Feasibility and Outcomes of Cell-Based Regenerative Endodontic Therapy in Post-Autogenous Transplantation of a Mature Tooth: A Case Report

Autogenous tooth transplantation (ATT) offers advantages; however, success rates depend on factors like socket formation, donor tooth manipulation, and endodontic treatment. Root canal treatment in a mature post-ATT tooth remains challenging. Cell-based regenerative endodontic therapy (RET) shows promise for regenerating the pulp-dentin complex in mature teeth. However, its application in a post-ATT tooth is unexplored. This case report demonstrates the feasibility and outcomes of cell-based RET in a post-ATT tooth. A 37-year-old male underwent ATT for a missing maxillary left first molar. The maxillary right third molar served as the donor tooth, and transplanted with surgical guides. Root canal treatment began two weeks after ATT, confirming no detectable residual bacteria and fungi after 11 weeks. Dental pulp stem cells (DPSCs) isolated from the maxillary left third molar were transplanted into the root canal 17 weeks after ATT. The ATT tooth responded positively to the electric pulp test after 1 week. Most of the periodontal ligament of the donor tooth was absent, and the ATT tooth initially showed ankylosis-like signs but regained normal mobility after 28 weeks after RET. Cone-beam computed tomography (CBCT) imaging showed successful outcomes with the presence of the periodontal ligament space and lamina dura, and without root resorption and ankylosis after 52 weeks. Magnetic resonance imaging (MRI) revealed signal intensity of the regenerated tissue comparable to normal pulp after 60 weeks. This case report suggests the effectiveness of DPSCs in regenerating dental pulp and periodontal ligament, potentially preventing root resorption and ankylosis in the post-ATT tooth.