{"paper_id":"34f16587-520d-4438-8a32-29f653ba357c","body_text":"An Alternate Approach involving Trans-alveolar Transplantation in a Case Involving Impacted Canines and Retained Deciduous Teeth. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Short Report An Alternate Approach involving Trans-alveolar Transplantation in a Case Involving Impacted Canines and Retained Deciduous Teeth. Christian Thaller, Dirk Nolte, Björn Ludwig, Adith Venugopal This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4309109/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Trans-alveolar transplantation, though rarely employed, stands as a viable adjunctive treatment for individuals grappling with severely impacted or ectopic teeth, particularly when executed by a collaborative, multidisciplinary team. In the case of a 25-year-old woman facing a complex palatal impaction involving both maxillary canines alongside aplasia of both lateral incisors, traditional orthodontic traction posed risks of complications. To navigate this challenge successfully, a blend of deciduous and permanent tooth transplantation coupled with fixed orthodontics was employed. Over a meticulous two-year monitoring period, no indications of root resorption or ankylosis surfaced on the transplanted canines, affirming the efficacy of the surgical intervention. Auto-transplantation impacted canines transplantation retained deciduous teeth Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 1. Introduction Congenitally missing, ectopically erupted or impacted teeth may present with a problem that may require either orthodontic space closure or prosthetic rehabilitation using implants or bridges. Prosthetic implants may be successfully used in adults, but their usage in growing subjects are questionable since they most often stay infra-occluded as the patient grows. 1 In cases with delayed eruption of deciduous teeth due to congenitally missing permanent successors, it is important to maintain the deciduous teeth in place until implants are planned since, space maintenance on the edentulous site for future implant replacement has risks. Patient compliance with retainers is unpredictable, and even if crown position is maintained, the roots tend to migrate into the implant site. 2 Moreover, alveolar ridge constriction and residual ridge resorption occurs over time. 3 Maxillary canine impactions occur in approximately 2 per cent of the population, 4 with an astounding 85 per cent of these teeth being situated on the palatal side of the dental arch and 15 per cent located buccally. 4 , 5 Treatment options usually include interception in the form of surgical exposure (with or without orthodontic alignment), 5 , 6 transplantation, 7 and extraction. 8 Surgical exposure of the impacted canine, and the complex orthodontic mechanics applied to align the tooth back into the arch may frequently lead to complications involving supporting tissues (root resorption, ankylosis of impacted tooth, resorption of the adjacent tooth, etc.), not to mention the prolonged treatment time and high costs imposed to patients. 9 Transplantation of the impacted canines can be very reliable and provides growing patients’ with natural teeth that are functionally and esthetically superior to prosthetic replacements. It involves an atraumatic procedure of surgically removing a tooth from its impacted, ectopic or original site, the creation of a socket at the recipient site, and then re-implantation of the tooth into the recipient position within the alveolus. 1 , 7 , 10 The success of the procedure is determined by factors that include patient’s age, developmental stage of the transplanted tooth, apex closure of the root, type of tooth transplanted, surgical technique employed, and extra-oral storage time span before the tooth is transplanted. 11 , 12 A number of factors may lead a clinician to consider transplantation for an impacted maxillary canine, e.g. teeth that are markedly displaced and a reluctance of the patient to wear orthodontic appliances or undergo prolonged treatment to accommodate the canine with orthodontic traction. 9 Other factors include the presence of adequate space for transplantation within the arch, poor prognosis associated with the primary canine, good prognosis for the transplanted tooth (no evidence of ankylosis), and the potential for atraumatic removal maintaining the viability of the PDL. 11 , 13 In this report, we would like to demonstrate an alternate strategy involving transplantation of deciduous and permanent impacted canines as well as substitute the deciduous canines for the permanent lateral incisors, following orthodontic therapy in order to treat the patients esthetic and functional concerns. 2. Case Diagnosis and Treatment Plan A 25-year-old female came to the office with a complaint of a gap between her front teeth and her upper front teeth covering her lower front teeth completely. She was also concerned that her primary teeth were still intact and her permanent upper lateral incisor and canine had not erupted yet. Clinical and radiological examination revealed a midline diastema, anodontia of #12 and #22, impacted #13 and #23 with the root of the #23 dilacerated and its tip with the maxillary sinus, retained #53, #52, #62, and #63. Mesial rotation in #16, #15, #25, #26, #34, #32, #41 and distal rotation in #14, #11, #21, #33, #31, and #44 were noticed as well. Maxillary and mandibular central incisors were supra erupted, resulting in a deep impinging bite. The jaws were on a Class I skeletal base with a hypo-divergent mandibular plane and reduced lower facial thirds. (Table 1 , Figs. 1 & 2 ) Table 1: Cephalometric measurements. Treatment objectives The objective was to deal with the patient's complaints and address her compromised smile and facial aesthetics by: Closing the midline diastema Treating the retained deciduous teeth and bringing the impacted upper permanent canine to occlusion. Improving the inter-incisal relationship to achieve normal overjet and overbite; achieving Class I canine and molar relationship Achieving normal bone heights, gingival level, and contour following orthodontic rehabilitation. Treatment alternatives Following diastema closure and extraction of #52, #62, #53 and #63, canine substitution by bringing the impacted canine down into the arch orthodontically to replace the missing lateral incisors. This would be followed by protraction of the #14 and #24 into the remaining spaces. Following diastema closure and extraction of #52, #62, #53 and #63, canine substitution by bringing the impacted canine down into the arch to substitute the missing lateral incisors. This would be followed by placing prosthetic implants in place of the upper canines. The last option was to align the upper and lower arches following closure of the midline diastema. The #52 and #62 were to be extracted and the #53 and #63 were to be atraumatically extracted and auto transplanted into the prepared sockets of #52 and #62. The impacted #13 and #23 would be atraumatically and surgically removed and auto transplanted in the prepared sockets of #53 and #63. The arched would then be re-aligned and the occlusion settled. Future prosthetic implants may be necessary in place of the transplanted #53 and #63 depending on the prognosis of the auto-transplanted teeth. The patient was explained the risks that accompany orthodontic extrusion and alignment of an impacted canine of such severity such as loss of vitality, loss of periodontal attachment, root resorption of both the canine and adjacent teeth or even ankylosis of the canine. In addition, it was re-iterated that due to the particular position of the impacted canine, and the root tip of the #23 being dilacerated, and within the maxillary sinus, it was judged that the risks related to orthodontic traction were too high. With these considerations in mind, the patient and the orthodontist decided to auto transplant the impacted canine, as this procedure would imply less risk. The root length of #52 and #62 were less than 3 mm and risked dislodgement during the surgical exposure and removal of #13 and #23. The maneuver of transplanting #53 and #63 (with root length > 7mm) in place of the #52 and #62 (with root length < 3 mm) was proposed due to better long-term prognosis. In the event of post-transplant root resorption, there would still be enough stability to maintain ideal bone levels for a future implant on the lateral incisors regions. Treatment Progress Following impressions, setup models were fabricated which were then sent to Incognito for manufacturing the custom appliance. The customized lingual appliance was then bonded to the upper and lower arches. Initial levelling and de-rotation A sequence of .014” super elastic NiTi archwire, followed by .016” and .016 X .022” NiTi archwires were used for the initial leveling and alignment stages. The #53 and #63 were by-passed at this stage. Most rotations were corrected in this stage. (Fig. 3 ) Midline diastema closure & recipient site preparation An open coil spring was placed from the #14 to #52 and #24 to #62 on an .016 X .022” NiTi archwire in order to close the midline diastema and at the same time gain space for the transplantation of the #13 and #23 as they were mesio-distally wider compared to the #53 and #63. (Fig. 4 ) Transalveolar transplantation Following the extraction of the #52 and #62, the #53 and #63 were atraumatically extracted and auto transplanted into the prepared sockets of #52 and #62. The #13 and #23 were then carefully surgically removed and auto transplanted in the prepared sockets of #53 and #63. (Fig. 5 ) Releveling and finishing Two weeks following the transplantation, orthodontic forces were re-initiated on the upper arch excluding the auto transplanted #53 and #63 in place of the #12 and #22. The facial, palatal and proximal surfaces of the now #12 and #22 were prepared and contoured to resemble regular lateral incisors for esthetic and functional purposes. (Fig. 6 ) Following 6 months of levelling and occlusal settling, the patient had to go abroad for a year. The fixed appliance was maintained until she returned. On return, the minor spaces were closed and the occlusion was settled. In addition, the transplanted #53 and #63 were further reshaped and prepared, in order to mimic the lateral incisors. (Fig. 7 ) The braces were then removed (Fig. 8 ) and fixed retention was provided on the upper and lower arches. 3. Treatment results Post-treatment intra-oral photographs showed good alignment, a reasonable relationship between upper and lower teeth, and ideal overjet and overbite. The midline diastema was completely closed. (Fig. 8 ) Post treatment radiographs show acceptable root angulations with mild root resorption of #12 and #22. No signs of PDL obliteration or ankylosis was seen on #13 and #23, alveolar bone levels were maintained satisfactorily around the transplanted teeth. (Fig. 9 ) Ideal red and white esthetics were maintained in the upper anterior region. An aesthetic and pleasing smile was achieved along with harmony between the upper and lower lips, lip competence, and a bilateral Class I canine and molar relationships. The dental midlines were corrected, and no muscle or joint problems arose during the treatment. (Fig. 8 ) Post-treatment cephalometric analysis showed that the sagittal jaw relationship improved while the mandibular plane remained almost constant (pre-FMA, 15.40; post-FMA, 15.58). There was a marked increase in the upper and lower incisor inclination (pre-IMPA, 100.12; post-IMPA, 106.5; pre-U1-SN, 90.01; post- U1-SN, 101.16). (Table 1 and Fig. 10 ) Mild intrusion of the lower incisors may be noted that resulted in the correction of the increased overbite. The patient was provided with a fixed lingual retainer along with an Essix retainer on the upper and lower arch to maintain the corrected teeth positions. Routine check-ups were emphasized to closely monitor the treatment results. Two-year post-treatment follow up records showed a stable occlusion with no signs of ankylosis or further post-transplant resorption, improvement in the gingival health and a well maintained Class I canine and molar relationship. (Figs. 11 & 12 ) 4. Discussion Trans alveolar transplantation is a very viable option in cases of impacted or ectopic teeth, congenitally missing teeth or replacement of teeth with poor prognosis. This procedure involves the surgical re-implantation of a delicately extracted tooth into a new prepared socket. Although there are many indications and contraindications that are obvious to seasoned practitioners, extreme caution must be taken at each step of the procedure to ensure a successful result. A successful transplantation must result in the preservation and regeneration of the periodontal ligament at the recipient site. 14 The advantages of trans-alveolar transplantation, compared to prosthetic rehabilitation, especially lies in providing a biological replacement tooth that retains the potential to induce alveolar bone growth, maintains bone volume through proprioceptive function and a normal PDL, is able to erupt with neighboring teeth during continued facial growth, maintains a normal interdental papilla, and can also be moved orthodontically. 15 , 16 In comparison, prosthetic implants are an artificial replacement, which may require alveolar bone grafting if the bony support is insufficient, are osseointegrated and non-adjustable after placement and thus do not adapt to facial growth. 15 , 17 From an orthodontic perspective, the failure to obtain adequate aesthetics when aligning impacted or ectopic canines can also be an important factor when considering treatment options. As mentioned before, exposure and subsequent orthodontic traction can lead to resorption of the adjacent teeth, compromised gingival margins, loss of periodontal support, ankylosis, and long treatment durations. 9 Based on this perspective, trans-alveolar transplantation may be considered a viable option in certain such cases that fit the clinical criteria. Transplantation on the other hand can be followed by unfavorable outcomes too, which include pulp necrosis and infection, replacement root resorption and lack of root development of immature teeth and possible ankylosis of the transplanted tooth. 18 , 19 In the case presented, due to the unfavorable positions of the impacted canine and dilacerated root of #23 within the maxillary sinus, the prognosis involving orthodontic traction seemed uncertain. Hence, transplantation was chosen as the treatment of choice. One of the most important factors that determine the success is the stage of root formation of the transplanted tooth. An evaluation of transplants to the maxillary incisor region showed a 96% survival rate with immature roots, while teeth with mature roots had an 82% survival rate. 20 Post-transplant root growth on the other hand was noticably more in transplanted teeth with more mature apices. Studies have shown an overall significant reduction in final root length when compared with the contralateral side, while postoperative resorption is rarely reported. 1 , 21 , 22 Another factor that plays a critical role is the extra-oral storage time. Andreasen et al. 21 found that teeth with completely formed roots with no extra-oral storage had less risk of pulpal necrosis compared to those who were stored until transplantation. It is known that traumatically avulsed teeth lose fifty percent probability of periodontal healing after 8 min of extra-oral dry storage, and the clonogenic capacity of the periodontal ligament cells fall upto 3% after 30 min of extra-oral dry storage. 23 Keeping these ranges in mind, in the present case, the teeth were stored for an acceptable time of less than 10 minutes in cold saline solution that is a viable media for extraoral storage. In our case, it was of important to maintain the deciduous canines in the recipient area free from any pathology or inflammation, and it was desirable to delay extraction until the time of transplantation, as the extraction site provided the basis of a crypt or a readymade socket for placement. At the same time, it is important to adequately prepare the recipient area by maintaining sufficient space for the transplant. 24 We used open coil springs placed between the upper premolars and deciduous lateral incisors for this purpose. In addition, there should be adequate alveolar support, adequate attached, keratinized tissue to allow proper coverage of the transplant. Nordenram and Bergman 25 disclosed better results in the maxilla than in the mandible. It is of vital importance that the transplant be removed as atraumatically as possible causing no damage to the periodontium. In certain cases of palatal impactions wherein the crown of the canines are very close to the apices of the incisors, atraumatic removal becomes impossible. 26 In such cases, orthodontic traction to bring the tooth to a more favorable position to facilitate atraumatic removal may be a possible solution. Ankylosis is one of the other major complications in tooth transplantation. It is reported that injury to the periodontal ligament during the surgical removal or improper seating into the prepared socket may contribute to such a situation. It is also suggested that lack of prolonged occlusal stimuli on the transplanted tooth may contribute to ankylosis. 27 A study on beagle dogs demonstrated that the application of orthodontic force after a period of 2 weeks of splinting promotes the periodontal healing and may prevent ankylosis. 28 Severance of the vessels and nerves to the pulp following removal of the transplanted tooth from the donor area may lead to serious damage to the architecture and function of the pulp. Subsequent healing usually restores the content of the pulp canal, including the nerve supply. Pulpal sensitivity without pulp canal obliteration may take place in rare cases; likewise, pulp canal obliteration without pulp sensitivity may occur when nerve regeneration fails. 29 , 30 Transalveolar transplantation can have complications such as loss of pulp vitality, poor periodontal healing, and root resorption, which can be minimized if mature transplants are root filled within 4 weeks of transplantation. 31 A successful transplantation would feature very little or no post-transplant root resorption and the presence of an intact lamina dura indicating healthy periodontal healing. Usually the healing completes within 2 months. Transplanted teeth with mature root development can develop resorption more frequently than teeth with immature roots; it can be detected radiographically within 6 months of transplantation. 32 In the present case, orthodontic movement was initiated a couple of weeks after the transplantation, to allow for adequate healing of the periodontal ligament. In fact, the American Academy of Endodontics (AAE) recommends a splinting period of 7– 14 days and International Association of Dental Traumatology (IADT) recommends a splinting period up to 2 weeks for adequate healing. In the case described here, there were no signs of root resorption or ankylosis even 2 years after surgery, thus confirming the success of the procedure. 5. Conclusions Transalveolar transplantation is an underutilized technique, which if conducted with a multidisciplinary team, can be an adjunct treatment option for patients with impacted/ ectopic teeth. In a case of a young female with a complex palatal impaction of maxillary canines, in whom orthodontic traction may risk complications, was successfully treated through transplantation and fixed orthodontics. After a 2-year observation period, no signs of root resorption or ankylosis were observed, thus confirming the success of the procedure. Declarations Ethical approval: Not required Funding Declaration: No funding was provided or obtained for this particular study Consent for publication: A written informed consent was obtained from the patient for the purpose of this publication Data availability declaration : All the data is available within the manuscript and if further information may be requested from the corresponding author if needed. Competing interests declaration: Authors disclose no competing interests References Hariri R, Alzoubi EEM. Autotransplantation in combination with orthodontic treatment. J Orthod Sci. 2019 Aug 8;8:11. doi: 10.4103/jos.JOS_62_18. PMID: 31497570; PMCID: PMC6702680. Rakhshan V. Congenitally missing teeth (hypodontia): A review of the literature concerning the etiology, prevalence, risk factors, patterns and treatment. Dent Res J (Isfahan). 2015 Jan-Feb;12(1):1-13. doi: 10.4103/1735-3327.150286. PMID: 25709668; PMCID: PMC4336964. 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J Clin Pediatr Dent. 2010 Winter;35(2):129-35. doi: 10.17796/jcpd.35.2.97816254u2140x88. PMID: 21417113. Yang Y, Bai Y, Li S, Li J, Gao W, Ru N. Effect of Early Orthodontic Force on Periodontal Healing After Autotransplantation of Permanent Incisors in Beagle Dogs. J Periodontol 2012;83:235–41. Bastos JV, Côrtes MIS. Pulp canal obliteration after traumatic injuries in permanent teeth - scientific fact or fiction? Braz Oral Res. 2018 Oct 18;32(suppl 1):e75. doi: 10.1590/1807-3107bor-2018.vol32.0075. PMID: 30365616. Sagne S, Thilander B. Transalveolar transplantation of maxillary canines. A critical evaluation of a clinical procedure. Acta Odontol Scand. 1997 Jan;55(1):1-8. doi: 10.3109/00016359709091932. PMID: 9083567. Patel S, Fanshawe T, Bister D, Cobourne MT. Survival and success of maxillary canine autotransplantation: a retrospective investigation. Eur J Orthod. 2011 Jun;33(3):298-304. doi: 10.1093/ejo/cjq071. Epub 2010 Sep 5. PMID: 20819783. Pogrel MA. Evaluation of over 400 autogenous tooth transplants. J Oral Maxillofacial Surg. 1987;45:205–11. - PubMed Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-4309109\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Short Report\",\"associatedPublications\":[],\"authors\":[{\"id\":296482184,\"identity\":\"c72f0f5b-e65d-4532-b0a1-65e0fe5c0a24\",\"order_by\":0,\"name\":\"Christian Thaller\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Private Pactice, Orthodontics, Munich\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Christian\",\"middleName\":\"\",\"lastName\":\"Thaller\",\"suffix\":\"\"},{\"id\":296482186,\"identity\":\"deb4156e-cfa5-4172-b619-6de75affc849\",\"order_by\":1,\"name\":\"Dirk Nolte\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Private Practice, Maxillofacial Surgery, Munich\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Dirk\",\"middleName\":\"\",\"lastName\":\"Nolte\",\"suffix\":\"\"},{\"id\":296482188,\"identity\":\"b8dc752a-0bb9-41a0-88d4-4ef7b87d9eaa\",\"order_by\":2,\"name\":\"Björn Ludwig\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Universitätsklinikum des Saarlandes\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Björn\",\"middleName\":\"\",\"lastName\":\"Ludwig\",\"suffix\":\"\"},{\"id\":296482190,\"identity\":\"29a5c9c5-136f-4f23-9e60-154e664c5fd6\",\"order_by\":3,\"name\":\"Adith Venugopal\",\"email\":\"data:image/png;base64,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\",\"orcid\":\"\",\"institution\":\"University of Otago\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Adith\",\"middleName\":\"\",\"lastName\":\"Venugopal\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2024-04-23 03:55:42\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-4309109/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-4309109/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":56015856,\"identity\":\"f95a5450-f381-433c-ac4c-d3166b04f6ab\",\"added_by\":\"auto\",\"created_at\":\"2024-05-07 15:11:52\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":1463003,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003ePre-treatment extra-oral and intra-oral pictures\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Fig1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4309109/v1/675e2bde3fabf690989701bc.png\"},{\"id\":56015857,\"identity\":\"906727a6-65ac-46ca-b30f-c4cb0f633eac\",\"added_by\":\"auto\",\"created_at\":\"2024-05-07 15:11:52\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":989206,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003ePre-treatment radiographs\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Fig2.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4309109/v1/363d366d64a0ec565e1bb1c7.png\"},{\"id\":56015861,\"identity\":\"c614f1a3-5e25-48ed-b51d-caace21c3940\",\"added_by\":\"auto\",\"created_at\":\"2024-05-07 15:11:52\",\"extension\":\"png\",\"order_by\":3,\"title\":\"Figure 3\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":1894117,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eIncognito custom lingual appliance. Stage: Initial Leveling and alignment\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Fig3.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4309109/v1/8b724e9bcba7713b9dfe43b3.png\"},{\"id\":56015859,\"identity\":\"c6185a82-e33f-4f79-ab82-844b4e3494ce\",\"added_by\":\"auto\",\"created_at\":\"2024-05-07 15:11:52\",\"extension\":\"png\",\"order_by\":4,\"title\":\"Figure 4\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":1434215,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eMidline diastema closure \\u0026amp; recipient site preparation\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Fig4.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4309109/v1/558a6d3e924d24c4fea0cb79.png\"},{\"id\":56015862,\"identity\":\"558fe2a5-aa9e-4f5b-99e0-f36d4ef8bd5c\",\"added_by\":\"auto\",\"created_at\":\"2024-05-07 15:11:52\",\"extension\":\"png\",\"order_by\":5,\"title\":\"Figure 5\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":873420,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003ePanoramic radiograph after trans-alveolar transplantation.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Fig5.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4309109/v1/c871c302aa892433f3e00d6f.png\"},{\"id\":56017422,\"identity\":\"5412255d-c6c0-4b1e-a2fb-f46620afb421\",\"added_by\":\"auto\",\"created_at\":\"2024-05-07 15:27:52\",\"extension\":\"png\",\"order_by\":6,\"title\":\"Figure 6\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":2013938,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eInitiation of orthodontic forces 2 weeks after transplantation.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Fig6.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4309109/v1/e7efa1093179388ce08ca7d7.png\"},{\"id\":56016390,\"identity\":\"18b18f2f-7c84-4858-aefa-a710a0f3dc8a\",\"added_by\":\"auto\",\"created_at\":\"2024-05-07 15:19:53\",\"extension\":\"png\",\"order_by\":7,\"title\":\"Figure 7\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":1875143,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eFinal space closure and finishing.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Fig7.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4309109/v1/b786adb42053aa54981a3217.png\"},{\"id\":56015865,\"identity\":\"f680f2d2-4cce-4473-adc2-d45ca253e6d7\",\"added_by\":\"auto\",\"created_at\":\"2024-05-07 15:11:52\",\"extension\":\"png\",\"order_by\":8,\"title\":\"Figure 8\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":1413381,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003ePost-treatment extra-oral and intra-oral pictures\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Fig8.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4309109/v1/7fbfdd3f5128f340f107dc5f.png\"},{\"id\":56015860,\"identity\":\"906b5131-1d43-4457-ba6f-c9e50ffdc605\",\"added_by\":\"auto\",\"created_at\":\"2024-05-07 15:11:52\",\"extension\":\"png\",\"order_by\":9,\"title\":\"Figure 9\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":957429,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003ePost-treatment radiographs.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Fig9.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4309109/v1/c478b9884ff95534a3ea47b7.png\"},{\"id\":56016388,\"identity\":\"2f688771-0e02-4c24-a92f-34a26e5b1a22\",\"added_by\":\"auto\",\"created_at\":\"2024-05-07 15:19:52\",\"extension\":\"png\",\"order_by\":10,\"title\":\"Figure 10\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":613848,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e(a) Pre- and Post-treatment cephalometric tracings superimposed on the SN plane at S: showing proclination of upper and lower molars, mild intrusion of the lower incisors and marginal protraction/ mesial tipping of the lower molars. Almost no change is seen w.r.t. the mandibular plane (b) superimposed on the palatal plane at ANS and (c) superimposed on the mandibular plane at Me.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Fig10.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4309109/v1/016b06438874503342b943da.png\"},{\"id\":56015868,\"identity\":\"b29089d1-2d0e-4f51-bac2-afbce4308348\",\"added_by\":\"auto\",\"created_at\":\"2024-05-07 15:11:53\",\"extension\":\"png\",\"order_by\":11,\"title\":\"Figure 11\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":1698515,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eTwo-year post-retention pictures showing stable occlusal results with improved esthetics.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Fig11.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4309109/v1/018a77fb740ffd2a925c5e73.png\"},{\"id\":56015866,\"identity\":\"9fc958be-b756-4e32-ae0c-a3a63fbb8669\",\"added_by\":\"auto\",\"created_at\":\"2024-05-07 15:11:53\",\"extension\":\"png\",\"order_by\":12,\"title\":\"Figure 12\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":847270,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eRadiographs from two-year post-retention showing no signs of ankylosis and intact lamina dura around the transplanted teeth.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Fig12.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4309109/v1/34c2de7b59a97f44e6af59e3.png\"},{\"id\":57996284,\"identity\":\"3f83c16f-5df5-45a2-8c7b-13155f373ac9\",\"added_by\":\"auto\",\"created_at\":\"2024-06-09 09:31:58\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":30230871,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4309109/v1/b441af35-6d98-40dd-9062-ac0e146452e5.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"An Alternate Approach involving Trans-alveolar Transplantation in a Case Involving Impacted Canines and Retained Deciduous Teeth.\",\"fulltext\":[{\"header\":\"1. Introduction\",\"content\":\"\\u003cp\\u003eCongenitally missing, ectopically erupted or impacted teeth may present with a problem that may require either orthodontic space closure or prosthetic rehabilitation using implants or bridges. Prosthetic implants may be successfully used in adults, but their usage in growing subjects are questionable since they most often stay infra-occluded as the patient grows.\\u003csup\\u003e\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e\\u003c/sup\\u003e In cases with delayed eruption of deciduous teeth due to congenitally missing permanent successors, it is important to maintain the deciduous teeth in place until implants are planned since, space maintenance on the edentulous site for future implant replacement has risks. Patient compliance with retainers is unpredictable, and even if crown position is maintained, the roots tend to migrate into the implant site.\\u003csup\\u003e\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e\\u003c/sup\\u003e Moreover, alveolar ridge constriction and residual ridge resorption occurs over time.\\u003csup\\u003e\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003eMaxillary canine impactions occur in approximately 2 per cent of the population, \\u003csup\\u003e\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e\\u003c/sup\\u003e with an astounding 85 per cent of these teeth being situated on the palatal side of the dental arch and 15 per cent located buccally.\\u003csup\\u003e\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e\\u003c/sup\\u003e Treatment options usually include interception in the form of surgical exposure (with or without orthodontic alignment),\\u003csup\\u003e\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e\\u003c/sup\\u003etransplantation,\\u003csup\\u003e\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e\\u003c/sup\\u003e and extraction.\\u003csup\\u003e\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003eSurgical exposure of the impacted canine, and the complex orthodontic mechanics applied to align the tooth back into the arch may frequently lead to complications involving supporting tissues (root resorption, ankylosis of impacted tooth, resorption of the adjacent tooth, etc.), not to mention the prolonged treatment time and high costs imposed to patients.\\u003csup\\u003e\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003eTransplantation of the impacted canines can be very reliable and provides growing patients\\u0026rsquo; with natural teeth that are functionally and esthetically superior to prosthetic replacements. It involves an atraumatic procedure of surgically removing a tooth from its impacted, ectopic or original site, the creation of a socket at the recipient site, and then re-implantation of the tooth into the recipient position within the alveolus.\\u003csup\\u003e\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e\\u003c/sup\\u003e The success of the procedure is determined by factors that include patient\\u0026rsquo;s age, developmental stage of the transplanted tooth, apex closure of the root, type of tooth transplanted, surgical technique employed, and extra-oral storage time span before the tooth is transplanted.\\u003csup\\u003e\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003eA number of factors may lead a clinician to consider transplantation for an impacted maxillary canine, e.g. teeth that are markedly displaced and a reluctance of the patient to wear orthodontic appliances or undergo prolonged treatment to accommodate the canine with orthodontic traction.\\u003csup\\u003e\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e\\u003c/sup\\u003eOther factors include the presence of adequate space for transplantation within the arch, poor prognosis associated with the primary canine, good prognosis for the transplanted tooth (no evidence of ankylosis), and the potential for atraumatic removal maintaining the viability of the PDL.\\u003csup\\u003e\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e\\u003c/sup\\u003e In this report, we would like to demonstrate an alternate strategy involving transplantation of deciduous and permanent impacted canines as well as substitute the deciduous canines for the permanent lateral incisors, following orthodontic therapy in order to treat the patients esthetic and functional concerns.\\u003c/p\\u003e\"},{\"header\":\"2. Case Diagnosis and Treatment Plan\",\"content\":\"\\u003cp\\u003eA 25-year-old female came to the office with a complaint of a gap between her front teeth and her upper front teeth covering her lower front teeth completely. She was also concerned that her primary teeth were still intact and her permanent upper lateral incisor and canine had not erupted yet. Clinical and radiological examination revealed a midline diastema, anodontia of #12 and #22, impacted #13 and #23 with the root of the #23 dilacerated and its tip with the maxillary sinus, retained #53, #52, #62, and #63. Mesial rotation in #16, #15, #25, #26, #34, #32, #41 and distal rotation in #14, #11, #21, #33, #31, and #44 were noticed as well. Maxillary and mandibular central incisors were supra erupted, resulting in a deep impinging bite. The jaws were on a Class I skeletal base with a hypo-divergent mandibular plane and reduced lower facial thirds. (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e, Figs.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e \\u0026amp; \\u003cspan refid=\\\"Fig2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e)\\u003c/p\\u003e \\u003cp\\u003e\\u003cstrong\\u003eTable 1: Cephalometric measurements.\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cimg 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rgIwRyQY1itOdR8jLzoNNjOmPENnldG7mceZLXddz3fQQqR3hWzvWsrecRljlrqvxqf9HJflW9fV4q9S4EiI1Zm49ONFeGJ6qnGSIJbzkMa7JnkejncOYdmzYJSEACEpDAWQms7n8Li8XO8ieAPcUFRcXoT3IpJLb+BmQxvcMSkIAEJCCBlyJgYXGH7aBgyN86zMzVv5IEPD/0+I2KjpktxyQgAQlIQAKvSMDC4hV3RZ8kIAEJSEACJyVgYXHSjdNtCUhAAhKQwCsSsLB4xV3RJwlIQAISkMBJCVhYnHTjdFsCEpCABCTwigQsLF5xV/RJAhKQgAQkcFICFhYn3TjdloAEJCABCbwiAQuLV9wVfZKABCQgAQmclICFxUk3TrclIAEJSEACr0jgoYUFxv3JwBgwBowBY8AYeK8YmBU8/l96z+g4JgEJSEACEpDALwQoImdtPjrRXBmeqDokAQlIQAISkMBJCazufwuLk26sbktAAhKQgASOIGBhcSfq/Oulo3/llH9gDMh7/5GyO7mjGQlIQAISkMAhBA4vLHAgPy7f/DPiPNPf/+VPLvGM8ewtlzn/FPkzGr7iU2/xAx/3FBaR3yPb5/JbAvckQJFccyzviU1yK30897b8C7/J88R8tcX7qEjfO8c7y1WO/UyqrMN/i1X2qdqrOpzJGevzbNm0/30IEBuzNh+daK4Mo0pw1qAkmPnVRjBjq8oxTpLUQB/pbI1X2c++cwDO5kky89zTkOsM9ugpI4F7Euj5RiGRAr/HdIqQ2fyR6Xb7Nzb2nB2zud51jP3JWZQ9qn+4gmu+kRuxhx171c8rbFfdzIM859WWrXfdi3df9yqHH1pY1EDPRtSApS8J0GUJ/C4bGylYVouL/GeezNGTsNpLgs9kqjzvWXPv91sCzyLQ45WY5MKhcYn03CPnMt595ELaypM+Dza67W7P7zEBLvi6B/WbPWOP0nIu5bs++57wXf+w0/eS/a3j1Zbv70lgdfc+tLAgGHuQ9m3IIUNSVGcJ9oxVHRKLQE/i1ESrcvd4x3ZN1tjM3PhLQvc1Zt3051f95N1EDU2fr0CAOE0j73rc0zfKR3SQTR5gp+vGbmTzJ+Pa7/uaAPyzTzCsnLMH1Qqye1izd/xoOduqXvp42iQAgcThFo1/T5MtiY3+lWHUEpDIbsnXwwqZJAu6dSxu1D5k63dk7vXEdrefNSXJGMfv+h2dyNaionK5l5/akcBnCPRLinglpuvlspVrifEe87moul9b50CX83tMgH2o52Sk+INKP2dGfZGvT2zWvUaPvjTG6hmXfp/vS2CVxw8tLII9ly/O5ACqY3lPAHMocWB1WcbrgZUDMPr3fjJ/94H5a18OVp40ErL62L+R6Tr39lt7EriFAPHcLyX6yNf66zLMQV//2zd0e19ka+7c4qOyfxPIecK+1HNmVESM+jpHzqK+Vzmf6t53mW7H7/ciQGzM2nx0orkyPFLNYVUPqH7QkCzYRqaPRb8GfGRH8322j/m6D0ns2E4S8qT1gxb/6p8GkOk6seVTAkcQIEZnjZjekunxjp1RH/3kTs+F2byO/UoAfrCl5Q9h+e7nEjKjs+dXi3//72lqgdLH+aaoWMmM9Oy7LoGt8yArnp8okRo8V4ZRIdh76wnQL+7oYb+P9e/Ijubp837km2TqczJX7RsVCSQi/vMbJeRI5yP+qSOBzxLgYqrxPLK3FcfIjmJ5ZBM5/9Q7oru/j32ohRn7lr3rZ1X2ZWWdPUF2q2GXeW0SqARWMfHhiFkZxglk6sWaYO/JUR3OO7pJGvp4HyVAr9yjf48nB2Q/DOnDN560JB59+IefdX0jP0Z2R3L2SeDRBCiUt+I1uVVzeOQPNmpxTy50m9hY2RnZtu9fApxF9UzkO+cQUjmDeGc/VrzZo7pv/8709xtj2LRJoBNYxcWHo2ZlGEdIAoIb2fxy4KTISH9PglzS2CGBIhd9+ruNWZJ0MHu/mZd5aqtrYo1Vpo7FZ561hUvt810CzyZAXPfCGR9SPNe4rr6NLpz0oVMvu+gxT8+jjPncT6CeKaMzM+O1AME6/f18RGZrr5DvNvZ7qeTVCRAfszYfnWiuDE9UTzVE4t2SYD3ZWSwHahJ46zA/FRSdlYAEJCCBtyWwuv8tLHaEBoXFnuKCv00ZAa+6jPsntx3QFZGABCQggZckMLrnqqMWFpXG5J2/icjfOkzE/ipAgF5/0Rv9tfPMlmMSkIAEJCCBVyNgYfFqO6I/EpCABCQggRMTsLA48ebpugQkIAEJSODVCFhYvNqO6I8EJCABCUjgxAQsLE68ebouAQlIQAISeDUCFhavtiP6IwEJSEACEjgxAQuLE2+erktAAhKQgARejYCFxavtiP5IQAISkIAETkzAwuLEm6frEpCABCQggVcjYGHxajuiPxKQgAQkIIETE3hoYYFxfzIwBowBY8AYMAbeKwZmdZH/l94zOo5JQAISkIAEJPALAYrIWZuPTjRXhieqDklAAhKQgAQkcFICq/vfwuKkG6vbEpCABCQggSMIWFjcgTr/Oin/uumoAZh/Ln3Vvn796j+XvoLkuAQkIAEJvDyBwwsLHMjvx48ff/2z4lD79u3bP/1curVxiUeHJ+P1u77nnySv+vd8xxd8HbX4saewQB/5vbKj+eyTwD0IEIOJ3fpMbJKntX+VY1UW3dpqLvc8r3K+zwlUjpV3tNij9H/58iXdm89ur+5bjQ/kbBLoBIi1WZuPTjRXhlHlIKmBScD3oE+BUeXQrUUI3wn26lKSo+tWmc+8M+fqMIRDDuQ9c+3htseOMhL4KIGeL+RazUveI5O8qxdPnbfqoVPzpf9NH7G/VaRXm77/TiD7kRHYhmX2KGPI1n1Jf31Gt/bxzj6zT9lv9nNVWHYbfl+fwOoee2hhweT90u0BzTeJ0GUJ7CrbkydbRwLVwyz993hiu/vf7Xa/+3j/Zq11XX3cbwk8mkAujcxDTPJL6zHdvyPHs9oiV2ou9guJOVYXXrXt+98EKuMwgXPOppyhGeM5O7vYl+hWHd6xVc8n5NyzTslvzoRZm49ONFeGUSUgkRslRkwniEmUahOdjCFLgNfx2tcPsNj+zHOWUPjBj4OSZ03SrCMykYsvo3VkzKcEjiBAntYcJYZzmZBbNQ9n/hHr1U6XxRa2bZ8jAOPsD5Zg2veIvlos1hlzLlcbGaevnqfMtdrX6Pp8HwLExKzNRyeaK8OoJiiR3ZKvCYFMDh5061gu5NjKE7lHNJIyvlT7zJtCohcWXQfZUXLT/yi/q6++S2BFgDjcumCI05qDW7aQQXYV18gld7Zs2b8m0Iu9nEP1TGFPR2cP1iOXfauFBHvY92jUt/ZSiSsTICZmbT460VwZrqoJYHR4r61+p3ggIQj+0VjVJSFGNqvMR9/xoRcWzNf7mD+JiL/V5/4dX6pO+nxK4AgCxPnoAiLOiV9itV48Mx/RQT4XV5Xt+VzHfL+NAJxz5kQz7OGfX5eJbH3mDE0ful1v1Bd5n+9JgJiYtfnoRHNleKQ6OqjqRYwOhxy2Cfg6RrCP5oz86DAb+bC3D7ska234U31iDJ+SiN3H/teKsVV10udTAkcQIEZ77tCXmM7Fk++Vj1ux3XNpZcfxMQH2iv2ZNc6ulUzVrzHAey0kmY897TFS9X1/PwLExKzNRyeaK8Oojg4T+gj8tH5RRw/7daxf2tFPYbH34Ive6klydf/xp/fhZ52bcfq6/3W+rlPHfJfAswgQtz2eRxcJMjVnZ/5xMdV8QBZ9L6YZtf1j7MNsL7J/tThYWa9FCGdctc9e1vGVLcffgwB32KzNRyeaK8OoIlODNEFfD55aPNTp0K1j6PQ50/eIwI/t6lP6sqb8aQ6/GKN/ldCxUe36LoEjCJBfo3jteZv4XvmIrV6o8E3Mp/E+mjPjPucEOOu2ijS4sle38O1nVs7oeMF8t9iLns9rEyDOZm0+OtFcGUY11S+y+eWQSQCnP5d1pmQ8hQWHU+T68xFFRXzAdvxNX5IXP/CPZ2TqWPWzHgSsM+uKTZ8SOIIAMTpqPTfrxZKYR4a4r3He47qO1ffRnPatCcC7F25ocaaE78gK51jOyb5n/dxFv8qMxkdz2PdeBIi3WZuPTjRXhieqpxnaSuStBWwlYe1/B25bfOyXgAQkIIHzE1jdYxYWiz2mKBj9KaGr5U959W8nkEE/faO/Ael2/JaABCQgAQm8MgELizvsDn8VXP/WYcskMgCvv+hRnKTA2NK3XwISkIAEJPDqBCwsXn2H9E8CEpCABCRwIgIWFifaLF2VgAQkIAEJvDoBC4tX3yH9k4AEJCABCZyIgIXFiTZLVyUgAQlIQAKvTsDC4tV3SP8kIAEJSEACJyJgYXGizdJVCUhAAhKQwKsTsLB49R3SPwlIQAISkMCJCFhYnGizdFUCEpCABCTw6gQeWlhg3J8MjAFjwBgwBoyB94qBWfHj/6X3jI5jEpCABCQgAQn8QoAictbmoxPNleGJqkMSkIAEJCABCZyUwOr+t7A46cbqtgQkIAEJSOAIAhYWn6T+7du3n/zz6b3Rt4IbHf5VU5sEJCABCUjgCgRWd9/T/sYiF3H/Fz75xsn8+iWefp5c8vW7vj/i8uZfJOVfNu0ta2H+PS3ye2SVkcDRBIh5YrvnavcrcY3sVv7VHCV/bY8hANutPagz1n+BmfOtN2xkz0ZnX5f3+z0JECOzNh+daK4Md1WCGJ38M+J9vBYYfYykqYcctrqdJEPX/eg39vsc1VYO1do3e0d+lMgzHcck8GwCtXivOdf9YKzG8ygnuZiIe9tjCaQYWBUW7Ec90zgza7HX95Bxi4vH7t1ZrRMbszYfnWiuDFdVDiECmN9W8CND0GO3HljYQa8ecj0BkCEB0L3HQcZcq/XdWljgI36bqDUyfH9FAontmnPdzz42KsTrpdX1/b4vAfhvna2ZqZ89VWd05iHfz+LY8vneBFb341MKCwKYwM2BNbr8GUcuMryn7SksSIBVYsXe6snco0MxvgEVmQ6X7/6ra0XHRF3Rd/xoAonzXjxs+YV8z70U+uRDv9C27Nj/cQKcLX0PVtZq4TDa8/St7Dj+fgT63dcJPKWwqJc0wU8S9JbCgv5c2gQ2bVRY9Au8ztFt3/rN5d997EmGTIVbdSIb/zM/37cmf3R9SuBZBBK/ewoL4pk86HEdXZ6j8Wet5V3m+UhhwZlZzyj2qZ6jKQ7fhaHr3E+g3n0jrYcXFgRn/RPLVgLUwgJH68U9Kiz6xZ8DLgfaaLF7+2qREB18qHPm8M0489d19m/kuk50fUrglQgkTm/JpVXxQD7U/Hml9V7Bl61zdWtt7G0tIpDLvrOX+XEW2iTQCRxeWKRASKDmSRDX1gsLxpBFf09hEfmeLHWOve+jwqIXCknC2CSxk4SsBd/7wdx1outTAq9EIHHa43fmY3S2ZCi675GbW/bfvf/WwiJn1YwbZ1j9w9JM1rH3IkBszNp8dKK5MozqqFign0u6HzIj2RxW/ZIeXfzYRW5PwkyW9dcQvvU/XfU/ccW3aov58xsl5Ein6vsugVcgkDi9pbBAltjfauRDz6ktWftvJ3BLYcEZudpbzkDOPJsERgRmuY789kkwslb6VoYR3brkOWTQ5wBLGxUWjJEwyNZEGBUW9CE3utAzx94nc3bf40d8JvGYjx8N+erjaK6R3ZGcfRI4ksBHCotRMV7X4CVVadz/nbNlD2POqZxheMF7PzOxs8fW/VehxbMQyL235e/DCotcujzrhZtDK+McSPWSHjnMODa6bmzk2RNka9Grfuba8iNzxefYynfGefbkJKnv5WPm9SmBexJIAZ04rvFaL5yZHP4Q67HB0/Y4Ap11ztucY5xNtLof9T2epY+9tUlgRmCV0x/O+JXhmVNnGCO5bkmwkSyFED8aTw4AmwQkIAEJSODMBFb3v4XFZHcpBEYFQ1fhT3X9byeQyZ8U8ieHrue3BCQgAQlI4GwELCw+uWMUB/lbh5mp/teRgI/eqKI8fjIAACAASURBVOiY2XJMAhKQgAQk8KoELCxedWf0SwISkIAEJHBCAhYWJ9w0XZaABCQgAQm8KgELi1fdGf2SgAQkIAEJnJCAhcUJN02XJSABCUhAAq9KwMLiVXdGvyQgAQlIQAInJGBhccJN02UJSEACEpDAqxKwsHjVndEvCUhAAhKQwAkJWFiccNN0WQISkIAEJPCqBCwsXnVn9EsCEpCABCRwQgIPLSww7k8GxoAxYAwYA8bAe8XArB7y3wqZ0XFMAhKQgAQkIIFfCFBEztp8dKK5MjxRdUgCEpCABCQggZMSWN3/FhYn3VjdloAEJCABCRxBwMLiTtT559P559F7yz+JznPV/FdOV4Qcl4AEJCCBVydwWGHBRczk+fHPinOx5jv/pPgIYP0nyPlny6NTn8hsNXRm41t6W/3YYz29pajArz2FReT3yPa5/JbAPQgkL0e2aq71GE3sEuvIrRr5jewoz+s5MCrWV7bfbZyzbOs8C8vZH1qyrzMZmMYW+7Y137uxd71jAsTIrM1HJ5orw1Hth0sOtq3AzQHWx6udHFpdhjmjj3w/HOPTLU8OvtlBmvn2zoXcKsFv8U9ZCewlQL6QF/x6Iy+TT4npKlPzj3wYFdqRT45XnYwxR3KF3BrJRNbnz3/2K3tTmdCXfYBll8k+9v5qI++cqRZ5oeFzRWB0hlSd30+YOjp5XxmOaj84CN4cPKM/zXBo8evJ0O0gQ18OqcyH7RQeSbqMfeQ5mqPaSfJ2P6pMf18dzF3ebwnci0Au825vlF/JH541HxPz3Ub9jkzNcfrqN/IU2Zmn6vv+L4HReZgz7l+pv1lWvuzp3mKBOWwS2EuA2Jq1+ehEc2U4qv3AItAJfg6UelhFPpduH+t2OIzo6xd6EoTnZ/9mAF+7H/iZQ5P5R34wL2P1VxOc98/6Fl4+JXALAWKPuKxtdEnVYoIc6Jc/NuolVu3xnhyZySCH7Zob3Y7fP4d/0Kr7E0Z1nxjPGZhzKHL9mf1Hru9zl/VbAhDoZ0in8usJ00cn3yvDUUWuHi4cInzngKuFAUHN2Chpqp0cWv1yjl3m5h2daj8+7X2SmClUopO5Y5fxOk/ViWw/ONMfmz4l8CwCybs6H309l2ofYz2GR33VZmKcPJy1Pu9M9l3HOFP6H3DqORMutQ+u6OScyndk6zMy9HGW8bNJYEZgFSMfjqCV4TiFXD1cOKDyTbCTDGl53yossJXf6EDqyYfMZyrwmqjxEXvxk74coEnO+qcGxvv3SCe2fUrg0QTIv567tYjI/LWPPOK7tlFfHU9eJNfrWN7Jpdl45N79yXnTz7bR2ZS+sM+ZBL/se+3b4spc9YzbkrP/fQn0M6STOLSwqMHOew6ZrcIi430RfCeZUnjkOSpARvqjviRqHeuFQuZNwrKOOid+dL+7TrXvuwQeSSA5V+cgPvtBUXOwxzy6o7iuNhPjPfYjQz9z2NYEOId6YVH3JxayT2GfM4nxUV/0+pO96fN1Gb/fm0A/LzqNQwsLnOES7hf4KGlWBxk6NZGwnQNz63DrMPo3NnvlTsLVvlHCsib85YeN3kY6XcZvCTyCwKiwYB5iteYPMZ7Y7XmQ+J35F5lR7jHmxTWj9+sYe9F5wbX+AQYNvsObd/Y6DeZdPmP9iY16xvVxvyXAeTFr89GJ5spwVJFLsNNHsNdvDi1kahLQ1xOp24l9niTNViJgZ29CVZvxtevmYI6/8R//4kddX7e5ZXckZ58E7k0g8dvt1uKB+CWea0t800dOIT9r5MIoZ0cX3Fbuzuy/09iosGD97EM9h+qZmXMpnPbsWWT7mZd+nxIIgX4+pD/PX0+P9O54rgwnsJHjR2ATsPU701RbGc+TpMo7z5o86OegHI113dWFH3/qE7schrXVtWWOyNSx6nfVRwc5mwSeSSCxmrjs+VDHE8/xj+/oIVcb/TUva04ylljv/Vv2qu13f69nJrx6y/ioGKhnUd2zFI7Zl7rvzNH3vs/ptwRGsVip/B6pdXTyvjI8UT3VEIdhTcqV80nWKkeiYofG++gQqPK+S0ACEpCABF6VwOr+t7DYsXMUFnuKi/xJoJusuv6JoNPxWwISkIAEzkTAwuJOu8XfRORvHWYmKSKAXn/R828qZuQck4AEJCCBMxCwsDjDLumjBCQgAQlI4CQELCxOslG6KQEJSEACEjgDAQuLM+ySPkpAAhKQgAROQsDC4iQbpZsSkIAEJCCBMxCwsDjDLumjBCQgAQlI4CQELCxOslG6KQEJSEACEjgDAQuLM+ySPkpAAhKQgAROQsDC4iQbpZsSkIAEJCCBMxB4aGGBcX8yMAaMAWPAGDAG3isGZgWQ/5feMzqOSUACEpCABCTwCwGKyFmbj040V4Ynqg5JQAISkIAEJHBSAqv738LipBur2xKQgAQkIIEjCFhY3JE6/3pp/ZdKq2n+gbH8Y2O1v7+jjx2bBCQgAQlI4IwEDissuGiZPL96mdaxelH/+PHjL/k9FzSbUf8l0fzro8yDfubtABivY9Wv2QZj8+vXr0ORrGev33uLkOFkdkrgjgTIm+TDKL5rjpGfs1bzbpQLyb29OTeb693Gsk+jda/2aKbb7e3Zo8zHOWZ7TwL9Xu0UHvpfhRDQW8HHWD1gVodSdxz5ajvJM7I5OjBHfX2OfHOg1rnSX5+Mjw7TKlPfkV8d1FXedwncm0DPIS6MmhfkVL5T9G/5kAsp48R3zcXkJwdS7Y+8z20C7EGKvy612qOZ7shW5hntUWIgMdH1/X4fAqcpLLIlOLznguYQ5FcbejUh+M6BxrO2W5ID2ZVPtxYW2LvFh+q77xK4B4FRXJN/KXh5r/lEvvU8ih/YqmOj+M7FVG1G3+ecADxHh/mePdrSHc042yPmwpZNAqNYrFRe5m8s4tTe4N0qGGKHJ0nAIRbZeqDtvdSTaNVu3ikm8JcDtxcW9DFWf7UQil2eNgkcQYCYrcUAPiSOyRVitzZkt/IG2ZpfI/3EfJWr9n3fJjAqDkaMR3s00t2aaWuPsJtzLmfalg37r0+gnw19xb+eHH108r0yjCrByEE1aoyNDhjs7q2KOeQS5CMd+jJHZOPL1gGZ8TyxMVpDDmDkkKl+dx1ka1ER2/THv/T5lMCzCKT4rfMljnsMIzPqoz+XUS2SZ33GfCW+7z1nTJUe7cdWH/u6p2Xf+h5xVnFmZo/zvcemMtcjsIqnfdE24LIyjMqjCwvmIAHwJb/qKklWEwSZFBR5VvnR+yhRsUli1cY3sjTWXe337+hVnfT5lMAzCRCDyZ08uTxGcT/qw9dcRrl0Vn01J5+51jPPBXv2p7bRfmz1dd1qp75nL+sepa/ub/ypfdWO79cmsIqnXyP1BhYrw5gaBXmm4LIdBSV20UtLUNPPr17YkeFJIvRx7NQEiczWRV/t5X20hpF+LRLic9aHz+j0VnX6mN8SeDYB/gYj+ZVcqT6M4j7j5N4o1zLOM3lR5eq479sEOIdgXNvePRrpVjv1fbRH6ct5hvyor9rx/doEeiz21f4aqX108r0yjOosoEf/1QA62EVv1dCvgZ75uKzTsNMPMQ5H5qhykR890e+y2Oh9fFe/89fMzJXDutvvOn3cbwk8i0AuqZovxG7NMWJ6VCDjIzFe45/3Hve5jOocz1rf2eeBJ/vR25492tLttvje2qN+ViHXz8CRPfuuSWAUi3Wlv0dqHZ28rwxHFbleRPDd+6p8PaDS35/o98DmIKt2sTM6xJDrut1+vpNoPNPSl7lyKLNW5uS3dQB3G9VuxnxK4JkEUmz3XKG/x/iWX+jWnCIXur3kTe/fsmn/vwQ4U0Zn7p492tL91/q/b1t7lBiJJGcofbb3JDCKxUri4YUFk+FE/eWwqo5w2Kxkqjw2kgTRq3Y55NLf/+SEnVFftV/fkSU5a6v+Ms58kalj8YFnPVCRvcWHOrfvErgHAfKFuKwFQbcbGeRqEZyLpsd04j25EHt8Z4ynl1LIrJ91D2BXmaNdx+se9bGuy3c9g1Z7lD1Hjzlt70uAGJi1+ehEc2V4onq6IZJ1dvj2BZGgPcGRqYcp9kYy3ZbfEpCABCQggVcisLr/LSx27hbFwt7iAuj9TxXop2/0NyA73VBMAhKQgAQkcCgBC4s74qcw2PNXgP2vFNmE6PFMgXFH1zQlAQlIQAISeAoBC4unYHYSCUhAAhKQwHsQsLB4j312lRKQgAQkIIGnELCweApmJ5GABCQgAQm8BwELi/fYZ1cpAQlIQAISeAoBC4unYHYSCUhAAhKQwHsQsLB4j312lRKQgAQkIIGnELCweApmJ5GABCQgAQm8BwELi/fYZ1cpAQlIQAISeAoBC4unYHYSCUhAAhKQwHsQeGhhgXF/MjAGjAFjwBgwBt4rBmYllP9WyIyOYxKQgAQkIAEJ/EKAInLW5qMTzZXhiapDEpCABCQgAQmclMDq/rewOOnG6rYEJCABCUjgCAIWFnei/v3795/8q6W9/fjx46//nQnPVdv7z66v7DguAQlIQAISOIrAYYUFlyiT51f/qfA6ln9OHEC5pEcXeAWITux+/fq1Dv2kAMgYz94yR/Wny/Rv5sNub7HFPHsKi8jvke1z+S2BRxAgf3oOZZ7k6aogTlwn76I/eiJzS+6NbNj3NwHOyTAf7VEdv+VM7WddPW9n87kv70OAOJi1+ehEc2UYVQJ0FPAZqwfMLUkQtxLwPRE46BgbtehsjXcd/JrJ5lDdWywgt8Wkz+23BB5JIJfEqLCgL3lFDoxk4luNZ3JlK1+wwZw172PD520EYFg5swd1jxivZzTjW9zZ5xQe/TzjO2PxEPnERvp8vheBGlujlb9MYRHncLgHcsb6k8QiwPthRTLUpKt6OTBXYKKDHPa2Wk/ELbnaH79rn+8SOIIAsVgvJHzolxJ9WxdTzw1yd5R7ubx6rh6x5ivM2c9IvuuZlnMua2W873PG+h6y1+nLM7I863jt9/19CNRYG6369IUFiyJh6kJJhtHhRnJxaDKOfE/ODmgrGaOPjRQ2NQFJPMbqr87FOzI2CRxNYFRYENP9EuoX1cjv5EUfI+ewmfGtPzl3Pb/3E4BpPVM4eypn3ulbNeKBvdpq2OmxsSVr/3UJrGJpHWkbbFaGUSNAa7BXU4zVwM8YduslnP7RsxYP6CXgOcDqWHRrH7L1OzL1yXiXyeHIk8Y4c9fv6ES2ryf9dS7fJXAEAWI1eZP56UsMz/oyxhMb5AG/3mI/cT/K+67j920EOE9zzoQzz7RRX8Z4pvBg/2aFBWOz8WrT9+sSGOV5Xe3vp0AdnbyvDKNKAD6rsEhiMCdJ1A9GxmtCkISrNYwOWGxU2z1hOUTrPP0bLl1ngtkhCTyUALGciz8TjeJ+1Bf5+iTfa15V24l7C4tK7D7vI87wTgv72pex+sy5WM+wOs7+rmxUed+vSaDm+GiFDy0sCNJZYTEKUBxO5Y3DSQj6+dUEqhc8siRD9PsY37FRn3WuDmh0mDJ/Tbr4l7X0NTNXP0i7Tp/Xbwk8iwAxXnOKeYnv3tfjfsu/Gtsp9mu+5b3m0JYt+/cR6HuFVj93shd7LI7OPfSwMZprj01lrkWA+Jq1+ehEc2UYVS7ZLTmCd9SQn132VWdkg8DHRh/r39hBdpYoHH5dD/naVw/S+JY/teHH6AAd6UTXpwSeSYBY7jnABdL/QMA3/XsacU+M95a432un6/v9OwH2b8STPa3nKO99n3+39nfP6NxjhLmqzS19+69PgByftfnoRHNlOKrI1YuYfr57X5XfG7wzG3WM99FBR0Li39Z89PcDlr6qQxLyzY85mGuU6Fkfz5HdOu67BJ5FgHgdXTj1YiLGRzIjH7cuJWQtLEbEPt7H3tWzC77wp3EG1bOL82l1LsWTnGX5zpN+mwQgsIqFD0fKynDFj2z9kRC95ZKP3EgmOjmgIptkquPRJ7kiVxOr29g6ONFFtjbmi03mqTJ1LDI8a0On+1zHfZfAMwjU3OgxyvwZrxcU/eRK5FNoJ9ZncZ2cq3n4jHVecY7sTbjnWc+quje1AMlZm73qtka80M+ZOhq3770IJP+3Vv3rjbclNehfGR6onLLr1oRKstbFkuxJbN77QV1lfZeABCQgAQm8MoHV/W9hsWP3qNT3VOv5k0A3WXXZkPqnii7rtwQkIAEJSOCVCVhY3Gl3+JuI/K3DzCRFBNDrL3r+TcWMnGMSkIAEJHAGAhYWZ9glfZSABCQgAQmchICFxUk2SjclIAEJSEACZyBgYXGGXdJHCUhAAhKQwEkIWFicZKN0UwISkIAEJHAGAhYWZ9glfZSABCQgAQmchICFxUk2SjclIAEJSEACZyBgYXGGXdJHCUhAAhKQwEkIWFicZKN0UwISkIAEJHAGAg8tLDDuTwbGgDFgDBgDxsB7xcCsAPL/0ntGxzEJSEACEpCABH4hQBE5a/PRiebK8ETVIQlIQAISkIAETkpgdf9bWJx0Y3VbAhKQgAQkcAQBC4sjqDunBCQgAQlI4KIELCwuurEuSwISkIAEJHAEAQuLI6g7pwQkIAEJSOCiBCwsLrqxLksCEpCABCRwBAELiyOoO6cEJCABCUjgogQsLC66sS5LAhKQgAQkcAQBC4sjqDunBCQgAQlI4KIELCwuurEuSwISkIAEJHAEAQuLI6g7pwQkIAEJSOCiBCwsLrqxLksCEpCABCRwBAELiyOoO6cEJCABCUjgogQsLC66sS5LAhKQgAQkcAQBC4sjqDunBCQgAQlI4KIELCwuurEuSwISkIAEJHAEAQuLI6g7pwQkIAEJSOCiBCwsdm7sly9fdkp+XOwZc3zcOzUlIAEJSEACawKHFRZfv379yeT8uFB//Pjxzzd9jKcxHtn//ve//7xH948//vilL7J5Vlvfvn37R/b79+8/0f3zzz8z1fCJHfx7dAuDZ8z16LVo/z0I1Hyaxe1Wjs503oPgcavkXOMMXLV6/vazku+cszxtEoDAKhY+HCkrw0xOUHc5grgWAtkm+uohhByHFY1nTRBsJgHQiT3k0EvL/JFNf32iOxuvsvd4x9/q4z1sakMCjyBA/iS3iNuey3XOmp/0k1PRrXK+P54A7Nkrfn1f+uzsUc7dfn5mz+v4LAa6bb+vS2AVBw8tLMCKAwlMvgne3sc4fzKqrRcW1Qb6tRhI8mCj22G+KlvnYOyIww8f43P1x3cJvBKBnmezuK35yRqQJb9sxxHgDF2dM3XfeK9/6EG3n6ecl+7rcXv6KjNzNszafHSiuTIcVQKxBneq6drHe7/8a2ERW3n2Ay/92GGs2s7Y6DlKEnSZO35mrv4de9jIgYssP1p8yXfkeZKYNYHrmO8SeAUCiffqCzFNvO9po7jfo6fM/Qhwxuw9C5k151484Fzr+01fLzYi7/N9CKzy++GFRb9EE6w1YOt7toYg36qMWVQvRKKHLcb5belHtttBPrrxCX/pq9/1PfJJYPymr37nPfPyJwNkbBJ4VQI9b/Fz1Dfyn9xMjozG7XsOgb2FBedTzrF6ruY8rH3sq4XFc/bvlWdZ3V8fvt1WhgMll2iCk6BMwDLGbxSoHy0smJe5kigzPxmLX/GXJGPutNV3T7TVN3bDhKdNAq9IYFREjPpGvifHR2P2PY/A3sIiHrFv/UxMXz1PiQPbexOY3auQeXhhwSS5bLnECcpcrLzz65c7Op8pLLLlKTCYf9R6EiGzKiT6eNYW+6tv5LJ+C4tQ83kkAWK6XxzJneoXclu5VOVWh06V9f3jBEb7Vq3dWligOzt3Oavd20r4fd9XcfCUwiKXMc9cphxQ/RKu2zQLcBY1KkaormM/tkgGbI0a/d1OfI386ruvYfWNXQuL0PX5ygTIs5pP5Bf5MGvkG3K24wlwvq32q3vJ+cUejhrxcKu9kR37zk/gJQqLXKT1gidAZ4GK7CzAe0HAVnGg1Tno6xd93VLGeqLwXW2svrv91Tfzz4qd6p/vEjiSALGfImH0Nxgj34j/UW6OZO17LAHOsX6+zWZk3+rZF9ns/S22ouvzmgReorAAbQ/yFBv9EOLSxen8aqAT2OnnySFWG4dg7EYuB2OVyztzVRvVfvyNndE3uhlnntV35kXWJA0Nn69MgFhNjNe/vUiu1PxlvObrK6/ryr71M3B0xrFvMzn41LO47v2V2bm2fQQ4E2ZtPjrRXBmeqL7UEElXD8dHO+fh+2jC2peABCQggUcSWN3/b19YAB9IzyoumMvq/5Ehr20JSEACEngkAQuLnXSf8Ve4z5hj53IVk4AEJCABCXyIgIXFh7CpJAEJSEACEpDAiICFxYiKfRKQgAQkIAEJfIiAhcWHsKkkAQlIQAISkMCIgIXFiIp9EpCABCQgAQl8iICFxYewqSQBCUhAAhKQwIiAhcWIin0SkIAEJCABCXyIgIXFh7CpJAEJSEACEpDAiICFxYiKfRKQgAQkIAEJfIiAhcWHsKkkAQlIQAISkMCIwEMLC4z7k4ExYAwYA8aAMfBeMTAqONLnvxUSEj4lIAEJSEACElgSoIictfnoRHNleKLqkAQkIAEJSEACJyWwuv8tLE66sbotAQlIQAISOIKAhcUR1J1TAhKQgAQkcFECFhYX3ViXJQEJSEACEjiCgIXFEdSdUwISkIAEJHBRAhYWF91YlyUBCUhAAhI4goCFxRHUnVMCEpCABCRwUQIWFhfdWJclAQlIQAISOIKAhcUR1J1TAhKQgAQkcFECFhYX3ViXJQEJSEACEjiCgIXFEdSdUwISkIAEJHBRAhYWF91YlyUBCUhAAhI4goCFxRHUnVMCEpCABCRwUQIWFhfdWJclAQlIQAISOIKAhcUR1J1TAhKQgAQkcFECFhYX3ViXJQEJSEACEjiCgIXFEdSdUwISkIAEJHBRAhYWF91Yl3VfAj9+/Pj59evXoVH6v3//Phyrncj88ccftct3CUhAApcjcFhhwSHL5PlxOOedZz+Av3z58s/4t2/ffvKr8v0d+1WnjzNG6/NWubrb+FPH0K/2+8VS7fJeWx3DJpcW66GNuES3zl91Ml6f+NZ9YrzPPZKpdkbvzI0vf/755y/D6Y+ffTz9PPu8dYx3WmSwMxqvk/e5u3z4Vp2978yfeOk64Rlf+3j/Rn6vbNd91DdrW/FBpudk/AkDnquWfeKZVvd3i3Nkfa4JsJcjjpVzcqxaQy95s4qHfh7W/aw2kRv5UmV8vx6BUXzVVf59wteene8rwzGDHAFfW4K7BysHcmQJ/LwnYWKDYM7hvRXY9RDs+tiJD7GZ5+iApW+0Dubml5ZDtc7NWPTrers9dLKm6GwlLHOivzU+Wm983PPMAbR1+GSd+NAbOnWd8aXbGvnfGXTbfGOn26K/Mx/pbvWN1lFl9/jV5Vn30a3u04hZ/GMMBjWWGdvau+iNnj3W8aHuza0sR3O8c1/49twfca4ynC19H7ZiInGTGEa32gr/yI3GIuPzmgRWZ+bvN8NODivDMYNcAjR9BDTB2AOSAI5svWRzwEWfZ8Y5DLudKsf7lj6+kRy1YasfsPhLUvY1I1dlkdnypa6N+TqX/o3MVuIzT9YUXnUNGat9t7xjH3/7emMDZhlHtjZ8rkyxMVtH1c28ta+/Y2vLXpfd842txNKW/B6/qi78t+Kgyj3rHf+3mCWG2acay7k0RvG15TdzYANbiYE8owPrFe/I+hwTgF+Pr7p3aOUMCH/k615mf0czRDdj/Tv9yYvuS8Z9XpfA1t2QFR9WWCSw64FHwtTgj5Nbgc04CdUDu9pEputnbhKjN2z1JI09YFYd5CKbOfYemtiqa2XeeiB3v/KN75kDnfiWcZ7xpfbtfWc96IdR1lf140PmiT/I4A/jNHT3rCm2c1Dle/TEfl9z/x7pbfVt+YcvjPHsfrFexuoPmdoYq/tbx579jm8jRuxT+vG37jX9dZ09x/oa0OWXmEgMVDnGVnaqvO9jAuzLiiP82dO0vr/0z2KUscQGzxob6NLHHHt8iQ8+r0OgxtZoVf9G3mh00rcyHNVR8CZgCVbGE7QE6egwzmEVm/UZG9jJrydd9DPOc6uhG38iE39jBz9pyEU2foz8j536xIcqm4MgPlbZ+s7cObS3kjp+Vr2971kr8rMLKQx41rXkwEGf9xnr7lO/wPt4tRlOPKvPI52tvi1O1Y/IZL35jk1k+fVGX2Kjjz37G19GjKrfcKz+8t3HRzZYC/GYsfBJjGat5BU2e25m3Od+Alt5Xy2wl4lZ+tnLyj7nDfs1ahnvcYEsthMre3wZ2bfv3ASIi1mbj040V4ajilwP3hxCyPCODIFMkHZZZHJYxWZ9EuA1YWKzylT9Ol+VyTu2kjTpq/7iY9ZUE4z39Edv9tySjX+M13ljqx72Sf7OrK43enue6NXDKGvqutmr9OMT/tLwmfG8p/+vjv//H3WNlQN26vxVJ+/odi79O7Kr54hTmFbd6hdMarz17+hVnfQd9cSXzojv7BN+sQ+shTbikrgfrQH7adGttjPGk3kqvzrm+z4C7MWKYd2TWIV9/2WsP9k/YoR50Ml+pj/ye3yJrM/rECAmZm0+OtFcGY4qchw2tfVDjuDlR5B2WfRyWFUbed862DM+0senUeIhix85YGOj+4suNpCLbHzMd3S3niMuVZY5M0f6sU1f/3X/4kv09j4zZ7ff18Thwl7Vhg5csJFDCBn6R3uKDGORxRb63W6dg3fs9/V2mb3fI06slRiorftV17TlT9ep9p79nn3JvGHPOvqP9Yy4jPqwtxWT2O1xg/yWnfjmc02AHOkxWrXYw5pXdSzvPSbSzzPxkT7ssZ+0vPe44Xs1Z+z5PD+BxMPWSl6isEgg4ywHT2+zw2h0EUSf5KF1/XyPLrE9hQU2k1j18ER3K+GRq7J9rfE1vvOkr/pIUvfGeN/krK/L8j2yEbnRGD5039iv6hf6mRNfcsBkX0dMMhZZbPT1xi/mihw+jvxk/u5T9LeeczWF1wAADbVJREFU8aGOs0edZ/crzJEbrQ17XafO8ex3fBkxq36wlll8whc7q5Y4yH51+RHzLuP3nADxtxV3jNV9HFlKjG/tEePdPvHB3vY286XL+n0dAv2M7Ct7icICpxLso+DNYdWdj15PAvo5BJNgI/1cDjxrw1b00j86lGOzyqav+4NMt9ETle/qSw5gbNKwUeeKbzzRrfbjR5XhHSax18fQHx00sVXnRq76GlthWu2gh3+dSdZXZfGv22X+eqHhZ11r5maOaiv9qyd6nQl9mTN+0odvyI7m7/OM7HaZZ32zlpXP+Fv3GPm6Z6O8GPmfeNnaC+z2PR7ZsW+bAPzq3kSS/s627zvf7PXW/mAre5i8yHfmqc8tX6qM79cjQAzN2nx0orkyTMAhk18ujXzz7MGNToI5U6NXdWrikFx1rL9jf6/+//zP//xiKwdptdl94yCuh3F87n7V5B5xQS8H7mi+HAaM1fWj1+fq6632eB+1aqOuEX5VH9vVl5E9xvu+jvxEF1laDq46V31nzd2XOs47a/hIw4fOtM6FXdYdmTpWfahxwHo+6s9H1jDTqT7OfEKurgGbda+zfvqRG8kzlr1MDKBXfehzzHx37HcCPb/DufeHefI54zx7S0wnHxnPHsdO5um67O8srrq839cgQFzM2nx0orkyPFF1SAIvReCWWOagzmFdF1EvXg7vkUyV910CEpDAWQmszkwLi7PurH7fjQBFwCpRMhl/Out/6kY/faO/AYmuTwlIQAJXILA6Ly0srrDLruHTBPir3tFfE3fDKUJIrPyix99apMDoen5LQAISuAoBC4ur7KTrkIAEJCABCbwAAQuLF9gEXZCABCQgAQlchYCFxVV20nVIQAISkIAEXoCAhcULbIIuSEACEpCABK5CwMLiKjvpOiQgAQlIQAIvQMDC4gU2QRckIAEJSEACVyFgYXGVnXQdEpCABCQggRcgYGHxApugCxKQgAQkIIGrEHhoYYFxfzIwBowBY8AYMAbeKwZmRZL/z5szOo5JQAISkIAEJPALAYrIWZuPTjRXhieqDklAAhKQgAQkcFICq/vfwuKkG6vbEpCABCQggSMIWFgcQd05JSABCUhAAhclYGFx0Y11WRKQgAQkIIEjCFhYHEHdOSUgAQlIQAIXJWBhcdGNdVkSkIAEJCCBIwhYWBxB3TklIAEJSEACFyVgYXHRjXVZEpCABCQggSMIWFgcQd05JSABCUhAAhclYGFx0Y11WRKQgAQkIIEjCFhYHEHdOSUgAQlIQAIXJWBhcdGNdVkSkIAEJCCBIwhYWBxB3TklIAEJSEACFyVgYXHRjXVZEpCABCQggSMIWFgcQd05JSABCUhAAhclYGFx0Y11WRKQgAQkIIEjCFhYHEHdOSUgAQlIQAIXJWBhcdGNvcqy/vzzz5/fvn176HL++OOPn9+/f3/oHBqXgAQk8C4EDissvnz58pPJ+4/+2jjwq8zXr1/r8E++6/iPHz/+uYj6HFwgjFf5XFq1r79nzu5Ll8MWc/T++h1bXJj05zuLwkbkmQ97yPa28mWPTp87c2T+PKtPfX/6ev/3f//3H/+jX58jvzJvf2J7y8cu+9lv1sjPtp8AMbjan5qD7KfttQnUfOasHLUq08+Dkbx970eAM3/W5qMTzZVhVAnQGpi59GtfpsBevZQi2w+2HGRJij4H9rDT7dG/dVBmjlz0yGb+zINNLibmQy6tzoNsbGW8ynZfGav60anP0Th2+G21kU6XZe6Rr+iOLuAuO5pj5Vf1AVajOKgy937P/t3b7hXtJYf6vte1Mpb8YO9HMVHlfT+WQM7OmRc55yKDziwGIufzvQiQ67M2H51orgyjymHTLw8O95FuP5QI5q4bd7gUSYDRHBx0I/vIji7T2Mx4vmMnB2fGWVPt634zRxr+I5/G2vulzXjWErn67Pbr2Nb7Hp0RC/r4oV/9Zp5+uOyZY8u/2OtzzOTvMZY9vYetq9tgv4nVvu9ZNyx73BLvNf4j6/N4AtnPlSc9J/km120SqARWMfHhiFkZxgmCshYHHETo9csVWfpzUEVuzyFV56jvFULesdcPypEvyOcSqkVE7NRn9bv2j95zae9ZV/S7fdYYTpHpz67Tx/kesaCP9cIEG3XtnVufY49f8SNs851nLqbMn9jp38gnRmILf8KV9/od+zyxia+2bQLZa7jnfVv63xFkZfsvj1d5I1eI++RRz92Zn9GdyTj2fgSIoVmbj040V4ZR5ZBBLr9cFCOzyOTCjF6+R/LpQzZJQ+LMGhdPfMlz6+DMhVUv15Ht6vdovPcxX+becwhHtj5XXPb4NCss8Bmmdb86p+pP3ld+hUX2LN88R1xiN5z45j17k3H06R991zl4J0ZSgPQxv/8uOLOPtxYWNV5k+ToEso/JI77JlT2NXIneHnll3oPAKn72RdeA1cowKgRkDptcHANTf3VhLwdaLol8b+lkDnSZhydJs9VGl+mWfC6vexcW+Ma68DW/LX/pR6ZygE39Hul2nZHMiAV9WW/WHz6jwqL6scev+FHjIn082UN8SJt9h2H8XX3HJuvJmtLn828CMKz84dT3fYsVejUetuTsfz4B8oicS0tu176M9efe/e96fl+bAHfMrM1HJ5orw6jWCyTBvHWo18swl8SewK9zRI9EGjUOv72JEn9zcY3s0Vf93pLZ6o+/M58+Yn+PzogFfXW9sMUWz+7jnjm21l33rMrMCgnk6njYxd/Vd+axsPibBHvNHuaXPc53f4bf6Al77NmOJ1D3LecgT/a3tlFfHee953wf9/t9CRBnszYfnWiuDKPaLxC+0etBjiz9HFBpBH4SI315oh8bPKtcCgLs5dKJ3ugyZQy5XvDETrcRW3l2v9M/ejJHt9f973pb9ke2ojvTicyIBX3dP+bBXj9kZnN0G5kzT/a57ln66asX1Ox7VUj08czBevjZ1gTg1Pe9a7HXK5mu4/dzCYxintya5Sk69Tx+rsfO9uoEOP9nbT460VwZRnV0aRKw6KYwyBT9osrF0C8g9LCRNpqDhMFetzm6TLHDHD2JYmOWfOj2OeLX6InffT0cynU9XW9knzXPDvORDmuvl/aIBX2j9eJzn280x8qvrG2LLfNUH2ffiY/4u/rO3NjET9uaAHHZ971qwR6etc1iucr5/jwCyY2ccaPcr96whzVH2Oeal1XW9/ckwPk/a/PRiebKMAcOMvnVQE0fT4K4fveDrNupB1cfyxy9v89R58t7XWqXr3NGjkSLLs/ud+TqEzu5VKM7so1Otx/5PEeJvtLJwRIbeebgyffIp6xvNcfIr8og79jLftFX9wwbs2/8i688sTP7TvER9vHB55wAnLPvSGbviZfOPPxHsTOfxdFnEKg5Tm7Vxt5ln2veZU95Joeqnu/vS4CYmLX56ERzZXii6pAE/jqo+gH3aCxcerWYefR82peABCRwRQKr+9/C4oq7fpI1cck/q7jgT9v+afokgaGbEpDASxOwsHjp7dE5/or20Rc+Bcze/4rGHZGABCQggTkBC4s5H0clIAEJSEACEriBgIXFDbAUlYAEJCABCUhgTsDCYs7HUQlIQAISkIAEbiBgYXEDLEUlIAEJSEACEpgTsLCY83FUAhKQgAQkIIEbCFhY3ABLUQlIQAISkIAE5gQsLOZ8HJWABCQgAQlI4AYCFhY3wFJUAhKQgAQkIIE5AQuLOR9HJSABCUhAAhK4gYCFxQ2wFJWABCQgAQlIYE7AwmLOx1EJSEACEpCABG4gYGFxAyxFJSABCUhAAhKYE7CwmPNxVAISkIAEJCCBGwhYWNwAS1EJSEACEpCABOYELCzmfByVgAQkIAEJSOAGAhYWN8BSVAISkIAEJCCBOQELizkfRyUgAQlIQAISuIGAhcUNsBSVgAQkIAEJSGBOwMJizsdRCUhAAhKQgARuIGBhcQMsRSUgAQlIQAISmBOwsJjzcVQCEpCABCQggRsIWFjcAEtRCUhAAhKQgATmBCws5nwclYAEJCABCUjgBgIWFjfAUlQCEpCABCQggTkBC4s5H0clIAEJSEACEriBgIXFDbAUlYAEJCABCUhgTsDCYs7HUQlIQAISkIAEbiBgYXEDLEUlIAEJSEACEpgTsLCY83FUAhKQgAQkIIEbCFhY3ABLUQlIQAISkIAE5gQsLOZ8HJWABCQgAQlI4AYCFhY3wFJUAhKQgAQkIIE5AQuLOR9HJSABCUhAAhK4gYCFxQ2wFJWABCQgAQlIYE7AwmLOx1EJSEACEpCABG4gYGFxAyxFJSABCUhAAhKYE7CwmPNxVAISkIAEJCCBGwhYWNwAS1EJSEACEpCABOYELCzmfByVgAQkIAEJSOAGAhYWN8BSVAISkIAEJCCBOQELizkfRyUgAQlIQAISuIGAhcUNsBSVgAQkIAEJSGBOwMJizsdRCUhAAhKQgARuIGBhcQMsRSUgAQlIQAISmBOwsJjzcVQCEpCABCQggRsIWFjcAEtRCUhAAhKQgATmBCws5nwclYAEJCABCUjgBgIWFjfAUlQCEpCABCQggTkBC4s5H0clIAEJSEACEriBwEMLC4z7k4ExYAwYA8aAMfBeMTCrQ/4zG3RMAhKQgAQkIAEJ3ELAwuIWWspKQAISkIAEJDAlYGExxeOgBCQgAQlIQAK3ELCwuIWWshKQgAQkIAEJTAn8Pxu35NYkuLgUAAAAAElFTkSuQmCC\\\"\\u003e\\u003c/p\\u003e\\u003cp\\u003e \\u003cb\\u003eTreatment objectives\\u003c/b\\u003e \\u003c/p\\u003e \\u003cp\\u003eThe objective was to deal with the patient's complaints and address her compromised smile and facial aesthetics by:\\u003c/p\\u003e \\u003cp\\u003e \\u003col\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003eClosing the midline diastema\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003eTreating the retained deciduous teeth and bringing the impacted upper permanent canine to occlusion.\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003eImproving the inter-incisal relationship to achieve normal overjet and overbite; achieving Class I canine and molar relationship\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003eAchieving normal bone heights, gingival level, and contour following orthodontic rehabilitation.\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003c/ol\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cb\\u003eTreatment alternatives\\u003c/b\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003col\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003eFollowing diastema closure and extraction of #52, #62, #53 and #63, canine substitution by bringing the impacted canine down into the arch orthodontically to replace the missing lateral incisors. This would be followed by protraction of the #14 and #24 into the remaining spaces.\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003eFollowing diastema closure and extraction of #52, #62, #53 and #63, canine substitution by bringing the impacted canine down into the arch to substitute the missing lateral incisors. This would be followed by placing prosthetic implants in place of the upper canines.\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003eThe last option was to align the upper and lower arches following closure of the midline diastema. The #52 and #62 were to be extracted and the #53 and #63 were to be atraumatically extracted and auto transplanted into the prepared sockets of #52 and #62. The impacted #13 and #23 would be atraumatically and surgically removed and auto transplanted in the prepared sockets of #53 and #63. The arched would then be re-aligned and the occlusion settled. Future prosthetic implants may be necessary in place of the transplanted #53 and #63 depending on the prognosis of the auto-transplanted teeth.\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003c/ol\\u003e \\u003c/p\\u003e \\u003cp\\u003eThe patient was explained the risks that accompany orthodontic extrusion and alignment of an impacted canine of such severity such as loss of vitality, loss of periodontal attachment, root resorption of both the canine and adjacent teeth or even ankylosis of the canine. In addition, it was re-iterated that due to the particular position of the impacted canine, and the root tip of the #23 being dilacerated, and within the maxillary sinus, it was judged that the risks related to orthodontic traction were too high. With these considerations in mind, the patient and the orthodontist decided to auto transplant the impacted canine, as this procedure would imply less risk. The root length of #52 and #62 were less than 3 mm and risked dislodgement during the surgical exposure and removal of #13 and #23. The maneuver of transplanting #53 and #63 (with root length\\u0026thinsp;\\u0026gt;\\u0026thinsp;7mm) in place of the #52 and #62 (with root length\\u0026thinsp;\\u0026lt;\\u0026thinsp;3 mm) was proposed due to better long-term prognosis. In the event of post-transplant root resorption, there would still be enough stability to maintain ideal bone levels for a future implant on the lateral incisors regions.\\u003c/p\\u003e \\u003cp\\u003e \\u003cb\\u003eTreatment Progress\\u003c/b\\u003e \\u003c/p\\u003e \\u003cp\\u003eFollowing impressions, setup models were fabricated which were then sent to \\u003cem\\u003eIncognito\\u003c/em\\u003e for manufacturing the custom appliance. The customized lingual appliance was then bonded to the upper and lower arches.\\u003c/p\\u003e \\u003cp\\u003e \\u003col\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003eInitial levelling and de-rotation\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003c/ol\\u003e \\u003cdiv class=\\\"BlockQuote\\\"\\u003e \\u003cp\\u003eA sequence of .014\\u0026rdquo; super elastic NiTi archwire, followed by .016\\u0026rdquo; and .016 X .022\\u0026rdquo; NiTi archwires were used for the initial leveling and alignment stages. The #53 and #63 were by-passed at this stage. Most rotations were corrected in this stage. (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003col\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003eMidline diastema closure \\u0026amp; recipient site preparation\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003c/ol\\u003e \\u003cdiv class=\\\"BlockQuote\\\"\\u003e \\u003cp\\u003eAn open coil spring was placed from the #14 to #52 and #24 to #62 on an .016 X .022\\u0026rdquo; NiTi archwire in order to close the midline diastema and at the same time gain space for the transplantation of the #13 and #23 as they were mesio-distally wider compared to the #53 and #63. (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig4\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003col\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003eTransalveolar transplantation\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003c/ol\\u003e \\u003c/p\\u003e \\u003cp\\u003eFollowing the extraction of the #52 and #62, the #53 and #63 were atraumatically extracted and auto transplanted into the prepared sockets of #52 and #62. The #13 and #23 were then carefully surgically removed and auto transplanted in the prepared sockets of #53 and #63. (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig5\\\" class=\\\"InternalRef\\\"\\u003e5\\u003c/span\\u003e)\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003col\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003eReleveling and finishing\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003c/ol\\u003e \\u003c/p\\u003e \\u003cp\\u003eTwo weeks following the transplantation, orthodontic forces were re-initiated on the upper arch excluding the auto transplanted #53 and #63 in place of the #12 and #22. The facial, palatal and proximal surfaces of the now #12 and #22 were prepared and contoured to resemble regular lateral incisors for esthetic and functional purposes. (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig6\\\" class=\\\"InternalRef\\\"\\u003e6\\u003c/span\\u003e)\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003eFollowing 6 months of levelling and occlusal settling, the patient had to go abroad for a year. The fixed appliance was maintained until she returned. On return, the minor spaces were closed and the occlusion was settled. In addition, the transplanted #53 and #63 were further reshaped and prepared, in order to mimic the lateral incisors. (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig7\\\" class=\\\"InternalRef\\\"\\u003e7\\u003c/span\\u003e) The braces were then removed (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig8\\\" class=\\\"InternalRef\\\"\\u003e8\\u003c/span\\u003e) and fixed retention was provided on the upper and lower arches.\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e\"},{\"header\":\"3. Treatment results\",\"content\":\"\\u003cp\\u003ePost-treatment intra-oral photographs showed good alignment, a reasonable relationship between upper and lower teeth, and ideal overjet and overbite. The midline diastema was completely closed. (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig8\\\" class=\\\"InternalRef\\\"\\u003e8\\u003c/span\\u003e) Post treatment radiographs show acceptable root angulations with mild root resorption of #12 and #22. No signs of PDL obliteration or ankylosis was seen on #13 and #23, alveolar bone levels were maintained satisfactorily around the transplanted teeth. (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig9\\\" class=\\\"InternalRef\\\"\\u003e9\\u003c/span\\u003e) Ideal red and white esthetics were maintained in the upper anterior region. An aesthetic and pleasing smile was achieved along with harmony between the upper and lower lips, lip competence, and a bilateral Class I canine and molar relationships. The dental midlines were corrected, and no muscle or joint problems arose during the treatment. (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig8\\\" class=\\\"InternalRef\\\"\\u003e8\\u003c/span\\u003e)\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003ePost-treatment cephalometric analysis showed that the sagittal jaw relationship improved while the mandibular plane remained almost constant (pre-FMA, 15.40; post-FMA, 15.58). There was a marked increase in the upper and lower incisor inclination (pre-IMPA, 100.12; post-IMPA, 106.5; pre-U1-SN, 90.01; post- U1-SN, 101.16). (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e and Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig10\\\" class=\\\"InternalRef\\\"\\u003e10\\u003c/span\\u003e) Mild intrusion of the lower incisors may be noted that resulted in the correction of the increased overbite. The patient was provided with a fixed lingual retainer along with an Essix retainer on the upper and lower arch to maintain the corrected teeth positions.\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003eRoutine check-ups were emphasized to closely monitor the treatment results. Two-year post-treatment follow up records showed a stable occlusion with no signs of ankylosis or further post-transplant resorption, improvement in the gingival health and a well maintained Class I canine and molar relationship. (Figs.\\u0026nbsp;\\u003cspan refid=\\\"Fig11\\\" class=\\\"InternalRef\\\"\\u003e11\\u003c/span\\u003e \\u0026amp; \\u003cspan refid=\\\"Fig12\\\" class=\\\"InternalRef\\\"\\u003e12\\u003c/span\\u003e)\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e\"},{\"header\":\"4. Discussion\",\"content\":\"\\u003cp\\u003eTrans alveolar transplantation is a very viable option in cases of impacted or ectopic teeth, congenitally missing teeth or replacement of teeth with poor prognosis. This procedure involves the surgical re-implantation of a delicately extracted tooth into a new prepared socket. Although there are many indications and contraindications that are obvious to seasoned practitioners, extreme caution must be taken at each step of the procedure to ensure a successful result. A successful transplantation must result in the preservation and regeneration of the periodontal ligament at the recipient site.\\u003csup\\u003e\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003eThe advantages of trans-alveolar transplantation, compared to prosthetic rehabilitation, especially lies in providing a biological replacement tooth that retains the potential to induce alveolar bone growth, maintains bone volume through proprioceptive function and a normal PDL, is able to erupt with neighboring teeth during continued facial growth, maintains a normal interdental papilla, and can also be moved orthodontically.\\u003csup\\u003e\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003eIn comparison, prosthetic implants are an artificial replacement, which may require alveolar bone grafting if the bony support is insufficient, are osseointegrated and non-adjustable after placement and thus do not adapt to facial growth.\\u003csup\\u003e\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e\\u003c/sup\\u003eFrom an orthodontic perspective, the failure to obtain adequate aesthetics when aligning impacted or ectopic canines can also be an important factor when considering treatment options. As mentioned before, exposure and subsequent orthodontic traction can lead to resorption of the adjacent teeth, compromised gingival margins, loss of periodontal support, ankylosis, and long treatment durations.\\u003csup\\u003e\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e\\u003c/sup\\u003e Based on this perspective, trans-alveolar transplantation may be considered a viable option in certain such cases that fit the clinical criteria.\\u003c/p\\u003e \\u003cp\\u003eTransplantation on the other hand can be followed by unfavorable outcomes too, which include pulp necrosis and infection, replacement root resorption and lack of root development of immature teeth and possible ankylosis of the transplanted tooth.\\u003csup\\u003e\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003eIn the case presented, due to the unfavorable positions of the impacted canine and dilacerated root of #23 within the maxillary sinus, the prognosis involving orthodontic traction seemed uncertain. Hence, transplantation was chosen as the treatment of choice.\\u003c/p\\u003e \\u003cp\\u003eOne of the most important factors that determine the success is the stage of root formation of the transplanted tooth. An evaluation of transplants to the maxillary incisor region showed a 96% survival rate with immature roots, while teeth with mature roots had an 82% survival rate.\\u003csup\\u003e\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e\\u003c/sup\\u003e Post-transplant root growth on the other hand was noticably more in transplanted teeth with more mature apices. Studies have shown an overall significant reduction in final root length when compared with the contralateral side, while postoperative resorption is rarely reported.\\u003csup\\u003e\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003eAnother factor that plays a critical role is the extra-oral storage time. Andreasen et al.\\u003csup\\u003e\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e\\u003c/sup\\u003e found that teeth with completely formed roots with no extra-oral storage had less risk of pulpal necrosis compared to those who were stored until transplantation. It is known that traumatically avulsed teeth lose fifty percent probability of periodontal healing after 8 min of extra-oral dry storage, and the clonogenic capacity of the periodontal ligament cells fall upto 3% after 30 min of extra-oral dry storage.\\u003csup\\u003e\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e\\u003c/sup\\u003e Keeping these ranges in mind, in the present case, the teeth were stored for an acceptable time of less than 10 minutes in cold saline solution that is a viable media for extraoral storage.\\u003c/p\\u003e \\u003cp\\u003eIn our case, it was of important to maintain the deciduous canines in the recipient area free from any pathology or inflammation, and it was desirable to delay extraction until the time of transplantation, as the extraction site provided the basis of a crypt or a readymade socket for placement. At the same time, it is important to adequately prepare the recipient area by maintaining sufficient space for the transplant.\\u003csup\\u003e\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e\\u003c/sup\\u003e We used open coil springs placed between the upper premolars and deciduous lateral incisors for this purpose. In addition, there should be adequate alveolar support, adequate attached, keratinized tissue to allow proper coverage of the transplant. Nordenram and Bergman\\u003csup\\u003e\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e\\u003c/sup\\u003e disclosed better results in the maxilla than in the mandible.\\u003c/p\\u003e \\u003cp\\u003eIt is of vital importance that the transplant be removed as atraumatically as possible causing no damage to the periodontium. In certain cases of palatal impactions wherein the crown of the canines are very close to the apices of the incisors, atraumatic removal becomes impossible.\\u003csup\\u003e\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e\\u003c/sup\\u003e In such cases, orthodontic traction to bring the tooth to a more favorable position to facilitate atraumatic removal may be a possible solution.\\u003c/p\\u003e \\u003cp\\u003eAnkylosis is one of the other major complications in tooth transplantation. It is reported that injury to the periodontal ligament during the surgical removal or improper seating into the prepared socket may contribute to such a situation. It is also suggested that lack of prolonged occlusal stimuli on the transplanted tooth may contribute to ankylosis.\\u003csup\\u003e\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e\\u003c/sup\\u003e A study on beagle dogs demonstrated that the application of orthodontic force after a period of 2 weeks of splinting promotes the periodontal healing and may prevent ankylosis.\\u003csup\\u003e\\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003eSeverance of the vessels and nerves to the pulp following removal of the transplanted tooth from the donor area may lead to serious damage to the architecture and function of the pulp. Subsequent healing usually restores the content of the pulp canal, including the nerve supply. Pulpal sensitivity without pulp canal obliteration may take place in rare cases; likewise, pulp canal obliteration without pulp sensitivity may occur when nerve regeneration fails.\\u003csup\\u003e\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e\\u003c/sup\\u003eTransalveolar transplantation can have complications such as loss of pulp vitality, poor periodontal healing, and root resorption, which can be minimized if mature transplants are root filled within 4 weeks of transplantation.\\u003csup\\u003e\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003eA successful transplantation would feature very little or no post-transplant root resorption and the presence of an intact lamina dura indicating healthy periodontal healing. Usually the healing completes within 2 months. Transplanted teeth with mature root development can develop resorption more frequently than teeth with immature roots; it can be detected radiographically within 6 months of transplantation.\\u003csup\\u003e\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003eIn the present case, orthodontic movement was initiated a couple of weeks after the transplantation, to allow for adequate healing of the periodontal ligament. In fact, the American Academy of Endodontics (AAE) recommends a splinting period of 7\\u0026ndash; 14 days and International Association of Dental Traumatology (IADT) recommends a splinting period up to 2 weeks for adequate healing. In the case described here, there were no signs of root resorption or ankylosis even 2 years after surgery, thus confirming the success of the procedure.\\u003c/p\\u003e\"},{\"header\":\"5. Conclusions\",\"content\":\"\\u003cp\\u003eTransalveolar transplantation is an underutilized technique, which if conducted with a multidisciplinary team, can be an adjunct treatment option for patients with impacted/ ectopic teeth. In a case of a young female with a complex palatal impaction of maxillary canines, in whom orthodontic traction may risk complications, was successfully treated through transplantation and fixed orthodontics. After a 2-year observation period, no signs of root resorption or ankylosis were observed, thus confirming the success of the procedure.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthical approval:\\u003c/strong\\u003e Not required\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding Declaration:\\u0026nbsp;\\u003c/strong\\u003eNo funding was provided or obtained for this particular study\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication:\\u0026nbsp;\\u003c/strong\\u003eA written informed consent was obtained from the patient for the purpose of this publication\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eData availability declaration\\u003c/strong\\u003e: All the data is available within the manuscript and if further information may be requested from the corresponding author if needed.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interests declaration:\\u0026nbsp;\\u003c/strong\\u003eAuthors disclose no competing interests\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eHariri R, Alzoubi EEM. Autotransplantation in combination with orthodontic treatment. J Orthod Sci. 2019 Aug 8;8:11. doi: 10.4103/jos.JOS_62_18. PMID: 31497570; PMCID: PMC6702680.\\u003c/li\\u003e\\n\\u003cli\\u003eRakhshan V. Congenitally missing teeth (hypodontia): A review of the literature concerning the etiology, prevalence, risk factors, patterns and treatment. Dent Res J (Isfahan). 2015 Jan-Feb;12(1):1-13. doi: 10.4103/1735-3327.150286. PMID: 25709668; PMCID: PMC4336964.\\u003c/li\\u003e\\n\\u003cli\\u003eAdith Venugopal, Mona Sayegh Ghoussoub, Paolo Manzano, Prateek Mehta, Anand Marya, Nikhilesh R Vaid, Bj\\u0026ouml;rn Ludwig \\u0026amp; S. Jay Bowman (2021) Molar protraction on an adult with severe high-angle Class III malocclusion and knife-edge residual ridges, Orthodontic Waves, DOI: 10.1080/13440241.2021.1940749\\u003c/li\\u003e\\n\\u003cli\\u003eEricson S, Kurol J 1986 Radiographic assessment of maxillary canine eruption in children with clinical signs of eruption disturbance. European Journal of Orthodontics 8: 133\\u0026ndash;140\\u003c/li\\u003e\\n\\u003cli\\u003eVenugopal A, Vaid NR. Interarch Traction Strategy for Palatal Cuspid Impactions. J Contemp Dent Pract. 2020 Dec 1;21(12):1408-1411. PMID: 33893268.\\u003c/li\\u003e\\n\\u003cli\\u003eVenugopal A. Interarch traction for impacted canines. APOS Trends Orthod 2020;10(1):60-1.\\u003c/li\\u003e\\n\\u003cli\\u003eZuf\\u0026iacute;a J, Abella F, G\\u0026oacute;mez-Meda R, Blanco H, Roig M. Autotransplantation of impacted maxillary canines into surgically modified sockets and orthodontic treatment: a 4-year follow-up case report. Int J Esthet Dent. 2020;15(2):196-210. PMID: 32467948.\\u003c/li\\u003e\\n\\u003cli\\u003eMirabella D, Giunta G, Lombardo L. Substitution of impacted canines by maxillary first premolars: a valid alternative to traditional orthodontic treatment. Am J Orthod Dentofacial Orthop. 2013 Jan;143(1):125-33. doi: 10.1016/j.ajodo.2011.08.029. PMID: 23273368.\\u003c/li\\u003e\\n\\u003cli\\u003eCruz RM. Orthodontic traction of impacted canines: Concepts and clinical application. Dental Press J Orthod. 2019 Jan-Feb;24(1):74-87. doi: 10.1590/2177-6709.24.1.074-087.bbo. PMID: 30916252; PMCID: PMC6434671.\\u003c/li\\u003e\\n\\u003cli\\u003eClokie CM, Yau DM, Chano L. Autogenous tooth transplantation: an alternative to dental implant placement? J Can Dent Assoc. 2001 Feb;67(2):92-6. PMID: 11253297.\\u003c/li\\u003e\\n\\u003cli\\u003eKallu R, Vincker F, Politis C, Mwalili S, Willems G 2005 Tooth transplantations: a descriptive retrospective study. International Journal of Maxillofacial Surgery 34: 745\\u0026ndash;755\\u003c/li\\u003e\\n\\u003cli\\u003eKim E, Jung J-Y, Chai I-H, Kun K-Y, Lee S-J 2005 Evaluation of the prognosis and causes of failure of 182 cases of autogenous tooth transplantation. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology \\u0026amp; Endodontics 100: 112\\u0026ndash;119\\u003c/li\\u003e\\n\\u003cli\\u003eB. I. Aslan and N. \\u0026Uuml;\\u0026ccedil;\\u0026uuml;nc\\u0026uuml;, \\u0026ldquo;Clinical Consideration and Management of Impacted Maxillary Canine Teeth, Emerging Trends in Oral Health sceince and Dentistry,\\u0026rdquo; \\u003cem\\u003eInTech\\u003c/em\\u003e, 2015.\\u003c/li\\u003e\\n\\u003cli\\u003eNimčenko T, Omerca G, Varinauskas V, Bramanti E, Signorino F, Cicci\\u0026ugrave; M. Tooth auto-transplantation as an alternative treatment option: A literature review. Dent Res J (Isfahan). 2013 Jan;10(1):1-6. doi: 10.4103/1735-3327.111756. PMID: 23878556; PMCID: PMC3714809.\\u003c/li\\u003e\\n\\u003cli\\u003eZachrisson B U, Stenvik A, Haan\\u0026aelig;s H R2004 Management of missing maxillary teeth with emphasis on autotransplantation. American Journal of Orthodontics and Dentofacial Orthopedics 126: 284\\u0026ndash;288\\u003c/li\\u003e\\n\\u003cli\\u003eAmos MJ, Day P, Littlewood SJ. Autotransplantation of teeth: an overview. Dent Update. 2009 Mar;36(2):102-4, 107-10, 113. doi: 10.12968/denu.2009.36.2.102. PMID: 19388391.\\u003c/li\\u003e\\n\\u003cli\\u003eRosa M, Zachrisson BU. Integrating esthetic dentistry and space closure in patients with missing maxillary lateral incisors. J Clin Orthod. 2001 Apr;35(4):221-34. PMID: 11345569.\\u003c/li\\u003e\\n\\u003cli\\u003eKafourou V, Tong HJ, Day P, Houghton N, Spencer RJ, Duggal M. Outcomes and prognostic factors that influence the success of tooth autotransplantation in children and adolescents. Dent Traumatol. 2017 Oct;33(5):393-399. doi: 10.1111/edt.12353. Epub 2017 Jul 14. PMID: 28612428.\\u003c/li\\u003e\\n\\u003cli\\u003eTsukiboshi M, Yamauchi N, Tsukiboshi Y. Long-term Outcomes of Autotransplantation of Teeth: A Case Series. J Endod. 2019 Dec;45(12S):S72-S83. doi: 10.1016/j.joen.2019.05.016. Epub 2019 Oct 14. PMID: 31623912.\\u003c/li\\u003e\\n\\u003cli\\u003eKugelberg R, Tegsj\\u0026ouml; U, Malmgren O. Autotransplantation of 45 teeth to the upper incisor region in adolescents. Swed Dent J. 1993;18:165\\u0026ndash;72. - PubMed\\u003c/li\\u003e\\n\\u003cli\\u003eAndreasen JO, Paulsen HU, Yu Z, Schwartz O. A long-term study of 370 autotransplanted premolars. Part III. Periodontal healing subsequent to transplantation. Eur J Orthod. 1990;12:25\\u0026ndash;37. - PubMed\\u003c/li\\u003e\\n\\u003cli\\u003eSlagsvold O, Bjercke B. Autotransplantation of premolars with partly formed roots: A radiographic study of root growth. Am J Orthod. 1974;66:355\\u0026ndash;66. - PubMed\\u003c/li\\u003e\\n\\u003cli\\u003eKinane DF, Stathopoulou PG, Papapanou PN. Periodontal diseases. Nat Rev Dis Primers. 2017 Jun 22;3:17038. doi: 10.1038/nrdp.2017.38. PMID: 28805207.\\u003c/li\\u003e\\n\\u003cli\\u003eBoschini L,Tepedino M,Melillo M.et al. Autotransplantation of an impacted maxillary canine with complete root formation in a young female: a case report. \\u003cem\\u003eOral Surg.\\u003c/em\\u003e 2019; 12: 139-147.\\u003c/li\\u003e\\n\\u003cli\\u003eNordenram A, Bergman G. Allogeneic transplants using cobalt-60-irradiated teeth in monkeys. Oral Surg Oral Med Oral Pathol. 1970 Jun;29(6):944-9. doi: 10.1016/0030-4220(70)90451-2. PMID: 4986714.\\u003c/li\\u003e\\n\\u003cli\\u003eTsukiboshi M. Autotransplantation of teeth: requirements for predictable success. Dent Traumatol. 2002 Aug;18(4):157-80. doi: 10.1034/j.1600-9657.2002.00118.x. PMID: 12442825.\\u003c/li\\u003e\\n\\u003cli\\u003ePark JH, Tai K, Hayashi D. Tooth autotransplantation as a treatment option: a review. J Clin Pediatr Dent. 2010 Winter;35(2):129-35. doi: 10.17796/jcpd.35.2.97816254u2140x88. PMID: 21417113.\\u003c/li\\u003e\\n\\u003cli\\u003eYang Y, Bai Y, Li S, Li J, Gao W, Ru N. Effect of Early Orthodontic Force on Periodontal Healing After Autotransplantation of Permanent Incisors in Beagle Dogs. J Periodontol 2012;83:235\\u0026ndash;41.\\u003c/li\\u003e\\n\\u003cli\\u003eBastos JV, C\\u0026ocirc;rtes MIS. Pulp canal obliteration after traumatic injuries in permanent teeth - scientific fact or fiction? Braz Oral Res. 2018 Oct 18;32(suppl 1):e75. doi: 10.1590/1807-3107bor-2018.vol32.0075. PMID: 30365616.\\u003c/li\\u003e\\n\\u003cli\\u003eSagne S, Thilander B. Transalveolar transplantation of maxillary canines. A critical evaluation of a clinical procedure. Acta Odontol Scand. 1997 Jan;55(1):1-8. doi: 10.3109/00016359709091932. PMID: 9083567.\\u003c/li\\u003e\\n\\u003cli\\u003ePatel S, Fanshawe T, Bister D, Cobourne MT. Survival and success of maxillary canine autotransplantation: a retrospective investigation. Eur J Orthod. 2011 Jun;33(3):298-304. doi: 10.1093/ejo/cjq071. Epub 2010 Sep 5. PMID: 20819783.\\u003c/li\\u003e\\n\\u003cli\\u003ePogrel MA. Evaluation of over 400 autogenous tooth transplants. J Oral Maxillofacial Surg. 1987;45:205\\u0026ndash;11. - PubMed\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Auto-transplantation, impacted canines, transplantation, retained deciduous teeth\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-4309109/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-4309109/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003eTrans-alveolar transplantation, though rarely employed, stands as a viable adjunctive treatment for individuals grappling with severely impacted or ectopic teeth, particularly when executed by a collaborative, multidisciplinary team. In the case of a 25-year-old woman facing a complex palatal impaction involving both maxillary canines alongside aplasia of both lateral incisors, traditional orthodontic traction posed risks of complications. To navigate this challenge successfully, a blend of deciduous and permanent tooth transplantation coupled with fixed orthodontics was employed.\\u003c/p\\u003e \\u003cp\\u003eOver a meticulous two-year monitoring period, no indications of root resorption or ankylosis surfaced on the transplanted canines, affirming the efficacy of the surgical intervention.\\u003c/p\\u003e\",\"manuscriptTitle\":\"An Alternate Approach involving Trans-alveolar Transplantation in a Case Involving Impacted Canines and Retained Deciduous Teeth.\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2024-05-07 15:11:47\",\"doi\":\"10.21203/rs.3.rs-4309109/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"915c0f15-d779-403d-a839-7846bcbac350\",\"owner\":[],\"postedDate\":\"May 7th, 2024\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2024-06-09T09:23:39+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2024-05-07 15:11:47\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-4309109\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-4309109\",\"identity\":\"rs-4309109\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}