Successful Autotransplantation of a Mandibular Third Molar to Replace a Non-restorable Mandibular First Molar: A Case Report

This case report describes the successful autotransplantation of a mandibular left third molar (tooth 38) to replace a non-restorable mandibular left first molar (tooth 36) in a 38-year-old female patient who presented with severe pain due to extensive caries and periapical pathology. Preoperative intraoral periapical radiographs via radiovisiography (RVG) confirmed the suitability of tooth 38 as a donor owing to its vitality and compatible root morphology. The procedure involved atraumatic extraction of tooth 36, precise socket preparation using a 3D-printed replica, and immediate transplantation of tooth 38 under local anesthesia. A non-rigid splint stabilized the autotransplanted tooth, and elective root canal treatment was performed at two weeks to prevent pulp necrosis. Follow-up at one, three, six, and 12 months revealed clinical stability, normal occlusion, and radiographic evidence of periodontal ligament healing, without resorption or ankylosis. The patient reported restored function and satisfaction. This case highlights autotransplantation as a viable and cost-effective alternative to implants, preserving natural dentition in adults with mature donor teeth, and underscores the importance of digital planning for optimal outcomes. A long-term follow-up is recommended to ensure sustained success.