Treatment options for missing teeth in the anterior maxilla include, implant supported restorations, conventional fixed bridges, acid etched bridges, orthodontic space closure, or autotransplantation. Autotransplantation involves transplant of a tooth from its original position into an extraction socket all surgically prepared recipient site. The key challenge of autotransplantation is achieving periodontal and pulp healing of the grafted tooth.
The aim of this review was to report on the current evidence on survival and success rates ,aesthetic outcomes and patient reported outcomea is after autotransplantation of teeth into the anterior maxilla.
The Medline database was searched for prospective or retrospective studies of autotransplantation reporting on 10 or more auto transplanted teeth in the anterior maxilla. The main outcomes were success or survival rates aesthetic outcome and patient reported outcomes. A narrative summary of the findings was presented.
- 17 studies were included.
- 11 studies reporting on 264 transplanted premolars considered survival.
- Survival rates ranged from 93 to 100% percent after 9 to 22 years observation.
- Two studies reported on aesthetic outcomes.
- 4 studies evaluated patient reported outcomes.
The authors concluded: –
The present systematic review confirms a high survival rate of premolars autotransplanted to the anterior maxilla, although it is based on a limited number of documented cases. Adequate aesthetic results and patient satisfaction have been reported. However, the level of evidence is low and there is a strong need for additional studies on these aspects and an agreement on defined success criteria based on which teeth transplanted to the anterior maxilla may be evaluated.
This review is technically not a systematic review as only a single database has been searched. In addition, only English language studies have been included so there is a good possibility that relevant studies could have been excluded. Furthermore, no quality assessment of the included studies are presented.
Another challenge, the authors highlight is the lack of consensus regarding definition of success criteria in the studies examined or in the wider literature. The authors also found that the two studies examining aesthetic outcomes used different evaluation methods as did the studies examining patient reported outcomes. So while this review provides a helpful summary of some the evidence on this question the findings should be interpreted cautiously.
Akhlef Y, Schwartz O, Andreasen JO, Jensen SS. Autotransplantation of teeth to the anterior maxilla: A systematic review of survival and success, aesthetic presentation and patient-reported outcome. Dent Traumatol. 2018 Feb;34(1):20-27. doi: 10.1111/edt.12379. Epub 2017 Nov 28. Review. PubMed PMID: 28990720.