Revascularisation of Autotransplanted Teeth - Retrospective Analysis of a Novel Technique
Conditions: Endodontic Disease, Pulp Canal Obliteration
Sponsor: Medical University of Graz

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Study protocol 
 
Revascularization of autotransplantated adult teeth – 
retrospective analysis of a novel technique  
 
 
Revaskularisation von erwachsenen transplantierten Zähnen – 
Retrospektive Analyse einer neuen Technik 
 
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Version 2, 19.07.2021 
 
Author: Univ. Ass. Dr.in Petra Rugani 
 
 
Sponsor: 
 
Univ. Prof. DDr. Norbert Jakse 
Department of Dental Medicine and Oral Health 
Division of Oral Surgery and Orthodontics 
Medical University Graz 
 
 
Investigator: 
 
Univ. Ass. Dr. Petra Rugani  
Department of Dental Medicine and Oral Health 
Division of Oral Surgery and Orthodontics 
Medical University Graz

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Responsibilities and addresses 
 
Sponsor: 
Univ. Prof. Dr. med. univ. Dr. med. dent. Norbert Jakse 
Billrothgasse 4 
8010 Graz 
0316/385-82921 
norbert.jakse@medunigraz.at 
 
 
Investigator 
Dr. med. dent. et scient. med. Petra Rugani 
Billrothgasse 4 
8010 Graz 
0316/385-80339 
petra.rugani@medunigraz.at 
 
Univ. Prof. Dr. med. univ. Dr. med. dent. Norbert Jakse 
Billrothgasse 4 
8010 Graz 
0316/385-82921 
norbert.jakse@medunigraz.at 
 
Dr. med. dent. Barbara Kirnbauer 
Billrothgasse 4 
8010 Graz 
barbara.kirnbauer@medunigraz.at 
 
Dr. med. univ. Marton Magyar 
Universitätsklinik für Radiologie,  
Auenbruggerplatz 9, 8036 Graz 
marton.magyar@medunigraz.at 
 
Univ. Prof. Dr. med. univ. Kurt Ebeleseder 
Billrothgasse 4 
8010 Graz 
kurt.ebeleseder@medunigraz.at 
 
 
 
 

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Synopsis 
 
Sponsor 
Univ. Prof. DDr. Norbert Jakse 
Department of Dental Medicine and Oral Health, Divison of Oral Medicine and 
Orthodontics 
Medical University of Graz 
Title 
Revascularization of autotransplantated adult teeth – retrospective analysis of a 
novel technique 
Population 
Patients who experienced autotransplantation of adult teeth  
Study design 
Retrospective data analysis 
Objectives 
Evaluation of the success rate of reperfusion of autotransplanted adult teeth  
Outcome variables 
Primary outcome variable: Reperfusion of the transplanted tooth 
Secondary outcome variable: Periodontal healing 
Participants 
17 -20 patients 
Timetable 
Retrospective analysis and data evaluation over 1 month 
Inclusion criteria 
• 
Patients who experienced one or multiple autotransplantations of teeth  
• 
At least one year of follow-up 
Exclusion criteria 
• 
Immature teeth with open apices 
• 
Different surgical technique 
 

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1. Introduction 
 
Autotransplantation of immature teeth is a routine procedure. It has a high success rate 
regarding periodontal and pulpal healing. Disruption of blood supply in teeth removed from their 
socket leads to pulp tissue infarct and coagulation necrosis. (Adreasen and Kahler JOE 2015) After 
transplantation, there is a good chance of revascularization of necrotic pulp tissue in immature 
teeth with open apices. However, this outcome is not only threatened by the possibility of 
infection-related inflammatory root resorption, but the apical pulp canal diameter also seems to 
play an essential role. The chance of revascularization is significantly diminished in mature teeth 
with an apical constriction. 
Consequently, it is recommended to start root canal treatment of adult transplanted teeth within 
7 to 10 days. 
 
Jakse et al. (2018) already reported on a unique case, where combining transplantation with a 
resection of the root tip lead to successful revascularization in a mature tooth  
 
2. Methods: 
By a retrospective study design, clinical and radiological data regarding patients who experienced 
tooth transplantation with concomitant root tip resection between July 2017 and June 2020 will 
be obtained and analyzed.  Clinical and radiological findings will be evaluated regarding 
periodontal and pulpal healing.  
 
 
3. Risk and benefits 
It is a retrospective data analysis. There is no risk to patients.  
 
4. Objectives and hypotheses of the study 
 
a) 
Objectives 
To investigate the rate of successful reperfusion of autotransplanted adult teeth.  
 

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b) Hypothesis 
 
Simultaneous resection of the root tip leads to a higher rate of reperfusion.  
 
c) Outcome Variables: 
Primary Outcome: Reperfusion of transplanted teeth 
 
Secondary Outcome: Periodontal Healing, Tooth loss  
 
5. Synopsis 
5.1 Design 
Retrospective data analysis 
 
5.2 Participants 
Inclusion criteria 
- 
Patients who experienced one or multiple autotransplantations of teeth  
- 
At least one year of follow-up 
Exclusion critieria 
• 
Immature teeth with open apices 
• 
Different surgical technique 
 
5.3 Methods 
• 
Evaluation of medical history 
• 
Interpretation of existing x-rays 
 
Any known or foreseeable factors that may affect the results of the study or its interpretation: 
• 
Missing data 
 
 
 

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6. Statistical considerations 
Andreasen et al. determined in their long-term study over 370 transplanted premolars that with completed 
root growth (and consequently closed foramen apical) only in 60% of cases does periodontal healing occur, 
while this is to be expected in immature teeth in 90% of cases.  
If one compares the pulpal healing in teeth with completed and non-completed root growth, one even 
comes to a difference of 15 to 96%. 
 
Since this is a retrospective data analysis, the statistical evaluation is carried out by means of descriptive 
statistics. The result is then compared with published success rates in the subject-specific literature. (Chi 
square test) It should be shown that the success rate of transplantation of teeth with completed root growth 
according to the presented method  
does not differ from the success rate of transplanted immature teeth with open foramen apical. 
 
7. Data management 
Data will be anonymized and recorded in an excel document.  
The statistical analysis of the data is carried out by DI Irene Mischak. 
The collection, transfer, storage and evaluation of personal data within this study is carried out in 
accordance with legal provisions (Datenschutz-Grundverordnung, DSGVO).  
 
8. Legal basis 
8.1 General 
Guidelines of the Declaration of Helsinki apply.  
 
8.2. Vote of the Ethics Committee  
Since this is sensitive patient data, it can only be started if the approval opinion of the responsible ethics 
committee is available.  
 
9. Literature 
- 
Amos MJ, Day P, Littlewood SJ. Autotransplantation of teeth: an overview.Dent Update. 2009 
Mar;36(2):102-4, 107-10, 113. 

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Sugai T, Yoshizawa M, Kobayashi T, Ono K, Takagi R, Kitamura N, et al. Clinical study on prognostic 
factors for autotransplantation of teeth with complete root formation. Int J Oral Maxillofac Surg 
2010; 39:1193–203.  
- 
Cross D, El-Angbawi A, McLaughlin P, et al. Developments in autotransplantation of teethSurgeon, 
11 (2013), pp. 49–55 
- 
Cardona JL, Caldera MM, Vera J. Autotransplantation of a premolar: a long-term follow-up report 
of a clinical caseJ Endod, 38 (2012), pp. 1149–1152 
- 
Tanaka T, Deguchi  T, Kageyama T, Kanomi R, Inoue M and Foong KWC.Autotransplantation of 28 
Premolar Donor Teeth in 24 Orthodontic Patients. The Angle Orthodontist Jan 2008, Vol. 78, No. 1 
(January 2008) pp. 12-19 
- 
Almpani K, Papageorgiou SN, Papadopoulos MA. Autotransplantation of teeth in humans: a 
systematic review and meta-analysis. Clin Oral Investig. 2015 Jul;19(6):1157-79. doi: 
10.1007/s00784-015-1473-9. Epub 2015 Apr 24. Review. 
- 
Strbac GD, Giannis K, Mittlböck M, Fuerst G, Zechner W, Stavropoulos A, Ulm C. Survival rate of 
autotransplanted teeth after 5 years - A retrospective cohort study. J Craniomaxillofac Surg. 2017 
Aug;45(8):1143-1149. doi: 10.1016/j.jcms.2017.03.023. Epub 2017 Apr 18. 
- 
KRISTERSON L: Autotransplantation of human premolars. A clinical and radiographic study of 100 
teeth. Int J Oral Surg 14: 200–213 (1985), 5 
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KUGELBERG R, TEGSJO U, MALMGREN O: Autotransplantation of 45 teeth to the upper incisor 
region in adolescents. Swed Dent J 18: 165–172 (1994)  
- 
Lundberg T, Isaksson S (1996). A clinical follow-up study of 278 autotransplanted teeth. Br J Oral 
Maxillofac Surg 34:181-185 
- 
Andreasen JO1, Paulsen HU, Yu Z, Schwartz O. A long-term study of 370 autotransplanted 
premolars. Part III. Periodontal healing subsequent to transplantation. Eur J Orthod. 1990 
Feb;12(1):25-37.) 
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Paulsen HU, Andreasen JO, Schwartz O. Pulp and periodontal healing, root development and root 
resorption subsequent to transplantation and orthodontic rotation: a long-term study of 
autotransplanted premolars. Am J Orthod Dentofacial Orthop 1995; 108:630–40. 
- 
Skoglund A. Pulpal changes in replanted and autotransplanted apicoectomized mature teeth of 
dogs. 
- 
Skoglund A. Vascular changes in replanted and autotransplanted apicoectomized mature teeth of 
dogs.Int J Oral Surg. 1981 Apr;10(2):100-10. 
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