# Influencing Factors in Autotransplantation of Teeth with Open Apex: A Review of the Literature
## 4 Review
[23; 25; 27; 35] used sutures to stabilize the tooth in an interocclusal position, as did [PERSON] et al. [22], who also used sutures and kept them for a week. [PERSON] et al. used orthodontic wires with a composite to splint the transplanted teeth to the adjacent teeth for a month [42], and other authors such as [PERSON] et al. [26] used a combination of sutures and splints and kept the tooth in infraocclusion for 6 weeks or 3 weeks [33]. Meanwhile, [PERSON] et al. [27] indicated that in a series of treated cases, no significant differences were found in terms of the stabilization method. * **Extra-alveolar time of the donor tooth and its storage [23]:** Some authors state that it is vital to minimize the extra-alveolar time of the donor tooth as much as possible to preserve the periodontal ligament and maintain [PERSON]'s epithelial sheath [43], and to reduce complications [5; 23; 27]. [PERSON] et al. [25] suggested that during this time, the tooth must be preserved in a saline solution in order to not to interfere with the possibility of pulp revascularization [23]. [PERSON] et al. [30] highlighted that with the use of a replica, the donor tooth's extra-alveolar time is reduced to less than 1 minute, whereas the extra-alveolar time of the donor tooth can be around 10 min in other circumstances. * **Operator/surgeon's experience:** [PERSON] et al. [22], in their study, concluded that there are no significant differences in terms of the operator's experience, nor in the occurrence of adverse effects. Similarly, [PERSON] et al. [28], in their study, could not validate this factor, since the same operator performed all operations, but they noted that, as in all dental procedures, experience is a must. Meanwhile, [PERSON] et al. [39] confirmed that surgeon experience increased the survival rate of the dental autotransplantation in 17% of cases. * **Need for endodontic treatment [23]:** In the case of an open apex, an immediate root canal treatment should not be performed, so that a follow-up can be carried out and the root may finish forming without showing signs or symptoms of infection [2; 31]. Root canal treatment is needed only when there are radiological signs of resorption or periapical pathology [31]. If there is positive pulp sensitivity, it will be classified as success, while if there is negative pulp sensitivity, it will be classified as survival [10]. Moreover, 96% pulp healing success without the need for endodontics has been observed in autotransplants with open apex, compared with 15% in mature teeth [44]. [PERSON] et al. reflected that if root canal treatment is necessary, it should be performed prior to transplantation or 15 days after it [23]. [PERSON] et al. and [PERSON] et al. [17; 36] considered performing a root canal treatment when necessary, 15 days after transplantation. Furthermore, [PERSON] et al. [17] added that teeth treated endodontically after dental autotransplantation have a favorable prognosis. * **Treatment follow-up:** [PERSON] et al. [36] suggested a follow-up consisting of a monthly X-ray for the first 3 months to verify that there is no root resorption or pulp necrosis. If there is no evidence of this, further follow-up visits are scheduled after 6 months, 2 years and 3 years [36]. The follow-up schedule that [PERSON] et al. [29] described is as follows: 1 week, 2 weeks, 4 weeks, 2 months, 4 months, 6 months, 1 year, and 2 years. In addition, in open apex autotransplantation, it is important to have a radiological sequence taken in the follow-up sessions, where the continuous development of the root of a transplanted tooth with open apex can be ensured [30].