Protocols for autotransplantation for teeth have been in place for more than 40 years with success rates being reported between 60-100%. Previous reviews have reported on success rates in teeth with open and closed apices. This review focuses on those with open apices only.
The aim of the review was to determine the success rate of autotransplanted teeth with an open apex and to identify the factors involved in these results to establish which optimal conditions are necessary for autotransplantation to be a successful long-term treatment in growing patients.
Methods
Searches were conducted in the Medline, Embase LILACS and SciELO databases. Two reviewers independently selected studies, abstracted data and assessed study quality using the Effective Public Health Practice Project instrument which used 6 domains (selection bias, study design, confounders, blinding, data collection methods, and withdrawals and dropouts).
Primary studies published in English, Spanish, or Portuguese evaluating patients with autotransplantation with an open apex with or without preparation of the socket a minimum of 10 patients and a follow- up period of at least 12 months were considered. Random effects meta-analysis was carried out.
Results
- 25 papers reporting 21 studies were included.
- 11 studies were prospective, 10 retrospective.
- All 21 studies were methodologically weak.
- Mean sample size was 80 teeth (range 11-337).
- Mean follow up period was 6.25 years (range 1-41yrs).
- 5 studies did not report a survival rate, 7 reported a survival rate of 100%,
- 8 reporting a survival rate of more than 90%.
- Meta-analysis
- Success rate (17 studies) = 89.68% (95%CI; 86.77 to 92.59%).
- Survival rate (15 studies) = 98.21% (95%CI; 96.99 to 99.44%).
Conclusions
The authors concluded
The present systematic review found a success rate of 89% and a survival rate of 98%, based exclusively on autotransplanted teeth with an open apex, providing a viable therapy in the rehabilitation of growing patients. However, in the absence of clinical trials, and because of the high bias risk in the studies included in the present review, the results must be interpreted with caution
Comments
The reviewers have conducted a broad search of the literature for relevant studies however they note that none of the included studies was of high methodological quality. Almost half of the included studies were retrospective and are more prone to bias, restricting the review to only prospective studies or presenting a sensitivity analysis would have been helpful. The authors also note the wide variety of different criteria used to report treatment outcomes in the original studies and the fact that many of the original studies did not control for potential confounders. We have previously highlighted two earlier reviews (other references) which suggest good outcomes for autotransplantation. However, all 3 reviews suffer with similar problems with the quality of the primary studies. Consequently, high quality prospective studies are needed to properly assess the survival rates of autotransplanted teeth. Agreeing common outcomes for future studies would be helpful. Until high quality studies are available the results of this and previous reviews should be interpreted with caution.
Links
Primary paper
Atala-Acevedo C, Abarca J, Martínez-Zapata MJ, Díaz J, Olate S, Zaror C.Success Rate of Autotransplantation of Teeth With an Open Apex: Systematic Review and Meta-Analysis. J Oral Maxillofac Surg. 2017 Jan;75(1):35-50. doi: 10.1016/j.joms.2016.09.010. Review. PubMed PMID: 27725103.
Other references
Dental Elf – 29th Apr 2014
Dental Elf – 4th Mar 2016
Tooth autotransplantation: review suggests good survival but evidence limited
