A long-term study of 370 autotransplanted premolars. Part IV. Root development subsequent to transplantation

The purpose of the present study was to analyse the extent of root development subsequent to transplantation in a material of 370 transplanted premolars. Before transplantation, the grafts were classified according to stage of root development (i.e. quarters of root length and constriction of the apical foramen) and length of tooth development (measured in mm from the cusp tip to the apical foramen). At radiographic controls the extent of root formation was registered. These figures were compared to the final tooth length of 288 non-transplanted premolars from the present material as well as to tooth length determinations of 534 premolars extracted for orthodontic purposes. Furthermore, intra-individual and inter-individual differences in tooth length were examined in a skull material with 40 pairs of premolars. These method studies indicated that root growth was probably determined genetically with great right-left accuracy and variation related to location of premolar (maxilla or mandible) and sex. A statistical analysis of the transplant material revealed that stage as well as length of tooth development assessed prior to transplantation were significantly related to final tooth length after transplantation. In most cases of transplantation performed at early stages of root development, a reduction in the final root length was seen. When a qualitative analysis of root development was performed in teeth with incomplete root formation at the time of transplantation, and where a homologous non-transplanted premolar was present, it was found that 14 per cent showed total arrest of root formation, 65 per cent partial arrest whereas 21 per cent showed no arrest (i.e. normal root formation). Premolars in ectopic position in the mandible before transplantation showed a significantly reduced root growth compared to matched pairs with normal position of the tooth graft. The present study indicated that no, partial or total damage to the Hertwig's epithelial root sheath was probably the explanatory factor for variations in root growth.