Autotransplantation of a Fully Developed Third Molar Using Root‑end CEM Filling to Replace a Maxillary First Molar with Vertical Root Fracture: A 3-Year Case Report

Autogenous tooth transplantation (ATT) preserves the periodontal ligament (PDL) and alveolar remodeling. This case report describes the 3‑year outcome of ATT using a fully developed maxillary third molar to replace a non‑restorable maxillary first molar (#26) with vertical root fracture (VRF) and a large endodontic‑periodontic lesion. A 41‑year‑old female with a hypererupted, caries‑free maxillary left third molar (#28) presented with grade III mobility and deep probing depths on tooth #26. After atraumatic extraction of #26 and careful PDL‑sparing extraction of #28, the donor tooth underwent extraoral root‑end resection (1 mm), 3‑mm retrograde cavity preparation, and obturation with calcium‑enriched mixture (CEM) cement. Total extraoral time was 9 minutes (extraction: 2 min; preparation/filling: 5 min; moistening: 2 min). The recipient socket was larger than the donor root, providing no primary stability. The tooth was seated 0.5 mm infraocclusion and retained only with crossed silk sutures. The patient was instructed on a soft‑diet protocol (for 1 month) and to avoid chewing on the transplanted tooth. Clinically, at 3‑year recall, the tooth was functional/asymptomatic with normal mobility and probing depths <3mm. Radiographically, bone healing and no root resorption/ankylosis were evident at the same recall. ATT of a mature molar with root‑end filling/sealing with CEM, thorough extraoral moisture control, and soft tissue suture‑only retention, achieved long‑term stability/function. This biologically driven surgical approach needs validation through large sample clinical trials.