Prognostic factors, outcomes, and complications for dental autotransplantation: an umbrella review

Abstract

Background: Dental autotransplantation (DAT) is a biological way of replacing missing or compromised teeth for patients. The techniques often necessitate a multi-disciplinary approach. The prognosis and success of the procedure may be impacted by variable factors in varying degrees.

Objective: Evaluating outcomes and complications of DAT, including prognostic factors using an umbrella review.

Search methods: Six databases were searched for all relevant systematic reviews published up to 30 June 2022. No restrictions were applied to language or publication date.

Selection criteria: Systematic reviews and meta-analyses of DAT studies.

Data collection and analysis: Identification, screening, eligibility, and quality assessment using the AMSTAR 2 tool were performed independently by two authors (M.C. and S.A.). Two studies (20%) scored moderate, six studies (60%) scored low, and two studies (20%) scored critically low. Data were analysed using a random effects meta-analysis, and meta-regression was performed to investigate the effect of open and closed apices on the dependent variables. The results were summarised as relative risk ratios.

Results: A total of 310 studies were eligible for inclusion, of which 20 studies were selected for full-text evaluation. Ten systematic reviews were included, 9 of which had a meta-analysis. Overall findings suggest that DAT offers favourable success and survival rates. Meta-regression results indicate that a closed apex increased the proportion of ankylosis and resorption, reduced survival but had no effect on success during the observational period.

Limitations: A varying degree of heterogeneity and bias was present in all systematic reviews. The samples of donor teeth included in the systematic reviews also varied morphologically.

Conclusions: DAT is a technique-sensitive procedure requiring a multidisciplinary team, vigilant case assessment and thorough consideration of the respective prognostic factors involved. Despite methodological limitations reported across studies, DAT shows favourable success and survival rates, with a distinctive advantage of bone induction and soft tissue thickness preservation, and should, therefore, be considered as a viable treatment modality. Standardisation of clinical guidelines and practice are highly recommended.

Registration: CRD42020202484.

Keywords: autogenous tooth transplantation; autologous tooth transplantation; dental autotransplantation; tooth autotransplantation; umbrella review.