 |
| Title |
Auto-transplantation Demonstrates High Survival Rates and Can Be a Favorable Treatment Modality for Children with Missing Teeth |
| Clinical Question |
For children with missing teeth, does auto-transplantation provide favorable long-term treatment outcomes compared to dental implants? |
| Clinical Bottom Line |
For children with missing teeth, auto-transplantation provides long-term replacement for missing teeth with high survivability. This is supported by a systematic review and meta-analysis that demonstrates high survival rates of immature teeth that are auto-transplanted. Additionally, a systematic review evaluating the survival of implants and auto-transplants in children with congenitally missing teeth demonstrates increased survival of auto-transplanted teeth compared to dental implants in children. More research is needed to assess other factors related to clinical success aside from survivability, including esthetic outcomes and patient acceptance. |
| Best Evidence |
(you may view more info by clicking on the PubMed ID link) |
| PubMed ID |
Author / Year |
Patient Group |
Study type
(level of evidence) |
| #1) 35258700 | Sicilia-Pasos / 2022 | 610 teeth with incomplete root development | Meta-Analysis | | Key results | At least 165 patients were assessed; 12/17 articles did not list the number of patients and only the number of teeth transplanted. In the 17 included studies, a total of 610 teeth with incomplete root development were transplanted.
Teeth with incomplete root formation at time of auto-transplantation demonstrated an overall survival rate of 97.9% (CI:96.2%-99.6%). After 1 year, the survival rate was 98% (CI: 96.1%-99.9%), and at 5 year follow up the survival rate slightly decreased to 96% (CI: 92%-99.0%). | | #2) 27747652 | Terheyden / 2015 | 42 studies for quantitative analysis | Systematic review of non-randomized trials | | Key results | The survival of implants in children below the age of 13 was found to be 72.4% (CI: 18.8). For auto-transplantation, the mean survival was found to be 94.4% (CI 4.1). | |
| Evidence Search |
((missing teeth) OR (congenitally missing teeth)) AND (autotransplantation) |
Comments on
The Evidence |
Sicilia-Pasos and colleagues defined their PICO question to evaluate whether patients with auto-transplantation of teeth with incomplete dental development show survival and success at 2 or more years post-treatment. There was no comparison group considered in this evaluation. The authors systematically reviewed the literature published between 2010-2021 by searching MEDLINE, Web of Science, and the Cochrane Library. Utilizing explicit search criteria, 17 studies were reviewed, including 11 observation studies, 5 non-randomized clinical trials, and one RCT. Of these studies, 7 were graded as high quality and 10 were of medium methodological quality. From these studies, 14 provided data to complete the meta-analysis to evaluate the long-term survival of auto-transplanted teeth. Data from each individual article is displayed both in tables and visually with forest plots. Ultimately, the success of auto-transplantation was not analyzed in the meta-analysis due to the heterogeneity by which the various authors defined success.
Terhettden and Wusthooff defined their PICO question to evaluate whether in patients with congenitally missing teeth, dental implants, auto-transplantation, or other treatment modalities shows better survival, success, and patient centered outcomes. The authors systematically reviewed the literature published between 1980-2015 by searching PubMed and EMBASE. From the 42 studies included in the data synthesis, 25 studies were retrospective, 14 were prospective including 1 RCT, 1 study was cross-sectional, and 1 was listed as ‘unclear.’ Bias was evaluated and a rating was provided for each article; 30 of the 42 had a low risk of bias and the remaining articles included had a medium risk of bias. Summary statistics of survival and success are provided; however, the definition of these two outcome variables is not specified. Insufficient articles and subjects were available for comparative evaluation of patient centered outcomes.
|
| Applicability |
The studies evaluated in the systematic review and meta-analysis included patients who had not completed tooth development, presented with edentulism of one or more teeth, and the etiology of the missing teeth varied. In the second article reviewed, the systemic review included studies that evaluated children, adolescents, and adults with congenitally missing teeth.
While auto-transplantation provides higher survival rates in children, achieving an esthetic result may require additional restorative and periodontal procedures and consequently additional treatment time and cost. More research is needed to assess additional factors that contribute to treatment success aside from survivability.
Additionally, success criteria should be further developed for cross-comparison between studies.
|
| Specialty/Discipline |
(Endodontics) (General Dentistry) (Oral Surgery) (Orthodontics) (Pediatric Dentistry) (Periodontics) (Prosthodontics) (Restorative Dentistry) |
| Keywords |
Auto-transplantation, missing teeth
|
| ID# |
3508 |
| Date of submission: |
11/29/2022 |
| E-mail |
baigz@livemail.uthsca.edu |
| Author |
Zaara Baig |
| Co-author(s) |
Alexander Padalino |
| Co-author(s) e-mail |
padalino@livemail.uthscsa.edu |
| Faculty mentor/Co-author |
Dr. Maria Karakousoglou |
| Faculty mentor/Co-author e-mail |
karakousoglo@livemail.uthscsa.edu |
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) |
post a rationale |
| None available | |
|
Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
post a comment |
| None available | |
|
|
