Periodontal and pulpal tissue reactions after tooth transplantation: A narrative review

Tooth autotransplantation is a biologically based and cost-effective surgical procedure in which a tooth is repositioned within the same individual, offering a valuable alternative to prosthetics or implants, particularly in growing patients. Modern protocols, developed through advances in surgical techniques, imaging, and case selection, have significantly improved predictability and success rates. This narrative review aims to synthesize current knowledge on periodontal and pulpal healing following autotransplantation, with emphasis on biological mechanisms and factors influencing clinical outcomes. Periodontal healing depends largely on preservation of periodontal ligament vitality and stem cells, enabling regeneration and functional integration. Revascularization, increased dentin formation and obliteration of the pulp are favourable for survival of the transplant, although complete histological restoration is rare. In general, immature teeth demonstrate superior regenerative capacity compared to mature teeth, but complications such as root resorption and ankylosis remain challenges in both instances. Radiographic evaluation provides limited insight during early healing stages, highlighting discrepancies with histological findings. In conclusion, successful autotransplantation relies on careful case selection, atraumatic technique, and biological preservation, though further human-based research is needed to clarify healing mechanisms and optimize long-term results.