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Autotransplantation of teeth in humans: a systematic review and meta-analysis

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Abstract

Objectives

The aim of this investigation was to assess the currently available evidence concerning the complications and risk factors influencing the outcome of autotransplantation of teeth in humans.

Materials and methods

Electronic searches were conducted to identify randomized controlled and prospective clinical trials. Risk of bias within studies was assessed with the Downs and Black tool. Random-effects meta-analyses were conducted to pool the adverse event rates and relative risks with their 95 % confidence intervals. Risk of bias across studies was assessed with the GRADE framework followed by sensitivity analyses.

Results

Thirty-eight studies were included in the analysis. Reported complications included the need for extraction, failure, hypermobility, pulp necrosis, pulp obliteration, and root resorption. Pooled complication event rates varied considerably, with small studies (<100 teeth) reporting greater complication rates. The analysis of risk factors was associated with both the primary outcome (extraction need) and secondary outcomes (failure, hypermobility, pulp necrosis, pulp obliteration, root resorption). The stage of root development seems to influence both the future survival, as well as the success of the transplanted teeth. Teeth with open apex were less likely to be extracted in comparison to teeth with closed apex (3 studies; 413 teeth; relative risk 0.3; 95 % confidence interval 0.2–0.6).

Conclusions

Due to the small number of the contributing studies, their methodological limitations, and the heterogeneous results reported, no firm conclusions can be drawn.

Clinical relevance

Root development of the donor teeth has been established as one the most important factor related to the success of tooth autotransplantation.

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Appendix

Appendix

Table 6 Eligibility criteria used in this meta-analysis
Table 7 Commands used in the program Stata for the statistical analysis (database available upon request)
Table 8 The electronic databases searched, the search strategy used, and the corresponding results (as of November 20, 2012)
Table 9 Risk of bias analysis of the included studies according to the Downs and Black (1998)
Table 10 Meta-analysis of factors associated with the secondary outcome: ankylosis of autotransplanted teeth
Table 11 Meta-analysis of factors associated with the secondary outcome: hypermobility of autotransplanted teeth
Table 12 Meta-analysis of factors associated with the secondary outcome: pulp necrosis of autotransplanted teeth
Table 13 Meta-analysis of factors associated with the secondary outcome: pulp obliteration of autotransplanted teeth
Table 14 Meta-analysis of factors associated with the secondary outcome: root resorption of autotransplanted teeth
Table 15 Assessment of reporting biases in the meta-analyses of adverse events’ rates
Table 16 Sensitivity analyses of the pooled event rates according to study sample size using a cutoff of 100 transplanted teeth pro included study
Table 17 Sensitivity analyses for the pooled estimates of primary and secondary negative outcomes (adverse event rates) by including studies with a mean follow-up of at least 6 months

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Almpani, K., Papageorgiou, S.N. & Papadopoulos, M.A. Autotransplantation of teeth in humans: a systematic review and meta-analysis. Clin Oral Invest 19, 1157–1179 (2015). https://doi.org/10.1007/s00784-015-1473-9

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