Long-term survival and success rates of immature versus root-end resected mature tooth autotransplants: part I of a retrospective cohort study

OBJECTIVES: To compare the survival and success rates of autotransplanted immature teeth versus mature teeth treated with extraoral root-end resection (EORER), and assess inter-rater agreement in radiographic evaluation between oral surgeons (OS) and general practitioners (GPs). MATERIALS AND METHODS: Patients who underwent autotransplantation between 2000 and 2022 were retrospectively identified and invited for clinical and radiographic follow-up examinations. Periapical radiographs were independently evaluated by three OS and three GPs. Predictors of survival and success were analyzed using univariate generalized estimating equation models. RESULTS: Fifty-eight autotransplanted teeth (39 immature, 19 mature) in 50 patients were included. Immature transplants showed higher survival (89.7% vs. 73.7%; mean follow-up 8.4 vs. 5.6 years) and higher success rates (63.3% vs. 31.3%) than EORER-treated mature transplants. Pulp revascularization was observed in 88.5% of immature and 54.5% of EORER-treated mature teeth. Longer splinting and pristine recipient sites were associated with higher survival; premolar and molar sites with higher success (p ≤ 0.047). Inter-rater agreement was lowest for pulp canal obliteration, with OS showing higher agreement than GPs (p = 0.02). GPs generally reported more pathological findings on the radiographs. CONCLUSIONS: Immature transplants demonstrated higher survival and success rates than EORER-treated mature transplants. However, pulp revascularization was observed in over half of mature transplants. Radiographic assessment varied considerably between OS and GPs. CLINICAL RELEVANCE: Immature donor teeth remain the preferred option for autotransplantation. Nevertheless, EORER extends eligibility to mature donor teeth by promoting pulp revascularization, potentially avoiding root canal treatment. Standardized radiographic criteria and calibration are warranted for follow-up over time.