Autotransplantation of Premolars to the Anterior Maxilla: A Long‐Term Retrospective Cohort Study of Survival, Success, Esthetic, and Patient‐Reported Outcome With up to 38‐Year Follow‐Up

Background/Aim: Autotransplantation is a well-documented procedure for replacing missing teeth in the anterior maxilla.This retrospective study aims to evaluate long-term survival rate, success rate as well as esthetics and patient-reported outcomeof premolars autotransplanted to the anterior maxilla and secondarily to identify potential prognostic factors for survival, suc-cess, esthetic, and biological complications.Material and Methods: One hundred and twenty-two patients with 153 transplants were assessed on survival rate and potentialprognostic factors, while 50 patients with 61 autotransplanted premolars underwent clinical, radiographic, and esthetic assessment.Clinical and radiographic parameters were recorded. Esthetic outcomes were evaluated using a comprehensive score system compar-ing transplanted teeth to neighboring tooth. All patients filled in a questionnaire about the esthetic outcome of the treatment.Results: The survival rate of transplants after 16–38 years was 76%, with the majority showing no periodontal complications(95%). Radiographically, 46% of transplanted premolars showed no signs of pathosis. Ankylosis and inflammatory resorptionwere observed in 19% and 16%, respectively. Prognostic factors such as donor tooth type and root stage did not significantly affecttransplant survival. Premolars transplanted at an immature stage had a significant lower risk of ankylosis, compared to moremature transplants. Esthetically, 72% of the transplants matched their neighboring teeth, and taking the biological success intoconsideration an overall success rate was 57.3%. In total, 71% of all patients were esthetically satisfied with their autotransplant,18% were fairly satisfied, and 11% were dissatisfied.Conclusions: The transplants demonstrated high survival rate, albeit with biological complications such as ankylosis and inflam-matory root resorption. Developmental stage of the root at the time of transplantation had a significant influence on ankylosis oftransplanted teeth. Esthetic outcomes were generally satisfactory, although challenges were noted with certain restoration typesand donor tooth selections. Overall, the majority of patients expressed satisfaction with their autotransplanted teeth.