Introduction
Imagine a tooth 
being used as an implant to restore vision 
. Sounds like a plot of a sci-fi movie, doesn’t it? However, this procedure dates back to the 1960s. In Italy, Benedetto Strampelli, a surgeon developed a unique approach to treat end stage corneal blindness using patient’s own tooth.
Strampelli observed how dental restorative materials are accepted by the body when placed inside a tooth. However, if the same materials are placed directly into soft tissue, the body often rejects them as invaders.
He proposed an idea of using a tooth and the surrounding bone as a vehicle to carry plastic lens. By using the tooth as a framework, he created a “biological disguise” for the artificial plastic lens, preventing the eye from rejecting it. This “autograft” technique was referred to as “Tooth in eye surgery” or the “Osseo-odonto-keratoprosthesis (OOKP)”.
Who needs this surgery?
OOKP is not a first-line treatment; it is a “last resort” for patients with bilateral corneal blindness due to: -
· Severe end‑stage Stevens–Johnson syndrome
· Ocular cicatricial pemphigoid
· Chemical or thermal burns, physical injury limited only to cornea
· Multiple failed corneal transplants
· Lyell Syndrome
· Epidermolysis bullosa acquisita
· Erythema multiforme
Note: - For the surgery to be successful, the patient must still have a healthy, functioning retina and optic nerve.
The Surgical Procedure
Tooth in eye surgery is a complex multidisciplinary journey involving an ophthalmologist, dentist and a radiologist.
Stage 1: The journey begins with a collaboration between an ophthalmologist and a maxillofacial surgeon.
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Extraction: A patient’s canine tooth—chosen for its large root and sturdy bone—is extracted along with a surrounding block of alveolar bone.
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Lamina: This tooth is shaped into a thin, rectangular plate called a lamina. A central hole is drilled, and a high-grade plastic optical cylinder is cemented inside.
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Vascularization: This prepared unit is then surgically tucked under the skin of the patient’s cheek. Over the next 3 to 4 months, the tooth grows a new blood supply and remains viable.
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Eye preparation: Simultaneously, a flap of mucosal tissue is harvested from inside the patient’s mouth and grafted onto the surface of the eye to create a new surface to receive the OOKP.
Stage 2: Once the tooth-implant is “vascularized” and the eye graft has healed, the second stage operation begins.
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The living tooth-lens unit is removed from the cheek pocket.
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The surgeon reflects the mucosal graft on the eye and removes the iris, the natural lens, and some of the vitreous jelly to create a clear path for light.
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The tooth-lens unit is stitched directly to the front of the eye. The plastic cylinder sits in the center, protruding through a small opening made in the mucosal flap. This serves as the new, permanent window through which the patient can finally see.
Discussion
OOKP offers a medical miracle for those in total darkness. Because the implant uses the patient’s own tissue, it has excellent biocompatibility and high long-term retention rates.
However, the procedure has its drawbacks:
· Surgical complexity and duration
· Loss of healthy tooth
· Intra Oral complications like infection, scarring, difficulty in chewing
· Unesthetic appearance of the new eye: It looks like a fleshy pink mound (the mucosal graft) with a small, clear plastic “bolt” (the cylinder) protruding from the center.
· Long-term Maintenance and Complications like glaucoma, limited visual field, tooth/bone resorption
Conclusion:
OOKP, despite being the last resort, it is also a medical miracle. By bridging the gap between dentistry and eye surgery, it proves that the key to seeing the world again might actually be hidden in our oral cavity. While the journey is long and intensive, the result is life-changing. For those who have spent years in total darkness, losing a tooth is a small price to pay.
What are your views on OOKP?
Can you think of a less complex alternative to OOKP? Would you trade your tooth for your eyesight?
MBH/AB
!!