Extraoral root-end resection in autotransplantation of mature teeth with implications for orthodontic practice: A systematic review

Background : Extraoral root-end resection (EORER) has been proposed to promote pulpal healing and expand autotransplantation indications for mature teeth, but evidence remains limited. Objective : To synthesize clinical outcomes, complications, and orthodontic implications of EORER in autotransplantation of fully rooted permanent teeth. Methods : This PRISMA-based review searched PubMed/MEDLINE and Web of Science for human studies of mature/closed-apex tooth autotransplantation treated with EORER. Outcomes were survival, clinical success, pulpal revascularization/pulpal healing, periodontal health, root resorption, and ankylosis. Single-arm meta-analyses of logit-transformed proportions used random-effects models when data were extractable. Results Seven studies published from 2018 to 2025 were included: case reports, a case series, and retrospective observational studies; no randomized controlled trials were identified. The EORER-specific sample comprised 96 transplanted teeth, although analyzable sizes varied by outcome. Pooled survival was 89.7% (95% CI, 81.2–94.6%), and pooled clinical success was 62.9% (95% CI, 52.7–72.0%). Pooled pulpal revascularization/pulpal healing was 71.4% (95% CI, 35.2–92.0%) and periodontal health 70.5% (95% CI, 66.6–74.1%). Root resorption and ankylosis occurred in 29.5% (95% CI, 18.1–44.3%) and 23.9% (95% CI, 0.6–94.3%), respectively. Conclusions : EORER may be a feasible adjunct for selected mature autotransplantation cases and may be relevant to interdisciplinary orthodontic planning. However, evidence remains low certainty because of small samples, retrospective designs, heterogeneous indications, inconsistent outcome definitions, and limited follow-up. Standardized prospective studies are needed.