Saving an Impacted Canine with Autotransplantation

My goal was to save her permanent canine while protecting the neighboring teeth and making treatment manageable for a very anxious young patient.** When imaging was obtained, her lower right canine was lying horizontally, deep in the jaw near the roots of the lower incisors. The usual approach—surgically exposing the canine, bonding an attachment, and gradually pulling it into position—would have been particularly difficult in this case. Its position raised concerns about damaging the neighboring roots during traction. I was also concerned about whether the tooth would have adequate bone and gum coverage once brought into the arch, and whether additional grafting might be needed. After reviewing the research and consulting with an experienced specialist in the Seattle area, we offered the family another option: **autotransplantation, which involves surgically relocating the patient’s own tooth into a prepared site.** Her baby canine was still present, preserving a potential location for the permanent tooth, and the permanent canine’s root tip had not yet closed. That stage of development made transplantation a particularly valuable option to consider. The specialist removed the baby canine, carefully prepared a recipient socket, and repositioned the permanent canine while preserving its delicate periodontal ligament as much as possible. Our aim was for the tooth to heal with healthy supporting tissues so it could subsequently be moved orthodontically. This approach avoided the prolonged, challenging traction path that had concerned us. After healing was confirmed, we used Invisalign to align the transplanted canine, correct her deep bite, and finish the bite. At follow-up, the canine moved successfully without evidence of ankylosis or internal or external root resorption. This case also illustrates why timely imaging matters when a permanent tooth is not erupting as expected. Earlier detection might have provided more options, although we cannot know whether it would have prevented this impaction. I chose transplantation because it offered a meaningful opportunity to preserve her natural tooth when conventional traction carried substantial challenges.** Researching alternatives and collaborating with an experienced specialist allowed us to offer the family a choice beyond the usual treatment pathway.