Effectiveness of root canal therapy in auto-transplanted third molars: a systematic review, meta-analysis and case series report.

Abstract

Objectives: The existing literature indicates insufficient conclusive evidence regarding the efficacy of root canal therapy (RCT) in conjunction with third molar autologous tooth transplantation (ATT). This systematic review aims to evaluate the long-term survival rates and complications associated with this method.

Materials and methods: A comprehensive search was conducted across multiple databases, including PubMed, EMBASE (OVID), Web of Science (WOS), EBSCO, SpringerLink, Oxford, and ScienceDirect. This systematic review adhered to the guidelines set forth by the PRISMA and was registered in PROSPERO (CRD42024585817). This study calculated pooled survival rates, root resorption rates, and overall survival metrics. Subgroup analyses were performed to investigate the influence of follow-up duration, sample size, timing of endodontic treatment, and endodontic treatment on outcomes. Statistical significance was determined using an alpha value of 0.05, with 95% confidence intervals (CI) reported for pooled estimates. Heterogeneity was assessed using the I² statistic and Cochran's Q test.

Results: Among the 17 included studies, the follow-up period ranged from 1 to 29 years. After excluding two studies with 100% survival rates, the overall 1-year survival rate was 96% (P < .0001). Studies with mixed samples showed a higher 20-year survival rate compared to those exclusively involving third molars (46.2% vs. 41.3%; P = 0.029). RCT significantly improved survival and success rates in third molar autotransplantation, though heterogeneity varies across studies. The success rate reflects the completeness of treatment and indicates the restoration of tooth function, whereas the survival rate focuses more on the long-term retention of the tooth. The higher risk difference (RD) observed in the RCT group suggests that RCT enhances both survival and success rates. This finding highlights the potential role of RCT in enhancing the success of ATT. However, significant heterogeneity was observed across studies (I² = 73%), and the difference between the two groups were not statistically significant (P = 0.37, I² = 0%). These results may be influenced by follow-up duration, timing of endodontic treatment, and sample size. Therefore, the conclusions should be read with caution.

Conclusion: ATT of third molars with intact root formation represents a reliable approach for the replacement of missing teeth, demonstrating a high survival rate. Furthermore, RCT is associated with reduced complication rates and enhanced long-term survival.