Front teeth play a crucial role in aesthetics and self-confidence, and losing one through a sports injury or accident can be devastating, especially to a teenager.
It was not surprising that student Angela Chin, 19, did not have the confidence to smile with all her teeth showing until May 2023.
Miss Chin was 10 when she fell and broke her front tooth on a concrete floor.
“It fell out and I was rushed to CGH (Changi General Hospital), where it was placed back,” she said, adding that she never returned to the hospital for follow-up treatment to ensure the health of the tooth did not worsen.
It was seven years later, in 2022, that she went to the National Dental Centre Singapore (NDCS) to schedule a tooth transplant to replace her bad front tooth. That was on top of an orthodontic treatment – using braces to straighten her teeth.
“(But) in early 2023, my bad front tooth lost its joint and got shaky. We had to do the surgery as soon as possible. It was plucked out before the autotransplant was carried out, and I had to live with a missing tooth for two months,” she said.
Miss Chin said she was teased by friends in school, and though she took it in her stride, it made her more determined to have the dental autotransplant done.
A dental autotransplant is a procedure in which dentists move a tooth, usually a premolar, from one location in the mouth to another.
Dr Wu Siwen, who heads the endodontics unit in the Department of Restorative Dentistry of NDCS, explained that in this procedure, a healthy tooth is extracted from its original position and transplanted into the site of a missing or damaged tooth.
“The tooth is carefully positioned in the socket, and then the surrounding tissues are sutured to promote the healing and the reattachment.
“Sometimes, the tooth that is transplanted is attached by wires to stabilise it,” she said.
Dr Wu said the procedure is particularly suitable for young children and adolescents who are still not skeletally mature enough for a dental implant, “because dental implants are placed only in individuals whose jaws are skeletally mature – 21 years and above”.
“Replacement options like bridges may not be ideal because their (young) jaws are still growing and the teeth may move,” she added. “If that is the case, then the bridge may need constant replacement throughout their growing-up years.”
Dr Lim Si Yu, an associate consultant with the Department of Oral and Maxillofacial Surgery at NDCS, said the patient is given a 3D scan to allow the dentist to see the structure of the teeth and jaw.
“We can calculate the length of the root of the premolar that we want to transplant, and we will try to match it as closely to the front tooth as possible. For example, if the front tooth is 20mm, we hope to find a premolar that is similar in length and in shape, so that it will reduce the chances of us having to shape the tooth or shape the socket,” she said.
The 3D scan also allows dentists to print a replica of the tooth to try to fit it into the socket first, before they extract the real tooth that they want to transplant.
“That gives us a higher success rate – when we do not have to expose the transplanted tooth out of the mouth for a longer period of time,” she added.
However, not everyone is a candidate for a dental autotransplant.
Dr Wu said the “perfect candidate” is someone whose teeth would also need to be extracted to create space or who has a wisdom tooth that could be used for a transplant.
“Those two scenarios could be happening in the mouth of the same patient,” she said, adding that someone with perfectly aligned teeth is not suitable for the procedure.
Because of such niche case selections, only 12 dental autotransplants have been carried out here in the past 10 years.
Dr Wu added that a very strong factor is the viability of the periodontal cells on the external root surface that structurally and functionally anchors teeth in jaws.
“This is why the surgeon’s expertise and skill are important to pave the way for a very fast and smooth transplant. Any delay would lead to a sub-optimal attachment when the tooth is transmitted to the recipient site,” she said.
Some studies have shown that if the tooth is out of the socket for more than 30 to 60 minutes, that can reduce the chances of a successful transfer of the tooth.
Ms Chin’s surgery, which took about two to three hours, was carried out in May 2023. She was 18 then.
“The dentist told me that they would remove the bad tooth in the front and replace it with one of my own teeth from the lower jaw. I was quite apprehensive at first, but when I thought that I would look prettier after the surgery and have healthy teeth, I decided to do it,” she said.
“Now I feel more confident and less scared (to show all) my teeth.”
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