Allo‐ and autotransplantation of mature teeth in monkeys: a sequential time‐related histoquantitative study of periodontal and pulpal healing

Abstract – Root resorption is known to be the most relevant complication determining the long‐term prognosis of allotransplanted teeth, and it is initiated during the first few postoperative months. The aim of the present study was to quantitatively assess the dynamics of the periodontal ligament (PDL) and pulpal healing reactions during the first 8 weeks after allotransplantation of mature teeth. The material comprised 112 maxillary central and mandibular lateral incisors of 28 mature green Vervet monkeys, immunogenetically untested, and only matched according to the size of the grafts. Donors and recipients exchanged simultaneously both maxillary incisors and one mandibular incisor, whereas the contralateral mandibular incisors were autotransplanted as controls. At random, every second maxillary allograft was endodontically treated preoperatively. Histoquantitative analysis of the PDL and pulpal healing reactions was carried out after 1, 2, 4 and 8 weeks on serial cross‐sections of the grafts in 6, 6, 6 and 8 monkeys, respectively. Necrosis zones in the PDL were prominent in both auto‐ and allografts after 1 week. Inflammation in the PDL dominated healing in all types of grafts 1 week after transplantation, whereas it subsided significantly after 2 weeks in autografts compared to allografts ( P = 0.005). Inflammatory resorption (IR) became prominent after 4 weeks in autografts and this remained stationary. In contrast, IR initiated significantly earlier in allografts compared to autografts after 2 weeks ( P = 0.007), and this type of resorption was further increasing in allografts after 4 and 8 weeks. Endodontic treatment, however, reduced IR nearly totally in the allografts with time. Replacement resorption (RR) was nearly absent in autografts. In contrast, allografts showed increasing appearance of RR with time, initiating at 4 weeks. By removing IR from the allografts by endodontic treatment, RR was unmasked significantly at 4 weeks ( P = 0.02) and dominated most of the periodontal ligament (70%) after 8 weeks ( P = 0.0004). Within the 8 postoperative weeks autografts showed healing with increasing amount of normal PDL reaching significantly higher levels compared to allografts already after 2 weeks ( P = 0.02), with increasing differences thereafter. In most allografts, the normal PDL occupied less than 10% of the entire root surface and was located in the supra‐alveolar cervical region. Downgrowth of periodontal pocket epithelium was absent or found very infrequently in all groups irrespective of type, time and treatment. In conclusion, the healing of allo‐ and autotransplanted mature teeth differed significantly on several aspects during the first 8 postoperative weeks. The recorded differences included a higher amount of inflammation in the PDL of allografts after 2 weeks, inflammatory resorption from the second week, and replacement resorption dominating in the eighth week, indicated that an immunologic stimulus for root resorption existed in the allogenic PDL apart from the pulp. Furthermore, specific healing reactions was found in the cervical region with almost identical gingival healing in auto‐ and allografts.