Do Autotransplanted Teeth Require Elective Root Canal Therapy? A Long-Term Follow-Up Case Series

Abstract

To determine the long-term survival and outcomes of 252 autotransplanted teeth with a novel root canal therapy (RCT) and follow-up protocol and to establish whether elective RCT after autotransplantation is routinely required for teeth with complete root formation. A retrospective analysis of 209 patients 10 to 58years old, with a total of 252 autotransplants was carried out with a minimum observational period of 1year and a maximum period of 29years. Patients were reviewed at specified intervals. Only the teeth showing any radiographic or clinical signs of internal resorption (IR), external resorption (ER), or pulpal necrosis underwent RCT. A failure was considered the loss or extraction of the autotransplanted tooth. Ten of the 252 autotransplants constituted failures, with 249, 190, 155, 97, 70, and 35 teeth surviving at 1, 2, 3, 5, 7, and 10years, respectively; the remainder were lost to follow-up. Eighteen percent of teeth (n=46) showed radiographic signs of IR, ER, and apical pathology (AP). Most cases of ER were observed by 3years (18 of 28 teeth) and then at 5 to -8years. Only 3 teeth showed signs of IR, which were observed within 5years. Most cases of AP were observed within the first year (8 of 15 teeth) and then at 3 to 6years. Five teeth showed signs of pulp obliteration or sclerosis and did not require RCT, with a maximum period of 16years after identification of sclerosis. Retrospective analysis of the data showed that 184 autotransplanted teeth had complete root formation and 68 had incomplete root formation at the time of autotransplantation. Of the teeth that were followed for at least 5years, 59.3% had complete root formation with no signs of pathology and required no RCT. Despite the limitation of this long-term study of patients lost to follow-up, the results suggest that, with close monitoring, some autotransplanted teeth with complete root formation that do not undergo RCT could have the potential for revascularization. Hence, one could reconsider the protocol of routinely providing RCT after autotransplantation. Future long-term studies will be beneficial to assess the vascularity of autotransplanted teeth using Doppler flowmetry with a larger cohort of patients.