Do Autotransplanted Teeth Require Elective Root Canal Therapy?

Autotransplant is a viable treatment option when faced with managing a space due to a missing or unerupted tooth. The procedure is less commonly used nowadays compared to the past due to the advent of dental implants, however, the latter is not a viable option in the paediatric and adolescent population until the age of 18. Prior to this age, autotransplant is an ideal option either primarily or secondary due to failure of orthodontic management.^1,2 The advantages of autotransplant includes immediate space filling and maintenance as well as preservation of hard and soft tissue. The general consensus following an autotransplant is that the tooth should undergo root canal therapy (RCT) however the evidence is scant on the issue. This study aimed to review the long-term outcome of autotransplanted teeth and the need for RCT.

A retrospective analysis of all cases undergoing autotransplantation over a 34 year period (1969-2003) at a single centre was undertaken. The clinical records were reviewed and data collection included patient demographics, surgical factors as well as post-operative clinical and radiographic detail.

A total of 314 patients underwent 366 autotransplants over a 34 year period. The most common tooth used for autotransplantion was the maxillary canine (78%) followed by lower third molars (11%). The remainder of the cohort consisted of a mixture of other dentition (11%). The mean age of patients at treatment was 18 (range: 10-58 years) and review ranged from 3 weeks to 29 years.

Of the 366 autotransplants only 10 cases immediately failed giving an overall survival rate of 97.3%. Post-operative radiographic review showed no evidence of pathology in 84% of cases. The most common pathology noted was external root resorption in 8% of cases followed by periapical pathology in 5% of patients. Both external root resorption and periapical pathology presented predominantly within the first 3 years.  A total of 51/366 cases (14%) required RCT of which 62% were carried out within the first year and 92% within the first 6 years. Cases treated with RCT showed a 94% survival rate over 5 years.

It is a common misconception that all autotransplanted teeth require elective RCT following the surgical procedure. This large case series with long term follow up is testament that these teeth do not commonly show associated pathology. Close surveillance of the teeth are required especially in the first 3 years as if an autotransplanted tooth is to undergo pathological changes this occurs in the early years. It is apparent that when there is clinical evidence to undertake RCT a high chance of survival is seen. Hence the practice of elective RCT should be reconsidered in autotransplanted teeth.

Reference:

 

1. Czochrowska EM, Stenvik A, Bjercke B, Zachrisson BU. Outcome of tooth transplantation: survival and success rates 17-41 years posttreatment. Am J Orthod Dentofacial Orthop. 2002 Feb;121(2):110-9;
2. Czochrowska EM, Stenvik A, Album B, Zachrisson BU. Autotransplantation of premolars to replace maxillary incisors: a comparison with natural incisors. Am J Orthod Dentofacial Orthop. 2000 Dec;118(6):592-600.