Oral rehabilitation using three-dimensional-guided autotransplantation following pediatric rhabdomyosarcoma and secondary non-Hodgkin lymphoma with severe dental late effects: a case report.
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BACKGROUND: Pediatric cancer therapies often cause severe dental developmental disturbances. While extractions are common, biological rehabilitation using autotransplantation is rarely reported, particularly in patients with secondary malignancies and complex medical histories. This case describes multidisciplinary oral rehabilitation using tooth autotransplantation, guided implant placement, and three-dimensional digital planning in a young patient with dual pediatric malignancies and severe dental anomalies. CASE PRESENTATION: A 17-year-old White female patient from Latvia presented with multiple dental anomalies following intensive treatment for rhabdomyosarcoma at the age of 11 years and subsequent B-cell precursor non-Hodgkin lymphoma at the age of 14 years. Oncologic management included systemic chemotherapy, intrathecal therapy, and image-guided fractionated intensity-modulated radiation therapy to the entire brain and spinal cord (18 Gy total dose, 2 Gy per fraction, 9 fractions), resulting in severe root resorption of tooth 16, bilateral agenesis of mandibular second premolars (35, 45), and structural malformations of third molars. Treatment involved orthodontic space preparation, extraction of tooth 16, and autotransplantation of tooth 28 using a cone-beam computed tomography-guided three-dimensionally printed replica. Guided implant placement was performed in sites 35 and 45 after space opening. Extracted third molars were analyzed using micro-computed tomography, revealing therapy-induced disorganized dentin-pulp morphology and abnormal mineralization. At 3-year follow-up, the autotransplanted tooth exhibited complete root maturation and stable periodontal integration. Both implants showed stable osseointegration with no complications at 2-year follow-up. The patient reported high functional and aesthetic satisfaction. CONCLUSIONS: Biological rehabilitation using tooth autotransplantation and guided implant placement is feasible and effective in select patients post-oncology who have severe therapy-related dental anomalies. Integration of three-dimensional digital planning improves surgical accuracy and treatment outcomes. Interdisciplinary care is essential for managing complex oral rehabilitation after pediatric cancer therapy.