, that’s quite, you can understand that. So sure. We talked about alternatives, but that was for him the best treatment option.

And yeah, so we began, it’s always the most important thing when you’re doing any surgeries like planning. You have to get an idea what what to expect. And the best thing you can do, and we also have a lot of studies about that, is to perform CBCT scan and get a three dimensional expression.

You can just send the CBCT data to your technician. If you can do it yourself, please do that. But we couldn’t do that in our office, so I sent it to my technician. He just deleted the rest. Just extracted that tooth virtually. So the wisdom tooth, the donor tooth, and just made an STL file.

And we know that these STL files are really, really good. They don’t have any deviation to the real truth or like minor, which are not affecting our surgery. And he just-

[Jaz]
Just to make this tangible, what we’re aiming for here is, as well as having a look at the anatomy and making sure there’s no red flags to doing this procedure. What we want to do is, we want to 3D print that wisdom tooth.

[Lukas]
Yes. We come onto cut off that tooth.

[Jaz]
Yes. And the technician help you to delete all the bone, delete all the maxilla, delete everything, and just preserve a nice 3D printed tooth. And then now you’re gonna explain some, a lot of people ah, that’s clever and I got it. And some people thinking, hmm, why do you want a 3D printed tooth? So you’re gonna come onto that in a second.

[Lukas]
Yes, for sure. So you just print that as you said, you can also take biocompatible material. You can just disinfect it into alcohol because you need this one later, then just do anesthesia and then in my case, you extract the hopeless tooth. If there is no tooth at all, you can also make an incision. You have to create some space for the transplant. That’s just implant thinking. Okay. So you have to create space, you have to drill, you do that slowly. You do that with water cooling, you’re handling with bones. So just normal procedure. And it is perfect to take the replica and just check, do I have enough space? So that’s like the perfect condition you can have.

[Jaz]
And we’re talking about space not only in the osteotomy, but we’re also talking space like mesial distal.

[Lukas]
Yes.

[Jaz]
So you might have to do some enamel plasty, right? Mesial distal to allow the tooth to actually engage in, right?

[Lukas]
Yes, yes. And always, you shouldn’t expose the dentine, but you can do like 0.5 millimeters mesially distally of the gap. You can do 0.5.

[Jaz]
Is that the most easiest IPR ever?

[Lukas]
Yes. I loved it. And you can also do it on the transplant tooth and then you have two millimeters, for example, which you can use and that, as you said, you have to create some space for the transplant in the bone. You can just check with your replica, you just move it a little bit mesio-distally. You can check, can I move it a little bit? You just move it a little bit buccal lingually, if you cannot move it, okay, buccal lingual, I have two less space. I have to create some space.

[Jaz]
And what are you aiming for? Like, how do you know when to stop? Because you know, how much primary stability can you even get with an auto transplanted tooth, right? I mean, imagine the socket is too big, then it’s like kind of swimming around. So it’s interesting to know how you handle that scenario. But equally, if it’s too tight, like I imagine, obviously, you can’t start shaving the root tip because you’re getting rid of all the PDL, you have to remove the bone, right? But then what do you do in a scenario, basically, is it a no go, is it a abort mission if the extraction site is just way too wide for your donor tooth?

[Lukas]
No, because the PDL cells can differentiate into osteoblasts. So you really have the most osteoinductive force you can have. And that’s what we always aiming for in implantology. So here you have it. So you really have the most osteoinductive force and you get really a lot of bone growth. Okay. So best case scenario would be like 0. 5 millimeters around the tooth. And you need a bit more apically, like two to three millimeters. But if you have more, it is no problem at all. But as you said, if it doesn’t fit in, you have to create more space and it’s like with an implant, in the upper jaw, when the sinus is there, you can do some osteotomy, you can do bone splitting if you like, but in the best case scenario, you don’t have to do that.

So you create the space and you’re checking and checking and checking with replica, like that’s the most crucial part of it. And why the replica? Because otherwise you would have to take the donor tooth and the donor tooth has a really long extra old time and we know that the PDL cells, you’re going to kill them. Okay. So that’s the sound of the replica. That’s why a replica is so advisable and so good.

[Jaz]
Amazing. And so once you have found the right space, then you extract the wisdom tooth, right? And then you move it across. But one thing I’m interested to know is, do you have to then use particulate bone graft to help secure it, give it some stability or not really?

[Lukas]
No. So you shouldn’t do any like xenograft for example, or allograft. You really don’t need that. And we also know that if you do that, the survival rates are like decreases so you don’t have to do that. And if you have to like augment some bone before then the question starts to rise is it really the best case scenario for the patient because then it’s like yeah, then you can also do an implant.

So yes, and you do like normal extraction of the tooth, as you said, and that’s what we’re doing every day. Oh, that’s not a big deal for us. The only difference to a normal extraction is at least I don’t do that at a normal extraction. You just go with a blade into the sulcus. And going once around that you just do cautious and really like you want to handle it with care.

Yes. You want to do it as, as dramatic as possible. And best case scenario again, is like you have a vertical extraction device, but you can also do normal extraction. Just try to don’t touch the root surface. Try to stay in the crown. And that’s the thrilling part of the surgery, you want to get the tooth out in one piece because that’s all it takes. Yeah. So that’s like-

[Jaz]
The precious PDL layer preserved. And then you move it across and because you’ve already rehearsed with your 3d printed tooth, your path of insertion, and that maybe you need to shave it into proximally because you’ve already practiced that as well. And then you’re going to sink it in, but just tell us a bit about that. But is it just a matter of just sinking it in, in a couple of sutures or tell us about this bit.

[Lukas]
Yes. So as you said, you have your replica and you just know you taking the tooth out, everything is in one piece and you’re just putting it in and it just fits because you always checked before. And as you say, then you have to do some sort of fixture and there are two possibilities. So you should not do some rigid fixtures. So it should allow some micro movement. That’s really important for the PDL cells.

[Jaz]
Like a trauma splint, right?

[Lukas]
Yes, that would be the best case scenario, trauma splint, yes. Or like a really thin wire, like 0.3, 0.4 millimeters. So you have to allow some movement. That’s really important. If you have good primary stability, so if you have like mesially and distally good proximal contact, if you have good primary stability, you can just do X suture. Okay. So you’re just fixating it with a suture. It is important that the tooth is in slight intro position. So you should not have any occlusal contact.

You check that with your replica before you put it in slight intraposition. And then you’re just fixating it, as I said, normally with the trauma splint. But if you have really good primary stability and you can really get that. So in the case I had, I’m pretty sure I know that I could have gone without the trauma splint.

I am deciding for the transplant. I always like to be on the safe side, but it would have worked really well with just an X suture over it. If you have like really wide gums and the gum isn’t fitting on the new tooth, then you can just do some adaptation sutures that you have like a good dental alveolar seat to protect this blood clot in the new socket.

[Jaz]
Do you need antibiotics?

[Lukas]
We know that when you do systemic antibiotics that you have better success rates, so yes, I would do that. Just normal amoxicillin after the procedure for five days, that’s completely enough. You have to have good oral hygiene, so, when you are thinking about contraindications, there are no really major contraindications to the procedure. It’s like with every other surgery. So you have to have good old hygiene. You have to have a compliant patient. We are handling with-

[Jaz]
No active perio, smoking, the smoking mechanism. I wonder if smoke, I mean, who knows because the end numbers of smokers, the studies probably have never been done. It will never happen, but yeah, it makes sense. Impaired wound healing.

[Lukas]
It’s wound healing and as I said, it’s wound healing and it defected. And the odds that you lose this graft, it’s probably high, I guess. But otherwise you don’t really have like contraindications. I mean, we are handling with bone, we have to think about bisphosphonates or like real, I don’t know, real heavy and bad diabetes, which isn’t treated.

But otherwise you can really perform that like in every patient who is willing to do that and who has a missing tooth. She doesn’t need any more. So it’s really good procedure and you really like have a lot of advantages for patients.

[Jaz]
And then thereafter, like when do you review them? And then when do you do the root canal?

[Lukas]
So I always like to keep it simple. I always like to keep it cost efficient. So there are some studies that are suggesting that the sooner you do the root canal treatment, the better, so you can do root canal treatment before even transplanting the tooth. I don’t like to do that at wisdom teeth. So I like to keep it simple, just transplant the tooth.

Two weeks later, I remove the stitches or the wire or the trauma splint. And at that time, I’m doing the root canal treatment before. And as I said, if the apex is still open, when the, if the root formation isn’t done, you’re just controlling, doing the fixation away, but you should not perform any root canal treatment because the chances of revascularization are really, really high.

[Jaz]
Brilliant. And then thereafter, when would you look to do some sort of veneer, crown, restorative augmentation? When would that happen?

[Lukas]
If you take the third molar, if you take the wisdom tooth and really place it like, as we said, second premolar, first or second molar, then in most of the cases you don’t have to do like any restorative augmentation at all, because as I said, you’re doing it in slight interposition.

But the tooth is seeking for its opponent and it’s going to extrude anyway. And mostly it’s imperfect occlusion afterwards. Or you just do the minor occlusion adjustments, like you do after aligners to have like perfect occlusion. Yeah, that’s the way to go. So mostly you don’t need any extra treatment, but otherwise you do it.

Around one or two months after the procedure, two months after the procedure, the tooth is like it was there the whole time. So it is like fully healed. You can do nearly everything with this tooth. If you want to remove it atraumatically, you should wait three months or six months even. That it’s really completely healed before you move it. But we know that there are no higher or no significant higher root resorption when you move it. So you can really, it’s like a normal tooth. It’s like it has been there the whole time.

[Jaz]
Brilliant. Are there any papers you mind Lukas sending over so we can share with the Protruserati, just because you sparked their interest. They’re very geeky. That’d be great to read if you have any.

[Lukas]
I love that. I’m always trying that everything I say is like evidence based because I love not just sharing my opinion, but really like really papers and we have so much evidence out there. We have like a case reports. We have randomized controlled trials, split moth designs, even meta analysis over 30, 40 years. So we also have the long term data.

[Jaz]
I’ve just never looked for the literature because it’s something that you come across and then you never realize because yeah, it’s just something that the back of our minds. But you’ve done a great job in bringing it to the forefront of our mind and really reminding us that this is a really cool option. Yes, it has to be the perfect storm. perfect conditions, but you can really do something a little bit spicier and something that’s probably in the best interest of that patient at that time for their cycle of care. So very, very happy with that. Lukas, anything else you want to mention before I ask about how we can follow you and learn more?

[Lukas]
Not really. I mean, after you’ve performed the procedure, you should check the tooth in a closer interval. So you should check it like one month after it, three months after it, half a year in a year, like with any other trauma case, if you having a hard time extracting the tooth and you imagine that more of the PDL is damaged, then you should just do some kind of healing booster, everyone has a different concept, like hyaluronic acid, you can do Aminogen, you can do platelet rich plasma, you can do doxycycline to prevent root resorption, but you should just boost a little bit that healing, just some failure knowledge to prevent that.

[Jaz]
What’s your poison of choice in that scenario?

[Lukas]
I do doxycycline if I have root resorption. I tended to do Aminogen because I think it’s best for the patient. But nowadays I do more Hyaluronic Acid because it’s just not that expensive.

[Jaz]
It’s the honest answer. And I love it.

[Lukas]
Yes.

[Jaz]
No, excellent. I’m so, so happy we covered this. It really helped to remind me about making this an option. I’m sure everyone’s feeling like, Oh yeah, that’s perfect. Not only is that just cool, but you know what, there might be a time, I think all of us listening and watching right now, there will come a time in our career where we can actually implement this or even suggest this as an option and consider it.

So thanks so much for reminding us about how cool of an option it is and inspiring us as a GDP to consider this. I’m not saying guys go out there based on this podcast and start doing all the autotransplantations, but it’s something to inspire you to want to learn more. And I would definitely check out Lukas’s Instagram, Lukas, tell us more about how you can reach out to you and learn more from you, my friend.

[Lukas]
Just one more thing, because it’s so interesting what you mentioned, because I think that as a GDP, when we’re doing implants, you can really perform this procedure. It’s not that complicated. You’re just dealing with bone. You’re modulating bone. I wouldn’t go out and transplant the first premolar into the central incisal position.

You have to have a multidisciplinary approach there. You have to have a good orthodontist. But the scenario we made today and the scenario also from Instagram where you just transplant a third molar into the another molar position is like perfect scenario case to begin with and to start with.

[Jaz]
Not that I do implants, but I always hear that make your first implant on someone with a low smile line, a second premolar or a molar. It’s the same, similar principle, right? You want to start with the easier cases.

[Lukas]
With the simple cases, sure. Every one of us wants to do that. So how can you follow me? I’m on Instagram. I don’t have a private Instagram account because I was always like, no, I don’t need that. But I’m really happy that I started my professional Instagram account.

It’s just such a big chance to get connected. I mean, I’m sitting here talking to you. That’s like crazy and I’m really happy that I have this account. It’s like Dr. Lukas, or drlukashuber, and yeah, I’m sharing my cases. I’m more than happy to get connected. I love to get feedback on my cases. It’s crazy when you post the picture, you zoom like 20 times in and you see every mistake you’ve made like six months ago.

[Jaz]
I appreciate you, you sharing and also flying the flag for GDPs. And I think it’d be great to a great person to connect to and just get inspiration from and like minded, nice and geeky Protruserati as we like it. So, Lukas. Thanks for giving up some time tonight to talk about this very geeky topic, but I don’t know if anyone else had fun, but I enjoy this chat very much. So thank you so much.

[Lukas]
Thank you so much for having me and love to get connected.

Jaz’s Outro:
Well there we have it guys, Dr. Lukas Huber from Konstanz. Thanks so much for staying and listening all the way to the end. I just love interviewing fellow Protruserati so it was great to see his work on social media which prompted me to message him and say you know what can you share this with our Protruserati colleagues and didn’t he just do a brilliant job.

Look this episode is eligible for CPD so if you are a regular listener please consider joining Protrusive Guidance. We have two plans available on Protrusive Guidance and with both those plans you can collect CPD for every PDP episode even retrospectively as well. So if you’re already doing the hard work of listening then just answer a few questions and get your CPD. Mari, our CPD queen, will send you the certificate.

And she’ll send it again to you in three months, and every quarter, in an annual summary, your little special folder on Google Drive that we make for you, which has got all your certificates. So check out protrusive.App if you’re not already on there, or just download the iOS Android app.

I want to thank my team. We’ve got Mari on the CPD side of things. We’ve got our clinicians, Krissel and Nav. We have our editing team of Erika and Gian. Without my awesome team, none of the podcast would ever be possible. And lastly, thank you, The Protruserati, for clicking on such a niche topic. Like you decided to join us today on a topic of auto transplantation.

That means you are geeky and I love you. So if you satisfy the criteria of being nice and geeky, I would love to see you in our little community on Protrusive Guidance. Thanks so much. I’ll catch you same time, same place next week. Bye for now.

Hosted by
Jaz Gulati

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