J Clin Periodontol 2014; 41: 412–423 doi: 10.1111/jcpe.

12228

Systematic Review
Outcomes of autotransplanted Wen-Chen Chung1,2, Yu-Kang Tu3,
Yi-Hung Lin1,4 and Hsein-Kun Lu1,2
1
Clinical Periodontics, School of Dentistry,

teeth with complete root College of Oral Medicine, Taipei Medical

University, Taipei, Taiwan; 2Clinical
Periodontics of Dental Department, Taipei

formation: a systematic review Medical University Hospital, Taipei, Taiwan;

3
Institute of Epidemiology and Preventive
Medicine, College of Public Health, National
Taiwan University, Taipei, Taiwan; 4Division
and meta-analysis of Periodontics, Department of Dentistry,
Changhua Christian Hospital, Changhua,
Taiwan

Chung W-C, Tu Y-K, Lin Y-H, Lu H-K. Outcomes of autotransplanted teeth with
complete root formation: a systematic review and meta-analysis. J Clin Periodontol
2014; 41: 412–423. doi: 10.1111/jcpe.12228.

Abstract
Aim: In this review, we assessed clinical outcomes of autotransplanted teeth with
complete root formation and the effects of various influencing factors.
Materials and Methods: Pubmed, Scopus, Google scholar and a hand search were
used to identify prospective and retrospective cohort studies and case series till
February 2013. Using multilevel Poisson regression, the annual failure rate (FR),
1-year and 5-year survival rates (SRs), infection-related root resorption rate
(RR), ankylosis rate (AR), the influences of systemic antibiotics (SAs), endodon-
tic and splinting modalities and donor tooth morphology were analysed. Failure
was defined as a transplant being lost during follow-up.
Results: Twenty-six studies were included. The estimated FR, RR, AR, 1- and
5-year SRs were 2.0%, 2.1%, 1.2%, 98.0% and 90.5%, respectively. The esti-
mated FR was higher in the absence of SA, suture splinting, wire splinting
≤14 days and posterior donors. The estimated RR was higher in the absence of
SA, endodontic treatment within post-operative 14 days and anterior/premolar
Key words: complete root formation; meta-
donors. The estimated AR was higher with wire splinting and premolar donors. analysis; survival; systematic review; tooth
Conclusions: Tooth autotransplantation with complete root formation is a autotransplantation
favourable treatment with rare FR, RR and AR. However, SAs, endodontic and
splinting modalities and tooth morphology seemed to influence the outcomes. Accepted for publication 2 January 2014

Since the introduction of tooth auto-
transplantation to dentistry in the
18th century, biological knowledge
and surgical techniques have pro-
gressively developed, and the pre-
dictability has become acceptable to
Conflict of interest and source of
funding statement
No external funding, apart from the
support of the authors’ institution,
was available for this study.
The authors declare that there are no
conflicts of interest in this study.
412
dental professionals (Andreasen
1992). During the late 20th century,
Andreasen et al. published a series of
studies which clarified the prognosis
and risk factors of tooth autotrans-
plantation and proposed standard
surgical procedures (Andreasen et al.
1990a,b,c,d).
Unlike an immovable osseointe-
grated dental implant, tooth
autotransplantation provides vital
periodontium and continuous skele-
tal growth (Park et al. 2010). The
longevity and prognosis of tooth
autotransplantation, especially with
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
an immature root-formation donor
tooth, are comparable to those with
dental implants (Andreasen et al.
1990c, Tsukiboshi 2001). However,
unfavourable survival rates (SRs)
of autotransplanted teeth with com-
plete root formation were reported
(Kristerson, 1985, Andreasen 1992).
Furthermore, complications such
as infection-related root resorption
(inflammatory resorption) and anky-
losis (replacement resorption) occur
frequently in cases of donor tooth
with complete root formation (Krist-
erson, 1985, Andreasen et al. 1990d).

Many factors could influence the
longevity of and incidences of com-
plications with tooth autotransplan-
tation. First, systemic antibiotics
(SAs) are prescribed to prevent bac-
terial infection from extra-oral and
intra-oral sources. Consequently,
they may reduce the incidence of
infection-related root resorption
(Hammarstrom et al. 1986, Andrea-
sen et al. 1990b). Second, with
mature donor teeth, revasculariza-
tion is less reliable after tooth auto-
transplantation (Andreasen et al.
1990c). Endodontic treatment, initi-
ated pre-operatively, post-operatively
or extra-orally, seems necessary to
prevent or halt the development of
infection-related root resorption
(Andreasen et al. 1990d). Third,
splinting of teeth after surgery is an
issue that affects tooth autotrans-
plantation healing. The absence of
splinting may accelerate destruction
from trauma and instability during
healing (Oikarinen 1990, Tsukiboshi
2001). However, different splinting
materials and durations can influ-
ence periodontal healing. A longer
splinting duration and rigid splinting
materials may cause ankylosis
(Andreasen 1975, Andersson et al.
1985). Lastly, teeth with complicated
root morphology have a tendency
for root-surface trauma and greater
difficulties during tooth extraction.
Donor tooth morphology was
reported to be a risk factor of donor
teeth with complete root formation
(Kallu et al. 2006, Yoshino et al.
2013).
Still, in the field of tooth auto-
transplantation, failure rates (FRs)
reported in the literatures are not
identical. Incidences of infection-
related root resorption and ankylosis
varied among studies. Effects of a
SA regimen, endodontic treatment,
splinting protocols and the morphol-
ogy of the donor tooth on outcomes
of tooth autotransplantation are still
in question.
Therefore, by conducting a meta-
analysis in the present systematic
review, we attempted to reveal the
FR, infection-related root resorption
rate (RR) and ankylosis rate (AR)
of autotransplanted teeth with com-
plete root formation. Influencing fac-
tors, such as SAs, endodontic
treatment, splinting protocols and
the morphology of the donor tooth,
which might affect the outcomes of
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Outcomes of autotransplanted teeth
tooth autotransplantation, were also
analysed.
Materials and Methods
Protocol development and eligibility
criteria
We followed the PRISMA checklist
to develop the present systematic
review (Appendix S1) (Moher et al.
2009). The protocol of the this sys-
tematic review was designed accord-
ing to the goal of answering the
following specific questions (Needle-
man 2002): of autotransplanted teeth
with mature root formation, what
are the FR, RR and AR; and do the
taking SAs, timing of endodontic
treatment, splinting method and
duration and morphology of the
donor tooth influence the FR, RR
and AR?
Criteria for considering reviews for this
study
Inclusion criteria
We only considered studies which
included: (1) human subjects; (2) a
sample size of at least 10 permanent
transplanted teeth; (3) complete root
formation and a closed apical fora-
men; (4) publication in the English
language; and (5) at least a 1-year
follow-up period.
Exclusion criteria
The exclusion criteria were as fol-
lows: (1) donor teeth with immature
root formation; and (2) cryopreser-
vation and replantation techniques.
Literature search
An extensive literature search was con-
ducted in several electronic databases
(PubMed, Scopus, and Google Scho-
lar) for studies published between 1771
and February 28, 2013. The search
strategy utilized Boolean algebra and
text terms of [tooth autotransplanta-
tion] OR [teeth autotransplantation]
OR [tooth autotransplant] OR [teeth
autotransplant] OR [tooth transplant]
OR [teeth transplant] OR [autologous
teeth transplant] OR [autologous
tooth transplant] OR [autogenous
teeth transplant] OR [autogenous
tooth transplant] OR [incisor
autotransplantation] OR [canine auto-
transplantation] OR [molar autotrans-
plantation]. Manual searching of the
413
Journal of Dental Science for studies
published between January 2005 and
February 2013 was also conducted to
retrieve potential literature.
Study selection
In the initial stage, titles and
abstracts of potential papers
retrieved were screened, and studies
that did not meet the inclusion crite-
ria were discarded. A full-text analy-
sis was carried out when the abstract
was unavailable or when the abstract
indicated that the inclusion criteria
were fulfilled.
Data extraction
Data were extracted independently
and in duplicate by the authors.
Only data directly related to mea-
sures of the outcome of interest
were retrieved. All phases of
the study selection process were
independently performed by two
authors (W.C. Chung and Y.H.
Lin). Any disagreement between
reviewers at this stage was resolved
by discussion. A third reviewer
(H.K. Lu) was responsible for
checking the accuracy of all data
extracted.
Quality assessment of included studies
The methodological quality of the
included studies was evaluated using
the Newcastle-Ottawa (NOS) scale
(Wells et al. 2001). A maximum of 8
points (stars) was designed to fulfil
these quality assessment criteria.
Studies with 6–8 points (approxi-
mately 75% or more of total points)
were considered to be of high qual-
ity. Studies with ≦6 points were sug-
gested to be of low methodological
quality.
Inter-study heterogeneity and publication
bias
Inter-study heterogeneity was evalu-
ated with the I2 statistic. The value
of I2 ranges 0–100 (25% indicates
low; 50% indicates moderate; 75%
indicates high heterogeneity) (Hig-
gins et al. 2003). The presence of
publication bias was investigated
for the outcome of estimated FR.
The publication bias analysis was
performed using the regression
asymmetry test (Egger et al. 1997).
414 Chung et al.

Outcome measurements (IRR) estimates were calculated agreement was measured using an
Primary outcomes using the multilevel Poisson regres- unweighted j of 0.85. Finally, 26
sion, and dummy variables were publications were determined to fully
The primary outcomes considered used to denote different groups of a fit the inclusion criteria (Table 1).
were: (1) the estimated FR, (2) the esti- confounding factor. Statistical analy- In the absence of randomized
mated 1-year SR, (3) the estimated ses were performed using Stataâ controlled clinical trials (RCTs), our
5-year SR, (4) the estimated first-year (StataCorp. 2009, Stata Statistical systematic review was based on pro-
RR, and (5) the estimated first-year Software: Release 11. College spective and retrospective cohort
AR, of the total sample, and of ante- Station, TX, USA: StataCorp LP.). studies and case series. Details of the
rior, premolar and molar donor teeth. characteristics of these studies are
Failure in the present study was given in Table 1. The reported FR,
defined as loss of the autotransplant- Results
RR and AR from individual studies
ed tooth during the observation per- are summarized in Table 2. Informa-
Study selection
iod. Infection-related root resorption tion on the antibiotic regimen, onset
was defined as the autotransplanted Two reviewers screened the titles and of endodontic treatment, splinting
tooth exhibiting resorption signs on abstracts from initial 13,361 poten- materials and duration are given in
a radiograph. Ankylosis was defined tial references (Fig. 1). Inter-reviewer Table 3.
as the absence of clinical mobility
with or without root resorption on a
radiograph. However, the data of
failure, infection-related root resorp-
tion, and ankylosis were mainly
based on the reported results from
the original articles.
Secondary outcomes
The following secondary outcomes
were compared: (1) the FR and RR
between studies in which SA were and
were not taken; (2) the FR and RR
between studies initiating endodontic
treatment before and those after
14 days post-operatively; (3) the FR
and AR between studies which used
wire splinting or suture splinting sta-
bilization; (4) the FR and AR between
studies utilizing wire splinting for more
than or less than 14 days.

Statistical analysis

Kappa (j) statistics were used to

evaluate inter-examiner agreement
on the study eligibility and quality.
The FR, RR and AR were calcu-
lated by dividing the number of
events by the total time the recon-
structions were under observation.
The numerator could usually be
directly extracted from a publication.
The total exposure time was calcu-
lated as an offset variable for the
meta-analysis. The total exposure
time was estimated by either taking
the sum of the observation time of
individual samples or multiplying the
mean follow-up duration by the
number of sample teeth. For the pri-
mary outcome measurement, esti-
mates of the FR, RR and AR were
analysed using multilevel Poisson
regression. For secondary outcome Fig 1. Flow chart of literature search. A total of 26 studies were finally included for
measurements, incidence rate ratio systematic review.
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
 Outcomes of autotransplanted teeth 415

Table 1. Characteristics of included studies

Author (years) Study design Donor teeth Number of Follow-up Mean follow-up
type sample teeth duration duration (months)
(months)

Isa-Kara et al. Retrospective Mx & Md 3rd molars 34 N/A 31

(2011)
Niimi et al. Prospective Mx central incisor: 1 117 N/A 12
(2011) Mx 1st premolars: 8
Mx 2nd premolars: 2
Mx 2nd molars: 5
Mx 3rd molars: 35
Md 1st premolars: 13
Md 2nd premolars: 3
Md 2nd molars: 2
Md 3rd molars: 48
Patel et al. Retrospective Mx canines 63 16.8–333.6 174
(2011)
Yan et al. Prospective Md 3rd molars 19 12–132 62.4
(2010)
Watanabe et al. Retrospective Insufficient 67 73.2–174 110.4
(2010) information
provided
Sugai et al. Prospective Mx canine: 1 117 12–71.2 40.9
(2010) Mx 1st premolars: 9
Mx 2nd premolars: 2
Mx 2nd molars: 5
Mx 3rd molars: 35
Md 1st premolars: 12
Md 2nd premolars: 3
Md 2nd molars: 2
Md 3rd molars: 48
Arikan et al. Prospective Mx canines 32 24–96 70.44
(2008)
Wang et al. Retrospective Mx & Md 3rd molars 83 60
(2007)
Mej
are et al. Prospective Mx 3rd molars: 20 47 12–120 48
(2004) Md 3rd molars: 30
Gault & Prospective Mx canines: 2 47 24–84 47.04
Warocquier-Clerout Premolars: 2
(2002) Molars: 43
Nethander Prospective Incisor: 1 75 12–60 N/A
(1998) Canines: 17
Premolars: 18
3rd molars: 39
Kugelberg et al. Retrospective Incisor: 7 22 12–48 N/A
(1994) Canine: 3
Premolar: 12
Schatz & Joho (1993) Retrospective Mx canines 10 12–120 52.8
Kristerson et al. Prospective Mx 3rd molars: 9 18 18–72 N/A
(1991) Md 3rd molars: 9
Sange & Thilander Retrospective Mx canines 56 24–120 56.4
(1990)
Eliasson et al. Prospective N/A 36 N/A 55
(1988)
Forssell & Retrospective Mx canines 23 N/A 120
Oksala (1986)
Schwartz et al. Retrospective Insufficient 107 12–308 115.2
(1985) information
provided
Kristerson 1985 Prospective Mx & Md premolars 16 75.6
Thomsson et al. Prospective Mx canines: 12 16 15–69 N/A
(1984) Mx premolars: 2
Mx 3rd molar: 1
Md premolar: 1,
Md 3rd molars: 2
Ahlberg et al. (1983) Prospective Mx canines 33 N/A 72
Azaz et al. (1978) Prospective Mx canines 37 24–84 36

© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
416 Chung et al.

Table 1. (continued)
Author (years) Study design Donor teeth Number of Follow-up Mean follow-up
type sample teeth duration duration (months)
(months)

Masif & Youseff Prospective Mx canines 36 N/A 24

(1977)
†
Reade et al. (1973) Prospective Mx canines 28, 50* 12–60 , 0–60* N/A
Hovinga (1969) Retrospective Mx canines 30 12–174 47.8
Moss (1968) Prospective Mx canines 18, 24† 12–54†, 6–54* N/A

Total of 26 studies with complete root formation were included: Mx, Maxillary; Md, Mandibular.
*For infection related root resorption and ankylosis analysis only (follow-up duration less than a year; however, the signs of resorption or
ankylosis were reported).
†
For infection-related root resorption analysis only (follow-up duration less than a year; however, the signs of resorption were reported).

Table 2. Reported survival rate, infection-related root resorption rate and ankylosis rate (AR) in included studies
Mean follow-up Author (year) % of survival 1-year Infection-related Ankylosis
duration survival root resorption rate (%)
rate (%) rate (%)

≧5 years Patel et al. (2011) 82.5 100 15.9 0.0

Yan et al. (2010) 78.9 N/A 10.5 0.0
Watanabe et al. (2010) 92.5 100 1.5 9.0
Arikan et al. (2008) 96.9 100 6.3 0.0
Wang et al. (2007) 83.1 100 0.0 0.0
Forssell & Oksala (1986) 30.4 N/A 26.1 56.5
Schwartz et al. (1985) N/A N/A 55.1 N/A
Kristerson 1985 81.3 N/A 25.0 37.5
Ahlberg et al. (1983) 87.9 100 75.8 100.0
≧4 years Mej
are et al. (2004) 85.1 97.9 8.5 2.1
Schatz & Joho (1993) 100 100 0.0 20.0
Sange & Thilander (1990) 96.4 98.2 5.4 0.0
Eliasson et al. (1988) 88.9 N/A 27.8 5.6
≧3 years Sugai et al. (2010) 83.8 96 0.0 4.3
Gault & Warocquier-Clerout (2002) 95.7 97.8 0.0 0.0
Azaz et al. (1978) 94.6 97.3 24.3 32.4
Hovinga (1969) 50.0 N/A N/A 100.0
Moss (1968) 94.4 100 41.7 5.6
≧2 years Isa-Kara et al. (2011) 91.2 97.1 5.9 5.9
Nethander (1998) 89.3 N/A 20.0 5.3
Kristerson et al. (1991) 88.9 88.9 5.6 5.6
Thomsson et al. (1984) 100 N/A 12.5 25.0
Masif & Youseff (1977) 100 100 8.3 0.0
Reade et al. (1973) 100 100 30.0 16.0
≧1 year Niimi et al. (2011) 88.9 88.9 4.3 18.8
Kugelberg et al. (1994) 100 N/A 13.6 4.5

The reported survival rate were ranged from 30.4% to 100%. 1-year survival rate were 88.9–100%. The infection-related root resorption rate
were 0.0–75.8%. And the AR were from 0% to 100%.

Quality assessment of included studies
Five studies were considered to be of
high quality (Appendix S2). These five
studies fulfilled the criteria of “repre-
sentativeness of the exposed cohort”
and “demonstration that the outcome
of interest was not”, which was the
difference between these five studies
and other 21 studies scoring ≦6 points.
Inter-study heterogeneity and publication
bias
Study heterogeneity was evaluated
by the I2 statistics. The study
heterogeneity was moderate (I2 =
72%) (Funnel plot is presented in
Appendix S3). The publication bias for
outcomes of the estimated FRs was
analysed by Egger’s test (shown in
Appendix S4).
Treatment procedures
Except for two studies which used
their own proposed surgical proto-
cols (Nethander 1998, Gault & War-
ocquier-Clerout 2002), the surgical
procedures of tooth autotransplanta-
tion among other included studies
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
were identical or similar to the pro-
tocol demonstrated by Andreasen
et al. (1990a). The method and
sequence of follow-up maintenance
treatment in the present included
studies were not described in detail
other than including clinical and
radiographic examinations.
Study characteristics
The physical status of patients in the
included studies was evaluated in
only six studies (Appendix S5).
Patients were all either systemically
 Table 3. Influence factors related to tooth autotransplantation
Author (years) Antibiotic regimen Timing of endodontic treatment Splinting material Splinting duration

Isa-Kara et al. (2011) Pre-op 2 g amoxicillin/ Extra-oral or post-op within 2 weeks† Thermoplastic retainer N/A
clavulanic acid (removable splint)
Post-op 625 mg amoxicillin/
clavulanic acid BID for 5 days†
Niimi et al. (2011) Not taking* Initiating after post-op 3 weeks* Orthodontic wire or suture 1 week for suture
and 3 weeks for wire
Patel et al. (2011) Post-op† No endodontic treatment Wire* 2 weeks†
Yan et al. (2010) Post-op† Post-op within 1 months Wire or suture 1 week for suture
Watanabe et al. (2010) Not taking* Post-op within 3 weeks Wire* 3 weeks*
Sugai et al. (2010) Post-op cefditoren pivoxil Initiating after post-op 3 weeks* Wire or suture Wire for 3 weeks,
for 5 days† suture for 1 week
Arikan et al. (2008) Post-op amoxicillin Post-op within 4 weeks Orthodontic wire * 4 weeks*
500 mg TID for 10 days†
†
Wang et al. (2007) Post-op amoxicillin Extra-oral Orthodontic wire for some N/A
500 mg QID for 7 days† cases
Mej
are et al. (2004) Pre-op penicillin 2 g, Post-op within 4 weeks Luxatemp for 10 cases, 1.5 week
Post-op penicillin 1 g suture splinting for others
TID for 10 days†
Gault & Warocquier-Clerout (2002) Pre-op tetracycline for 1 day Pre-op or post-op Suture† 2 weeks†
Post-op tetracycline for 4 weeks†
Nethander (1998) Only provided for some Initiating after post-op 1 month* Acrylic bar 2 weeks

© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
patients at first stage of surgery
Kugelberg et al. (1994) Pre-op penicillin 2 g† Pre-op: four cases, post-op within 1 month: Suture† 1 week†
13 cases, post-op between 2 and
7 months: five cases
Schatz & Joho (1993) Pre-op penicillin for 7 days† Initiating after post-op 4–6 weeks* Orthodontic wire* 12 weeks*
Kristerson et al. (1991) Post-op penicillin 1 g BID Post-op within 3 weeks Soft arch bar 2–3 weeks
for 8 days†
Sange & Thilander (1990) Post-op penicillin 2 g BID Initiating after post-op 6–8 weeks* Arch wire* 6–8 weeks*
for 10 days†
Eliasson et al. (1988) Post-op penicillin 1.6–3.2 g Pre-op: five cases; post-op within 2 weeks: Acrylic splint for 23 cases, 1–10 weeks
for 8–10 days† four cases; post-op 3–12: 37 cases orthodontic wire for
10 cases, surgical cement
for three cases
Forssell & Oksala (1986) Not taking* Performing endodontic treatment when N/A N/A
signs and symptoms appeared
Schwartz et al. (1985) Post-op penicillin for 7 days Pre-op or post-op Flexible splinting or acrylic 1 week or more
for some patients splinting, or suture than 4 weeks
Kristerson 1985 Post-op penicillin for 7 days† Post-op N/A N/A
Thomsson et al. (1984) Post-op Phenoxymethylpenicillin Initiating post-op 3–11 weeks* Orthodontic arch* 0.5–8.5 weeks*
or Amoxicillin for 7 days†
Ahlberg et al. (1983) Not taking* Performing endodontic treatment when N/A 5 weeks
signs and symptoms appeared: 23 cases
Outcomes of autotransplanted teeth

Azaz et al. (1978) Post-op for 5 days† Extra-oral† Surgical or orthodontic arch* 10 weeks*
417
418 Chung et al.

healthy or had no systemic contrain- A study by Schwartz et al. (1985)

Splinting duration
dications for tooth autotransplanta- did not distinguish the AR of auto-

Use of antibiotic regimen, timing of endodontic treatment, and splinting material/duration were diverse different among included studies. Post-op, post-operative; Pre-op: pre-operative.
tion surgery. The periodontal transplanted teeth with complete
condition of patients was not clearly root formation; therefore, that study

1–61 weeks

6–8 weeks
mentioned in most of the included was excluded from our meta-analy-
6 weeks*

studies (Appendix S5). In one study, sis. An estimated first-year AR of

N/A

patients all had advanced periodon- 1.2% (95% CI: 0.5–3.2%) was
tal disease. Six of the included stud- recorded (Table 4).
ies indicated that some of the
patients may have had periodontal Secondary outcomes
disease. Regarding the reason for
Acrylic plate for some cases

SAs
tooth extraction from the recipient
Splinting material

site, periodontal infection was the Antibiotics were given to only some
Stainless steel wire *
Stainless steel wire *

cause for tooth extraction in some patients in three studies; therefore,

or all patients in five studies (Appen- those studies were excluded from this
dix S5). assessment (Table 3). Ultimately, 23
Silver cap

From the perspective of donor studies were included. Antibiotics

teeth, 16 studies indicated that a few
or all of the donor teeth were in an
impacted position (Appendix S5).
Furthermore, only two included
studies indicated that deep periodon-
tal probing depths existed on some
of their donor teeth pre-operatively
Not indicated; performing endodontic
Timing of endodontic treatment
were prescribed either pre- or post-
operatively to prevent infection. Pen-
icillin was used in the majority of
studies. The reference group was
defined as studies using SAs, and the
test group was defined as the
remaining studies in which SAs were

(Appendix S5). Some of the trans- not used. The estimated incidences
plants had periodontal attachment of FR (IRR = 2.5, 95% CI: 0.9–7.2)
loss, bone loss or gingival recession and RR (IRR = 1.4, 95% CI: 0.2–
post-operatively in 15 studies 8.9) when not taking SAs in studies
No endodontic treatment

treatment on two cases

(Appendix S5). One study found were both higher than those of stud-
periodontal inflammation of five ies in which SAs were prescribed
transplants (Niimi et al. 2011). A (Table 5).
few transplants were extracted or
Endodontic treatment
lost due to periodontal reasons in
†

Extra-oral†
Extra-oral

nine of the studies (Appendix S5). In total, 11 studies were included to

Primary outcomes
Estimated FR and SR
In total, 25 studies were included.
Due to an inability to extract data,
Post-op penicillin for 4 days
compare the onset time of endodon-
tic treatment at either before or after
post-operative day 14 (Table 3). The
reference group was comprised of
five studies that initiated endodontic
treatment pre-operatively, within

one study was excluded from this 14 days post-operatively, or extra-

Antibiotic regimen

analysis (Schwartz et al. 1985). The orally. The test group was comprised
summary estimate of the annual FR of six studies that initiated endodon-
†

Post-op for 5 days†

Post-op for 5 days

for some patients

Pre-op for 5 days†

was 2.0% [95% confidence interval tic treatment after post-operative

(CI): 1.2–3.2%]. The estimated 1- and
5-year SRs were 98.0% (95% CI:
96.8–98.8%) and 90.5% (95% CI:
84.9–94.1%) respectively (Table 4).
Estimated RR
Twenty-five studies assessed infec-
tion-related root resorption. Only
one study was excluded from this
analysis, because all reported root-
resorption cases were identified as
Masif & Youseff (1977)
day 14. Estimated FRs were compa-
rable between the two groups of
studies (IRR = 1.0, 95% CI: 0.2–5.2)
(Table 5). However, the RR in stud-
ies in which endodontic treatment
was initiated after postoperative day
14 was two times higher (IRR = 2.0,
95% CI: 0.2–9.3) than that of studies
in which treatment was begun within
14 days post-operatively.
Splinting modalities and duration

replacement root resorption (i.e.

Table 3. (continued)

ankylosis) (Hovinga 1969). The esti- In the present analysis, we compared

Reade et al. (1973)

Reference group.

mated first-year RR was 2.1% (95% studies using wire splinting with
Hovinga (1969)
Author (years)

CI: 1.1–4.0%) (Table 4). studies using only sutures (Table 3).
*Test group.
Moss (1968)

Eleven studies fulfilled the criteria

Estimated AR
All of the studies except for one
were included in the AR assessment.
†
for this assessment. Studies with
insufficient information or using
splinting materials other than wire

© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
 Outcomes of autotransplanted teeth 419

Table 4. Results of estimated survival rate, infection-related root resorption rate (RR) and (Table 5). Moreover, the estimated
ankylosis rate (AR) from meta-analysis FR was also lower in studies with a
Failure rate wire-splinting duration of >14 days
Estimated total failure rate (CI 95%) 2.0% (1.2–3.2%) than those with a duration of
Estimated failure rate of anterior 0.6% (0.2–2.3%) ≤14 days (IRR = 0.4, 95% CI: 0.1–
donor teeth (CI 95%) 2.0). The estimated AR in studies
Estimated failure rate of premolar 1.6% (0.3–9.1%) using wire splinting was three times
donor teeth (CI 95%) higher than that of studies using
Estimated failure rate of molar 3.3% (2.4–4.7%) suture splinting (IRR = 3.0, 95% CI:
donor teeth (CI 95%)
0.0–607.9). However, we were unable
Survival rate
Estimated 1-year total survival 98.0% (96.8–98.8%) to compare the AR with different
rate (CI 95%) wire splinting durations, because
Estimated 5-year total survival 90.5% (84.9–94.1%) there was only one study in the
rate (CI 95%) reference group.
Estimated 1-year survival rate of 99.4% (97.7–99.8%)
anterior donor teeth (CI 95%)
Donor tooth morphology
Estimated 5-year survival rate of anterior 96.9% (89.1–99.2%) Four studies were excluded from this
donor teeth (CI 95%) analysis (Schwartz et al. 1985, Net-
Estimated 1-year survival rate of premolar 98.4% (90.9–99.7%) hander 1998, Watanabe et al. 2010,
donor teeth (CI 95%)
Estimated 5-year survival rate of premolar 92.3% (62.1–98.6%)
Niimi et al. 2011). In total, 22
donor teeth (CI 95%) studies were included (Table 1). We
Estimated 1-year survival rate of molar 96.7% (95.3–97.6%) analysed the annual FR, 1-year SR,
donor teeth (CI 95%) 5-year SR, RR and AR of the ante-
Estimated 5-year survival rate of molar 84.3% (78.7–88.6%) rior, premolar and molar donors
donor teeth (CI 95%) separately. The results showed that
Infection-related root resorption rate the estimated annual FR of anterior,
Estimated total Infection-related root 2.1% (1.1–4.0%) premolar and molar donors was
RR (CI 95%) 0.6% (95% CI: 0.2–2.3%), 1.6%
Estimated Infection-related root RR of 2.4% (0.9–6.6%)
(95% CI 0.3–9.1%), and 3.3% (95%
anterior donor teeth (CI 95%)
Estimated Infection-related root RR of 2.4% (0.6–8.9%) CI: 2.4–4.7%) respectively (Table 4).
premolar donor teeth (CI 95%) The estimated 1-year SR of anterior,
Estimated Infection-related root RR of 0.6% (0.2–1.8%) premolar and molar donors was
molar donor teeth (CI 95%) 99.4% (95% CI: 97.7–99.8%),
AR 98.4% (95% CI: 90.9–99.7%) and
Estimated total AR (CI 95%) 1.2% (0.5–3.2%) 96.7% (95% CI: 95.3–97.6%) respec-
Estimated AR of anterior donor teeth (CI 95%) 0.7% (0.1–4.3%) tively. The estimated 5-year SR of
Estimated AR of premolar donor teeth (CI 95%) 5.1% (2.4–10.8%) anterior, premolar and molar donors
Estimated AR of molar donor teeth (CI 95%) 0.4% (0.1–1.5%)
was 96.9% (95% CI: 89.1–99.2%),
The estimated results were analysed by Multilevel Poisson regression. 92.3% (95% CI: 62.1–98.6%) and
84.3% (95% CI: 78.7–88.6%) respec-
tively.
Table 5. Comparison of factors influencing the results of estimated survival rate, infection-
related root resorption rate and ankylosis rate (AR) from meta-analysis
Discussion
Failure IRR Infection-related root Ankylosis IRR
(CI 95%) resorption IRR (CI 95%) (CI 95%) This systematic review is the first
comprehensive meta-analysis of
No antibiotic versus taking 2.5 (0.9–7.2) 1.4 (0.2–8.9) N/A autotransplanted teeth with complete
antibiotic (ref.) root formation. Our study assessed
Endo tx >14 days 1.0 (0.2–5.2) 2.0 (0.2–9.3) N/A
outcomes of autotransplanted teeth
versus ≦14 days (ref.)
Wire splinting versus suture 0.8 (0.1–5.5) N/A 3.0 (0.0–607.9)
with complete root formation and a
splinting (ref.) closed apical foramen and at least a
Wire splinting >14 days 0.4 (0.1–2.0) N/A N/A* 1-year follow-up period. To mini-
versus ≦14 days (ref.) mize the publication and small study
bias, we only considered studies with
The estimated results were analysed by Multilevel Poisson regression. IRR, incidence rate at least 10 permanent transplanted
ratio; Ref: reference group; Endo tx: endodontic treatment.
teeth. Assessment of the root devel-
*Could not be analysed due to scarce data under reference group.
opmental stage relied on description
in the included literatures. Prospec-
and sutures were excluded. One 1973). The meta-analytical results tive and retrospective cohort studies
study did not indicate the splinting showed that the estimated FR was with stringent inclusion criteria were
duration; therefore, it was excluded lower in studies with wire splinting included in this systematic review to
from the analysis of the effect of than those with suture splinting summarize the available information
wire-splinting duration (Reade et al. (IRR = 0.8, 95% CI: 0.1–5.5) about FRs, RRs and ARs of
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
420 Chung et al.
autotransplanted teeth with complete
root formation.
FR and SR
Reported percentage of survival from
individual studies ranged widely at
30–100% (Table 2). Some studies
also presented the 1-year SR. All
reported 1-year SRs were >88%. On
the basis of the current meta-analysis,
we found that the estimated FR of
autotransplanted teeth with complete
root formation was only 2.0%, the
estimated 1-year and 5-year SRs were
98.0% and 90.5% respectively. These
results were in line with findings of a
long-term study which showed a high
SR for autotransplanted teeth with
complete root formation after 5 years
of observation (Andreasen et al.
1990c). However, the FR could be
influenced by several risk factors,
such as endodontic treatment and the
morphology of the donor tooth
(Aoyama et al. 2012).
RR
Infection-related root resorption (i.e.
inflammatory resorption) is a progres-
sive dentin resorption process in which
a tooth with a damaged periodontal
ligament surface and infected pulp is
transplanted or replanted (Tsukiboshi
2001, Fuss et al. 2003). In general,
radiographic signs of infection-related
root resorption can be observed
1–2 months after tooth autotransplan-
tation or replantation (Andreasen
et al. 1990d). Therefore, in the present
meta-analysis, we estimated the first-
year RR from 25 included studies, and
it was only 2.1%. Two of the included
studies presented a RR of >50%
(Table 2). The high RRs in these two
studies probably resulted from delays
in endodontic treatment. On the other
hand, we considered four studies
which did not report the occurrence of
infection-related root resorption as no
occurrence (Schatz & Joho 1993,
Gault & Warocquier-Clerout 2002,
Wang et al. 2007, Sugai et al. 2010).
The absence of root resorption compli-
cation might have resulted from gentle
manipulation of the transplants in
these studies.
AR
One of the common complications
of tooth autotransplantation is root
ankylosis. This phenomenon may be
caused by large injury to the root sur-
face of a donor tooth during surgery.
The bone directly contacts the dentin
without an intermediate attachment
apparatus. Subsequently, the root is
resorbed and replaced by bone (Fuss
et al. 2003). Similar to infection-
related root resorption, clinical signs
of ankylosis can be found within a
year after tooth autotransplantation
(Andreasen et al. 1990d). Therefore,
only the 5-year AR was calculated.
Twenty-five studies were included in
this part of the meta-analysis. Our
results showed that the estimated
first-year AR was 1.2%. This result is
encouraging. However, two aberrant
studies demonstrated 100% ARs
(Table 2). These high ARs could
have been caused by traumatic inju-
ries either from donor tooth extrac-
tion or from extraoral root-canal
treatment. There were seven studies
which did not report the occurrence
of ankylosis (Masif & Youseff 1977,
Sange & Thilander 1990, Gault &
Warocquier-Clerout 2002, Wang
et al. 2007, Arikan et al. 2008, Yan
et al. 2010, Patel et al. 2011). These
phenomena of a low AR might have
resulted from minimizing the trauma
from surgical procedures.
SAs
Previous studies suggested that SA
therapy can help prevent complica-
tions (Andreasen 1992, Tsukiboshi
2001). Recent systematic review
showed insufficient clinical benefits
for prescribing SAs for dental
replantation (Hinckfuss & Messer
2009b). As there are no evidence-
based guidelines for SA therapy for
tooth autotransplantation, we tried
to compare studies that did and did
not use SA therapy for tooth auto-
transplantation. Twenty-three studies
were included for comparison of
FRs between using and not using
SAs. Our meta-analysis showed that
the FR was 2.5 times higher in stud-
ies not using SA therapy than in
those using it. Twenty-three studies
were included in the meta-analysis of
RRs. Results showed a 1.4 times
higher RR in studies not using SA
therapy than studies using it. These
results demonstrate the clinical bene-
fits of taking SAs to prevent compli-
cations and increase SRs of tooth
autotransplantation.
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Endodontic treatment
Endodontic treatment is important
for the success of autotransplanted
teeth with complete root formation.
However, the timing of pulp extirpa-
tion is still controversial. Different
guidelines suggest various times for
endodontic treatment of 7–14 days
after dental replantation (Andreasen
1992, Gregg & Boyd 1998, Flores
et al. 2001, Andersson et al. 2012).
Recent systematic review found an
association between pulp extirpation
performed at least 14 days after den-
tal replantation and the development
of inflammatory resorption (Hinck-
fuss & Messer 2009a). In the present
meta-analysis, we tried to figure out
better access timing for endodontic
treatment of autotransplanted teeth
with complete root formation.
Results showed comparable FRs
between studies initiating endodontic
treatment post-operatively within
and beyond 14 days. In contrast, the
RR was two times higher in studies
initiating endodontic treatment
beyond 14 days than within 14 days
post-operatively. This result was in
agreement with previous guidelines
and studies mentioned above.
Splinting modalities and duration
Splinting helps to stabilize autotrans-
planted teeth in position. Wire
splinting for a long duration may
increase the risk of tooth ankylosis
(Bauss et al. 2002, 2005). In con-
trast, suture splinting provides physi-
ological loading on the replanted
teeth, which might facilitate peri-
odontal healing. A recent meta-
analysis study showed that successful
periodontal healing after replanta-
tion was unaffected by the splinting
duration (Hinckfuss & Messer
2009c). However, there is still a lack
of evidence for the effects of differ-
ent splinting materials and durations
for tooth autotransplantation. In the
present study, we compared studies
that used sutures alone and wire for
splinting. Based on results of our
meta-analysis, tooth autotransplan-
tation with wire splinting showed a
smaller likelihood of failure than
with suture splinting. However, the
AR was three times higher with wire
splinting than with suture splinting.
We consequently performed a sub-
group analysis for the duration of

wire splinting. Results showed infe-
rior FRs in studies using wire splint-
ing for >14 days than in studies
using wire splinting for ≤14 days.
However, as there were only two
studies in the suture-splinting group,
this result should be interpreted with
caution.
Tooth morphology
The prognosis of toot autotransplan-
tation is influenced by the root
morphology of the donor tooth
(Aoyama et al. 2012). In the present
review, we categorized three groups
of tooth types: anterior teeth, pre-
molars and molars. The estimated
annual FR was lower with anterior
donors and higher with posterior
donors, especially with molar teeth.
However, RRs were lower with
molar than with premolar and ante-
rior donors. Moreover, the AR was
lower with molar than anterior and
premolar donors. The reason for the
higher FR and lower complication
rates of molar donor teeth may be
because of higher masticatory load-
ing and broader root-surface area of
molar teeth. However, an insufficient
sample size among the groups and a
lack of RCTs may also have
increased the bias of the results.
Limitations
First, for this systematic review, the
included studies were observational
studies which are rated as having a
lower level of evidence than RCTs.
Due to the absence of RCTs, a lower
evidence-based level of our system-
atic review was resulted. Second, the
study design of these included stud-
ies, mainly observational studies,
directly caused the moderate study
heterogeneity (I2 = 72%) and publi-
cation bias of this systematic review.
Third, the diagnosis of root develop-
mental stage, infection-related root
resorption and ankylosis mainly
relied on the description of original
articles. Hence, the definition of out-
comes may have varied among stud-
ies. Lastly, we tried to analyse the
effect of pre-operative periodontal
probing depth of donor teeth and
the incidence of post-operative
periodontal attachment loss of trans-
plants which seems to be a complica-
tion of tooth autotransplantation
(Yoshino et al. 2013). However, due
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Outcomes of autotransplanted teeth
to insufficient information, we were
unable to analyse the influence
between periodontal probing depth
and RR or AR and the incidence
of post-operative periodontal attach-
ment loss. Only two studies demon-
strated that some of the donor teeth
were measured deep periodontal prob-
ing depth (Sugai et al. 2010, Niimi
et al. 2011). In these two studies, RR
(4.3% and 0%) and AR (18.8% and
4.3%) were not higher than most of
other included studies (RR: 0–75.8%,
AR: 0–100%) (Table 2).
Conclusions
This systematic review provides the
first evidence of outcomes of auto-
transplanted teeth with complete
root formation. The FRs, RRs and
ARs were occasionally in autotrans-
planted teeth with complete root for-
mation. However, the absence of SA
therapy, suture splinting method,
wire splinting for ≦14 days and pos-
terior donor tooth were influencing
factors which aggravated FR. The
RR and AR were affected by SA
therapy, endodontic timing, the
splinting method and the donor
tooth morphology. Finally, the lack
of RCTs limited the power of the
present review. It is highly desirable
that further research on this issue be
undertaken based on a greater
amount of RCTs.
References
Ahlberg, K., Bystedt, H., Eliasson, S. & Oden-
rick, L. (1983) Long-term evaluation of auto-
transplanted maxillary canines with completed
root formation. Acta Odontologica Scandinavica
41, 23–31.
Andersson, L., Andreasen, J. O., Day, P., Hei-
thersay, G., Trope, M., Diangelis, A. J.,
Kenny, D. J., Sigurdsson, A., Bourguignon, C.,
Flores, M. T., Hicks, M. L., Lenzi, A. R.,
Malmgren, B., Moule, A. J. & Tsukiboshi, M.;
International Association of Dental Traumatol-
ogy (2012) International Association of Dental
Traumatology guidelines for the management
of traumatic dental injuries: 2. Avulsion of
permanent teeth. Dental Traumatology 28, 88–
96.
Andersson, L., Lindskog, S., Blomlof, L., Hed-
strom, K. G. & Hammarstrom, L. (1985) Effect
of masticatory stimulation on dentoalveolar
ankylosis after experimental tooth replantation.
Endodontics and Dental Traumatology 1, 13–16.
Andreasen, J. O. (1975) The effect of splinting
upon periodontal healing after replantation of
permanent incisors in monkeys. Acta Odonto-
logica Scandinavica 33, 313–323.
Andreasen, J. O. (1992) Atlas of replantation and
transplantation of teeth. London: W B Saunders
Co.
421
Andreasen, J. O., Paulsen, H. U., Yu, Z., Ahl-
quist, R., Bayer, T. & Schwartz, O. (1990a) A
long-term study of 370 autotransplanted pre-
molars. Part I. Surgical procedures and stan-
dardized techniques for monitoring healing.
European Journal of Orthodontics 12, 3–13.
Andreasen, J. O., Paulsen, H. U., Yu, Z. & Bayer,
T. (1990b) A long-term study of 370 autotrans-
planted premolars. Part IV. Root development
subsequent to transplantation. European Jour-
nal of Orthodontics 12, 38–50.
Andreasen, J. O., Paulsen, H. U., Yu, Z., Bayer,
T. & Schwartz, O. (1990c) A long-term study
of 370 autotransplanted premolars. Part II.
Tooth survival and pulp healing subsequent to
transplantation. European Journal of Orthodon-
tics 12, 14–24.
Andreasen, J. O., Paulsen, H. U., Yu, Z. &
Schwartz, O. (1990d) A long-term study of 370
autotransplanted premolars. Part III. Periodon-
tal healing subsequent to transplantation. Euro-
pean Journal of Orthodontics 12, 25–37.
Aoyama, S., Yoshizawa, M., Niimi, K., Sugai, T.,
Kitamura, N. & Saito, C. (2012) Prognostic
factors for autotransplantation of teeth with
complete root formation. Oral Surgery, Oral
Medicine, Oral Pathology and Oral Radiology
114, S216–S228.
Arikan, F., Nizam, N. & Sonmez, S. (2008)
5-Year longitudinal study of survival rate and
periodontal parameter changes at sites of max-
illary canine autotransplantation. Journal of
Periodontology 79, 595–602.
Azaz, B., Zilberman, Y. & Hackak, T. (1978)
Clinical and roentgenographic evaluation of
thirty-seven autotransplanted impacted maxil-
lary canines. Oral Surgery, Oral Medicine, Oral
Pathology 45, 8–16.
Bauss, O., Schilke, R., Fenske, C., Engelke, W. &
Kiliaridis, S. (2002) Autotransplantation of
immature third molars: Influence of different
splinting methods and fixation periods. Dental
Traumatology 18, 322–328.
Bauss, O., Schwestka-Polly, R., Schilke, R. &
Kiliaridis, S. (2005) Effect of different splinting
methods and fixation periods on root develop-
ment of autotransplanted immature third
molars. Journal of Oral and Maxillofacial Sur-
gery 63, 304–310.
Egger, M., Davey Smith, G., Schneider, M. &
Minder, C. (1997) Bias in meta-analysis
detected by a simple, graphical test. BMJ 315,
629–634.
Eliasson, S., L aftman, A. C. & Strindberg, L.
(1988) Autotransplanted teeth with early-stage
endodontic treatment: A radiographic evalua-
tion. Oral Surgery, Oral Medicine, Oral Pathol-
ogy 65, 598–603.
Flores, M. T., Andreasen, J. O., Bakland, L. K.,
Feiglin, B., Gutmann, J. L., Oikarinen, K., Pitt
Ford, T. R., Sigurdsson, A., Trope, M., Vann,
W. F., Jr, Andreasen, F. M.; International
Association of Dental Traumatology (2001)
Guidelines for the evaluation and management
of traumatic dental injuries. Dental Traumatol-
ogy 17, 193–198.
Forssell, H. & Oksala, E. (1986) A 10-year fol-
low-up of maxillary canine transplantations.
Proceedings of the Finnish Dental Society 82,
209–212.
Fuss, Z., Tsesis, I. & Lin, S. (2003) Root resorp-
tion–diagnosis, classification and treatment
choices based on stimulation factors. Dental
Traumatology 19, 175–182.
Gault, P. C. & Warocquier-Clerout, R. (2002)
Tooth auto-transplantation with double peri-
odontal ligament stimulation to replace peri-
422 Chung et al.
odontally compromised teeth. Journal of Peri-
odontology 73, 575–583.
Gregg, T. A. & Boyd, D. H. (1998) Treatment of
avulsed permanent teeth in children. UK
National Guidelines in Paediatric Dentistry.
Royal College of Surgeons, Faculty of Dental
Surgery. International Journal of Paediatric
Dentistry 8, 75–81.
Hammarstrom, L., Blomlof, L., Feiglin, B., An-
dersson, L. & Lindskog, S. (1986) Replantation
of teeth and antibiotic treatment. Endodontics
and Dental Traumatology 2, 51–57.
Higgins, J. P., Thompson, S. G., Deeks, J. J. &
Altman, D. G. (2003) Measuring inconsistency
in meta-analyses. BMJ 327, 557–560.
Hinckfuss, S. E. & Messer, L. B. (2009a) An evi-
dence-based assessment of the clinical guide-
lines for replanted avulsed teeth. Part I: Timing
of pulp extirpation. Dental Traumatology 25,
32–42.
Hinckfuss, S. E. & Messer, L. B. (2009b) An evi-
dence-based assessment of the clinical guide-
lines for replanted avulsed teeth. Part II:
prescription of systemic antibiotics. Dental
Traumatology 25, 158–164.
Hinckfuss, S. E. & Messer, L. B. (2009c) Splinting
duration and periodontal outcomes for
replanted avulsed teeth: a systematic review.
Dental Traumatology 25, 150–157.
Hovinga, J. (1969) Autotransplantation of maxil-
lary canines: a long-term evaluation. Journal of
Oral Surgery 27, 701–708.
Isa-Kara, M., Sari, F., Emre-Coskun, M., Kust-
arci, A., Burak-Polat, H., Ozdemir, H. & Polat,
S. (2011) Stabilization of autotransplanted
teeth using thermoplastic retainers. Medicina
Oral, Patologıa Oral y Cirugıa Bucal 16,
e369–e375.
Kallu, R., Vinckier, F., Politis, C., Mwalili, S. &
Willems, G. (2006) Tooth transplantations: A
descriptive retrospective study. International
Journal of Oral and Maxillofacial Surgery 34,
745–755.
Kristerson, L. (1985) Autotransplantation of
human premolars. A clinical and radiographic
study of 100 teeth. International Journal of Oral
Surgery 14, 200–213.
Kristerson, L., Johansson, L. A., Kisch, J. & Stadler,
L. E. (1991) Autotransplantation of third molars
as treatment in advanced periodontal disease.
Journal of Clinical Periodontology 18, 521–528.
Kugelberg, R., Tegsj€ o, U. & Malmgren, O. (1994)
Autotransplantation of 45 teeth to the upper
incisor region in adolescents. Swedish Dental
Journal 18, 165–172.
Masif, A. & Youseff, H. A. (1977) Autogenous
transplantation of maxillary canine–a modified
technique. Egyptian Dental Journal 23, 49–56.
Mej
are, B., Wannfors, K. & Jansson, L. (2004) A
prospective study on transplantation of third
molars with complete root formation. Oral Sur-
gery, Oral Medicine, Oral Pathology, Oral
Radiology, and Endodontics 97, 231–238.
Moher, D., Liberati, A., Tetzlaff, J. & Altman,
D. G.; PRISMA Group (2009) Preferred
reporting items for systematic reviews and
meta-analyses: the PRISMA statement. Journal
of Clinical Epidemiology 62, 1006–1012.
Moss, J. P. (1968) Autogenous transplantation of
maxillary canines. Journal of Oral Surgery 26,
775–783.
Needleman, I. G. (2002) A guide to systematic
reviews. Journal of Clinical Periodontology 29
(Suppl. 3), 6–9; discussion 37-38.
Nethander, G. (1998) Autogenous free tooth
transplantation by the two-stage operation
technique: An analysis of treatment factors.
Acta Odontologica Scandinavica 56, 110–115.
Niimi, K., Yoshizawa, M., Sugai, T., Kobayashi,
T., Ono, K., Takagi, R., Okiji, T. & Saito, C.
(2011) Clinical study on root resorption of
autotransplanted teeth with complete root for-
mation. Asian Journal of Oral and Maxillofacial
Surgery 23, 18–24.
Oikarinen, K. (1990) Tooth splinting: a review of
the literature and consideration of the versatil-
ity of a wire-composite splint. Endodontics and
Dental Traumatology 6, 237–250.
Park, J. H., Tai, K. & Hayashi, D. (2010) Tooth
autotransplantation as a treatment option: a
review. The Journal of Clinical Pediatric Den-
tistry 35, 129–135.
Patel, S., Fanshawe, T., Bister, D. & Cobourne,
M. T. (2011) Survival and success of maxillary
canine autotransplantation: A retrospective
investigation. European Journal of Orthodontics
33, 298–304.
Reade, P., Mansour, A. & Bowker, P. (1973) A
clinical study of the autotransplantation of
unerupted maxillary canines. Australian Dental
Journal 18, 273–280.
Sange, S. & Thilander, B. (1990) Transalveolar
transplantation of maxillary canines. A follow-
up study. European Journal of Orthodontics 12,
140–147.
Schatz, J. P. & Joho, J. P. (1993) A clinical and
radiologic study of autotransplanted impacted
canines. International Journal of Oral and Max-
illofacial Surgery 22, 342–346.
Schwartz, O. L. E., Bergmann, P. E. R. &
Klausen, B. (1985) Resorption of autotrans-
planted human teeth: a retrospective study of
291 transplantations over a period of 25
years. International Endodontic Journal 18,
119–131.
Sugai, T., Yoshizawa, M., Kobayashi, T., Ono,
K., Takagi, R., Kitamura, N., Okiji, T. &
Saito, C. (2010) Clinical study on prognostic
factors for autotransplantation of teeth with
complete root formation. International Journal
of Oral and Maxillofacial Surgery 39, 1193–
1203.
Thomsson, M., Bloml€ of, L., Otteskog, P. & Ham-
marstr€ om, L. (1984) A clinical and radio-
graphic evaluation of cultivated and
autotransplanted human teeth. International
Journal of Oral Surgery 13, 211–220.
Tsukiboshi, M. (2001) Autotransplantation of
Teeth. Chicago: Quintessence Publishing Com-
pany, Incorporated.
Wang, I. K., Wu, H. T., Fong, J. H. J., Yu, E.
H., Wu, C. H., Kao, S. Y., Lui, M. T. & Pai,
S. F. (2007) A retrospective survival analysis of
autotransplanted molars in Taipei Veterans
General Hospital 1996-2004. Journal of Dental
Sciences 2, 193–200.
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Watanabe, Y., Mohri, T., Takeyama, M.,
Yamaki, M., Okiji, T., Saito, C. & Saito, I.
(2010) Long-term observation of autotrans-
planted teeth with complete root formation in
orthodontic patients. American Journal of
Orthodontics and Dentofacial Orthopedics 138,
720–726.
Wells, G. A., Shea, B., O’Connell, D., Peterson,
J., Welch, V., Losos, M. & Tugwell, P. (2001)
The Newcastle-Ottawa Scale (NOS) for assess-
ing the quality of nonrandomised studies in
meta-analyses [WWW document]. Available at:
http://www.ohri.ca/programs/clinical_epidemi-
ology/oxford.htm [accessed on 5 March 2013].
Yan, Q., Li, B. & Long, X. (2010) Immediate
autotransplantation of mandibular third molar
in China. Oral Surgery, Oral Medicine, Oral
Pathology, Oral Radiology and Endodontology
110, 436–440.
Yoshino, K., Kariya, N., Namura, D., Noji, I.,
Mitsuhashi, K., Kimura, H., Fukuda, A.,
Kikukawa, I., Hayashi, T., Yamazaki, N.,
Kimura, M., Tsukiyama, K., Yamamoto, K.,
Fukuyama, A., Hidaka, D., Shinoda, J., Mibu,
H., Shimakura, Y., Saito, A., Ikumi, S., Ume-
hara, K., Kamei, F., Fukuda, H., Toake, T.,
Takahashi, Y., Miyata, Y., Shioji, S., Toyoda,
M., Hattori, N., Nishihara, H., Matsushima,
R., Nishibori, M., Hokkedo, O., Nojima, M.,
Kimura, T., Fujiseki, M., Okudaira, S., Tana-
be, K., Nakano, M., Ito, K., Kuroda, M. &
Matsukubo, T. (2013) Comparison of progno-
sis of separated and non-separated tooth auto-
transplantation. Journal of Oral Rehabilitation
40, 33–42.
Supporting Information
Additional Supporting Information
may be found in the online version
of this article:
Appendix S1. PRISMA 2009 Check-
list.
Appendix S2. NOS scale.
Appendix S3. Funnel plot.
Appendix S4. Publication bias
(Egger’s test).
Appendix S5. Case characteristics.
Address:
Hsein Kun Lu
College of Oral Medicine,
Taipei Medical University,
250 Wu-Hsing Street, Taipei 110-31,
Taiwan
E-mail: jackson@tmu.edu.tw
 Outcomes of autotransplanted teeth 423

Clinical Relevance
Scientific rationale for the study:
Autotransplanted teeth with com-
plete root formation appear to
have poor prognoses. This study
used a meta-analysis to evaluate
the failure rate, infection-related
root resorption rate and AR. The
influences of various factors were
also analysed.
Principle findings: The estimated fail-
ure rate, infection-related root
resorption rate and AR were extre-
mely low when using autotransplant-
ed teeth with complete root
formation. Some factors possibly
influenced these outcomes.
Practical implications: Results of
this meta-analysis suggest that tooth
autotransplantation using donor
tooth with complete root formation
has favourable outcomes.

© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd