Intemationai Endodontic JoumaH\9S5) 18,119-!

31
Resorption of autotransplanted human teeth: a retrospective
study of 291 transplantations over a period of 25 years
OLE SCHWARTZ,* PER BERGMANN* & BJARNE KLAUSENf Departments of*Oral
Surgery and \Oral Diagnosis, Royal Dental College, Copenhagen, Denmark
Sununary. An assessment was made of the post-
operative fate of 291 autotransplamed human
teeth, carried out in the period from 1955 to 1980,
with special reference to root resorption.
Root resorption was found to be the major cause
of graft loss (/"< 0.0001). During the observation
period, inflammatory resorption (IR) was
diagnosed in 94 cases, leading to graft loss in 39
cases (mean survival time for grafts with IR was
7.2 years). Replacement resorption (RR) was
found in 52 cases, leading to graft loss in 19 cases
during the observation period, but with a consider-
ably lower intensity of graft loss than in the IR
group (mean survival time for grafts with RR was
12.0 years).
The influence of several pre- and peroperative
factors on the appearance of the two types of root
resorption following autotransplantation was
investigated. Premolars were found to bt signifi-
cantly less affected by IR compared with molars,
and canines were more frequently affected by IR
(64 per cent). The younger the patient, and
especially the earlier the suge of root development
of the donor tooth, the less IR, although pulp
obliteration occurred more frequently in the early
graft developmental stage. Ectopia of the donor
tooth seemed to be followed by an increased
frequency of IR and RR after transplantation.
Extraoral storage induced both IR and RR.
Peroperative endodontic treatment should be
avoided, although endodontic treatment, in
general, seemed to have an arresting influence on
IR. Marginal bone toss seemed to affect fully
developed grafts more than grafts transplanted at
an earlier stage but, in general, root resorption was
found to be the most relevant complication of
autotransptanted human teeth.
Introduction
Autotransplantation of huntan teeth has
Correspondence: Dr O. Schwartz, Department of
Chill Sui^ery, Royal Dental CoH^^ 160 Jagtvej,
DK 2100 Copenhagen, Denmark.
been described in many reports, often in
studies limited to single tooth types such
as molars (Apfel 1950, Fong & Agnew 1958,
Nordenram 1963, Andreasen et al. 1970),
canines (Heslop 1967, Hovinga 1969,
Thonner 1971, Reade et al. 1973, Moss 1974,
Hasseigren et at. 1977, Azaz et al. 1978,
Altonen et al. 1978, Gardiner J979) or
premolars (Slagsvold & Bjercke 1974, 1978).
The observation period and the number of
transplanted teeth have often been rather
limited, reducing the feasibility of statistical
analysis. Recently, however, larger groups
have been described with more than iOO
tratisplantadons and observation periods of
up to 10 years {Kristerson & Kvint 1981,
Reade & Hall 1982). In general, a large
variety of criteria has been used to estimate
the clinical results, thus making a comparison
of different studies difficult. Often, mere
retention of the graft is described as success,
irrespective of root resorption or other
unfavourable clinical features. Root resorp-
tion is known to be the major cause of
tooth loss following trauma to the teeth
(Andreasen 1981c) as well as tooth trans-
plantation (Hansen & Fibaek 1972, Oksala &
Kallioniemi 1977).
The purpose oi the present study was to
investigate the effect of different pre- and
peroperative factors on the development of
root resorption or other healing complications
of autotransplanted human teeth in a group of
291 tratisplatitations carried out by 27 oral
surgeons with observation periods up to 25
years.
A detailed evaluation of difierent pro-
gnostic factors related to loss of autotrans-
planted human teeth is presented elsewhere
(Schwartz a/. 1985).
119
120 0. Schwartz, P. Bergmann (S B. Klausen
DONOR TEETH
RECIPIENT REGIONS
NUMBER
120-
no-
100-
90-
80-
70-
60-
50-
40-
30-
20-
10-
121
123
Indas Canine Pre malar Molar
NUMBER
120-
110-
100-
90-
80-
70-
60-
50-
40-
30-
20-
10-
123
e
f l
t18
Incisof Canine Premol ar Mol ar
Fig. 1. Distribution of autotransplanted teeth according to donor tooth type (left) and recipient region
(right).
Material and methods
The study comprised of 291 autotransplanted
teeth iti 259 patients treated at the Depart-
ment of Oral Surgery, Royal Dental College,
Copenhagen, during the period from 1955 to
1980. The follow-up was termitiated on 1
June 1982. Transplanted teeth still present
and functioning at this closing-date were
included in the life-tabie analysis considered
as censored observations. Sixty-two patients
failed to attend the final follow-up because of
emigration, geographical reasons or because
they could not be traced. These transplants
were considered censored at the time of the
last control day when the transplant was
registered as present.
The transplantations were carried out by
27 oral surgeons during a period of 26 years,
each surgeon operating on 1-75 teeth. The
follow-up treatment and controls were pro-
vided by the same staff of 27 oral surgeons.
From September 1981 to June 1982, how-
ever, all controls were provided by two of the
authors. The mean observation period was
9.6 years (range 1-25.7 years). The trans-
planted teeth were comprised of 123 molars,
121 premolars, 45 canines and 2 incisors (Fig.
1). The recipient regions were distributed
according to Fig. 1. The ages of the patients
are shown in Fig. 2 (mean 16.8 years). The
sex distribution of the patients was 121 males
and 170 females.
Pre- and peroperative variables
Information from the time of transplantation
was taken from the patient's record and from
the radiographs at the time of transplantation.
Censored transplants (still present at the
Resorption of autotransflanted human teeth
AGE AT TIME OF SURGERY
121
110-
100-
90-
80-
70-
60-
50-
40-
30-
20-
10-
a
83
23
IWi
5-10 11-15 16-20 21-2S 26-M 31-35 36-40 41-45 46-
AGE
Fig. 2. The ages ofthe patients from whom the teeth were autotransplanted.
latest controi day) were registered, together
witb registrations and radiographs from a
control tooth (cotitralateral tooth). All
recorded information was registered on a
standardized form for computerization.
Indication for transpkntation was recorded
as aplasia (27.5 per cent), ectopia (31.9 per
cent), trautnatic loss (4.1 per cent) and extrac-
tion (37.5 per cent). The position ofthe donor
tooth was recorded as retained (74.5 per cent),
infra-occiusion (9.3 per cetit), and in occlu-
sion (16.2 per cent). The developmental stage
of the graft was divided into the following
categories: less than half root length (3.7 per
cent), half to three-quarters root length (27.2
per cent), three-quarters to whole root with
open apex (34.1 per cent), and fully formed
with a closed apex (35.0 per cent) (Fig. 3).
During removal ofthe donor tooth, osteotomy
was recorded as necessary in 63 per cent,
extraoral storage was recorded in 25,3 per
cent, immediate trattsplantation in 47.9 per
cent, and storage was not mentioned in 27 per
ROOT DEVELOPMENTAL STAGE
root l ength
1] 1/2 < root l ength ^ 3/4
Ml 3'^ < ^oot lenglh ^ 1/1
open apex
rool length = 1/1
closed apex
Fig. 3. aassification of root developmenial stages
of the donor teeth at the time of transplantation.
122 0. Sdaartz, P. Bergmann (S B. Klaasen
cent of the operations. Antibiotics (usually
penicillin) were recorded as prescribed
during the first postoperative week in 65.9
per cent. In the recipient region, a tooth was
extracted during the operation in 7!.2 per
cent, mostly a deciduous tooth or a carious
permanent tooth. Periodontal bone loss before
or during transplantation was recorded as
more than half root length in 15.1 per cent
and less then half root length in 17.9 per cent.
The fixation type was recorded as flexible in
46.8 per cent and rigid (acrylic or Sauer bar)
in 37.6 per cent, 15.6 per cent being trans-
planted without fixation. The fixation period
was less than 1 week in 18.7 per cent and
more than 4 weeks in 49.2 per cent. Extraoral
endodontic treatment was carried out in 43
teeth (13.9 per cent), conventional endodon-
tic treatment in 28; notes made at operation
revealed information concerning damage to
the periodontal membrane in 6.2 per cent.
Postoperative variables
Registration of postoperative variables was
collected from the clinical examination and
from radiographs taken during the control
period and at the last follow-up. Clinical
examination included the transplanted tooth
and a control tooth, normally the contralateral
tooth, but if this was missing, a tooth of
similar type and position was registered. The
vertical and horizontal position and state of
occlusion were recorded.
Mobility was evaluated according to
Kantorowicz (1924), into 0, 1% 2 and i".
Electric vitality testing was carried out using
a Sirotest I I . ' The percussion test was per-
formed by gently tapping against the occlusal
and facial surface of each tooth examined. If
the tone obtained was a high metallic sound,
compared with the adjacent teeth or control
tooth, ankylosis was diagnosed.
Gingival and plaque indices were recorded
according to Loe & Silness (1963). Periodon-
tat pocket probing and measurement of
gingival retraction was performed using a
periodontal probe.
'Siemens, Bensheim, W. Germany.
Intraoral radiographs were obtained using
the bisecting-angle technique. At the latest
follow-up control day, this view was sup-
plemented by one with a 15 mesial angula-
tion horizontally and another with a 15 distal
angutation horizontally compared with the
normal centra! ray of the bisecting-angle
exposure of the tooth. The following pulpal
and periodontat complications are recorded
from the follow-up radiographs.
Inflammatory resorption and replacement
resorption were registered according to the
criteria of Andreasen & Hjorting-Hansen
(1966). The diagnosis of inflammatory
resorption was based entirely on the radio-
graphic evaluation. The diagnosis of replace-
ment resorption (ankylosis) was based
primarily on the percussion test and mobility
test, and only supplemented by the radio-
graphic evaluation. If both types of resorp-
tion were diagnosed on the same graft, only
ankylosis was considered.
Progressive resorption was recorded when
successive radiographs showed an increased
area of tooth involved in the resorptive pro-
cess. When the outlined resorption remained
unaltered for at least 1 year, it was considered
arrested (Reade & Hall 1982).
Pulp canal obliteration: decrease in the size
of the pulp chamber observed compared with
the control tooth. The amount was divided
into ' none' , ' incomplete' and ' complete'
(modified from Oksala 1974).
Loss of marginal bone: increase in distance
from crest of alveolar bone to the amelo-
cementat junction.
Arrest in root formation; root length was
compared with the root of the contralateral
tooth.
Statistical methods
Life-table analysis of the influence of type of
resorption on the loss of grafts was determined
by dividing the transplant material into three
groups according to the presence of inflam-
matory resorption (94), replacement resorp-
tion (52) or no resorption (145). Survival
curves were calculated for each of these
Resorption of autotransplanted human teeth
SURVIVAL OF AUTOTRANSPLANTED TEETH
RESORPTION TYPE DIAGNOSED:
c INFLAMMATORY RESORPTION <N=94)
, , REPLACEMENT RESORPTION CN=S2)
NO RESORPTION (N=14S)
123
2S-
0-'
AT RISK:
58 33
94 D-o O"
10 15 20 25
TIME AFTER AUTOTRANSPLANTATION (YEARS)
10
52 -
145 .
49
129
29
55
10
23
Fig. 4. Life-table estimates of occurrence of graft loss after autotransplanution of human teeth according to
Peto et al. 1977. The hazard curves of teeth with each type of resorption or without resorption diagnosed
after transplantation are shown. The number of teeth at risk in each ofthe curves at 1, 5, 10, 15, 20 and 25
years after transplantation is indicated on the lines below.
groups (Fig. 4). The statistical significance of
the differences between survival curves was
tested by the Log rank test (Peto et al. 1977,
Schwartz rt a/. 1985).
Single factor analysis of factors of relevance to
healing complications
The patients were divided into groups
according to presence or absence of the fol-
lowitig cotnplications: inflammatory resorp-
tion, ankyiosis, obliteration of the pulp,
pulpal necrosis, and marginal bone loss. The
sigtiiftcance ofthe clinical pre- and peropcra-
tive parameters on the the listed complica-
tions were tested by the x^ t*st or Fisher's
exact test (Table XII). Unless otherwise
mentioned, the level of significance was 1 per
cent.
Results
Resorption was diagnosed in 146 teeth during
the observation period, 58 of them being lost.
The life-table of autotransplanted teeth with
the two types of root resorption is shown in
Fig. 4 (for explanation of life-table analysis,
see Peto et al. 1977). Itiflammatory resorption
appeared to lead to graft loss relatively
quickly (MST = 7.2 years)' in contrast to
'Mean survival time (MST): time from transplan-
tation during which 50 per cent of the teeth in the
group were lost.
124 0. Schwartz, P. Bergmann (S B. Klausen
teeth with replacement resorption
( MST=12. 0 years) ( P < 0.001). A detailed
evaluation of prognostic factors of relevance
to graft loss is presented elsewhere (Schwartz
1985).
Table I. The relationship of donor tooth type to
inflammatory resorption of autotransplanted teeth
Inflammatory resorption (IR)
Donor tooth type related to IR: canines were
noted to be resorbed significantly more than
molars and premolars (/' <0.00I)", (Table I).
Age ofthe patient at time of surgery related
to IR: the frequency of IR was found to
increase with age (/" = 0.0002). Thi s is pro-
bably related to similar findings concerning
root developmental stage.
Root developmental stage related to IR:
increased developmental stage of the donor
tooth appeared to increase frequency of IR
(/ ' <0. 001), (Table II).
Position ofthe donor tooth related to IR: no
significant relation was found between the
degree of retention of the crown of the donor
tooth within bone and IR ( ^ = 0.66). How-
ever, ectopia ofthe donor tooth seemed to be
related to an increase in IR, compared with
all other indications combined (P = 0.005),
see (Table XII).
Operative procedures related to IR:
osteotomy during removal of the graft was
recorded in 79 cases, but could not be related
to an increase in IR {P=Q.T1). However,
extra-oral endodontics peroperatively seemed
to induce increased IR (P = 0.0001). Thi s
finding could be explained by the close cor-
relation between extraoral storage and IR
(/ ' <0. 0001), (Table III).
Endodontic treatment, including conven-
tional postoperative as well as peroperative
treatment, was found to reduce the intensity
of inflammatory resorption (/" = 0.003),
(Table IV).
Surprisingly, peroperative antibiotic treat-
ment, registered in 193 cases, was not
correlated significantly with either acute post-
operative inflammation, found in 12 cases
(P= 0.93), or IR (P = 0.07), (Table XII).
Tooth type
Canine
Premolar
Molar
Inflammatory resorption
-
16(36)
92(76)
69(56)
+
29(64)
29 (24)
54(44)
Total
45(100)
121(100)
123(100)
The figures in parentheses represent the per-
centage of teeth. The two incisors are not included
in the statistical analysis.
n = 289.
Table II. The relationship of root developmental
stage of the donor tooth at the time of surgery to
inflammatory resorption of autotransplanted teeth
Root
developmental
stage
I
II
III
IV
Inflammatory

10(91)
63(82)
73(78)
48(45)
+
1(9)
14(18)
20(22)
59(55)
resorption
Total
11(100)
77(100)
96(100)
107(100)
The figures in parentheses represent the per-
centage of teeth.
= 291.
Table Ul. The relationship of extraoral storage
recorded during transplantation to inflammatory'
resorption of autotransplanted teeth
Extraoral
storage
Yes
No
Inflammalorj' resorption
+ Total
48(43) 63(57) 111(100)
149(82) 31(17) 180(100)
The figures in parentheses represent the per-
centage of teeth.
Resorption ofautotransplanted human teeth 125
TaWe IV. The relatiotiship of endodontic treatment (per-
and postoperative) of the graft to the type of inflammatory
resorption
Endodontic
treatment
The figures
teeth.
/>=0.003.
n = 94.
Inflammatory resorption
Progressive
27(38)
16(68)
Arrested
44(62)
7(32)
in parentheses represent the
Total
71(100)
23(100)
percentage of
Table V. The relationship of indication for autotransplantation to
replacement resorption ofautotransplanted teeth
Indication
.\pla&ia
Ectopia
Sequel to caries
Replacement resorption
-
7J(91)
61 (67)
93(85)
+
7(9)
29(33)
16(15)
Total
80(100)
90(100)
109(100)
The figures in parentheses represent the percentage of teeth.
Twelve teeth transplanted for other reasons were excluded from the
statistical analysis.
Fixation type and fixation time were not
found to be related to IR (both P=0.65). The
oral surgeon, exemplified by the two most
experienced orai surgeons (104 cases) con-
trasted with all the other surgeons cotnbined,
did not demonstrate any influence on IR
(/'=0.64).
Replacement resorption (RR)
Donor tooth type related to RR: this factor
was not found to be significantly related to
RR (/>=0.06), although canines showed con-
siderably more RR (33 per cent) compared
with molars (15 per cent) alone (P=0.03).
Age of the patient at the time of surgery
seemed to be positively related to RR
(/' = 0.02), but such a relation was less certain
for the developmental stage of the donor
tooth (P=0.06).
Position of the donor tooth (retained vs
erupted) was not correlated to RR (/'=0.79),
however, ectopia of the donor tooth as an
indication for transplantation was related to a
significant increase in RR compared with
other indications {P = 0.009), (Table V).
Operative procedures: extraoral endodontics
peroperatively seemed to be closely related to
development of RR (P = 0.008), (Table VI),
and this could also be found for the factor:
126 0. Schwartz, P. Betpnam (S B. Klausen
Table VI. The relationship of peroperative endodontic tr^tment
ofthe graft to replacement resorption of autotransplanted teedi
Peroperative
endodontics
No
Yes
Replacement resorption
-
212(85) 37(15)
28(68) 13(32)
Total
250(100)
41(100)
The figures in parentheses represent the percentage of teeth.
Table VH. The relationship of type of fixation of the graft to
replacement resorption of aucotransplanted teeth
Fixation type
No fixation
Flexible
Rigid
Replacement resorption
-
38(86)
117(79)
84(84)
6(14)
30(21)
16(16)
Total
44(100)
147(100)
100(100)
The figures in parentheses represent the percentage of teeth.
^=0. 48.
n=291.
Table VIII. The relationship of length ofthe fixation period of Che
graft to replacement resorption ofautotransplanted teeth
Fixation time
1 week
1-4 weeks
4 weeks
Replacement resorption
-
44(87)
56(76)
115(84)
+
7(13)
20(24)
25 (16)
Total
52(100)
76(100)
140(100)
The figures in parentheses represent the percentage of teeth.
/ ' =0. 33.
= 291.
Resorption ofautotransplanted human teeth 127
Table IX. The relationship of the root developmoital stage of the donor
tooth to obliteration of the pulp dumber of autMranspUnted teeth
Root
development stage
I + II
III
IV
None
14(18)
16(23)
39(80)
Putp obliteration
Incomplete
36(47)
34(48)
9(18)
Complete
27(35)
21(29)
1(2)
Total
77(100)
71(100)
49(100)
The figures in parentheses represent the percentage of teeth. Evaluation of
the obliteration was not done until 6 months after transplantation, exduding
23 teeth. Furthermore, endodonticaliy ceated teeth were not induded,
excluding a further 71 teeth from the statistical evaluation.
/'=0.0001.
Table X. The relationship of age of the patient at time of surgery to
increase in marginal bone loss of autotran&planted teeth compared
to the contralateral control teeth
Age at time of
transplantation
(years)
0-15
16-20
21-25
26-70
Marginal bone loss
-
118(91)
60(75)
33(82
25(59)
+
12(9)
19(25)
7(18)
17(41)
Total
130(100)
79(100)
40(100)
42(100)
The figures in parentheses represent the percentage of teeth.
/> = 0.001.
B = 291.
Table XI. The relationship of root developmental sage of the graft
to marginal bone loss of autotransplanted teeth compared to the
coGtralatend control tooth
Root
development stage
Qosedapex
Open apex
Marginal bone loss
- +
76(71) 31(29)
160(87) 24(13)
Total
107(100)
184(100)
The figures in parentheses represent the percentage of teeth.
0.001
291.
]28
O. Schwartz, P. Bergmitm (S B. Klausen
extraoral storage (/'=0.(K)7). However, ^ i -
ation type and fixation time could not be
related to RR (/' =0.33, / ' = 0.48), (Tables
VII and VIII).
Obliteration ofthe pulp chamber
This entity was recorded in 128 grafts out of
197 grafts without root cana! treatment and
an observation period of more than 6 months.
Root developmental stage of the donor tooth
seemed to be inversely related to increased
puip obliteration (P = 0.0001), (Table IX).
Marginal bone loss
By recorditig periodontal pocket formation
and radiographic signs of marginal bone
destruction after the first year of the control
period, and registering the difference between
the deepest periodotttal pocket found on the
transplant compared with the control tooth,
marginal bone loss was found in 55 cases.
This bone loss seetned to be related to the
developmental stage of the root at the time of
transplantation (/*=0.0001) and the age ofthe
patient at the time of transplantation
(/* = 0.001), (Tables X and XI).
Discussion
The nature of the present investigatioti is
basically heterogeneous, collected over a
period of 25 years. Throughout this period,
itidications for transplantation, as well as the
surgical and postoperative follow-up tech-
niques, have beets modified as a consequence
of acquired experience. Furthermore, all the
oral surgery and clinicai follow-up of the
transplants has been carried out by 27 dif-
ferent oral surgeons with a wide variety of
experience from one to 75 transplantations.
However, the relatively high frequency of
root resorption found in the present investi-
gation is in accordance with most previous
investigations of larger series of auto-
transplantations (Andreasen et al. 1970,
Kristerson & Kvint 1981, Reade & Hall
1982).
The common feature associated with fail-
ing or lost autotransplanted teeth was root
resorption, and previous studies have
reported the same finding (Altonen et al.
1978, Andreasen et al. 1970, Azaz et al. 1978,
Hovinga 1969, Moss 1974, Oksala 1974,
Reade & Hall 1982, Kristerson & Kvint
1981).
Table XII. Survey of some of the results of the single factor
analyses by y^ of the relation of the pre- and peroperative factors to
the two types of root resorption
Factor analysed
Tooth type
Age at time of surgery
Root development
Ectopia of donor tooth
Extraoral storage
Peroperative endodontics
Fixation type
Fixation time
Peroperative antibiotics
Resorption type
Replacement
NS

NS
**
#
**
NS
NS
NS
Inflammatory
***
**
**
*#
***
***
NS
NS
NS
NS, not significant.
*/' <0. 05.
P < 0.001.
In Table XI I , a review of part of the
results of the sitigle factor atialyses is
outlined, together with the levels of signifi-
cance found, when they were related to each
ofthe two types of root resorption.
Replacement resorption
Thi s type of resorption seems to lead to graft
loss over a relatively long period of years, as
previously discovered by Andreasen &
Hjerting-Hansen (1966). Itt the present
study, it appears that RR is only related
significantly to ectopia of the donor tooth
and to peroperative endodontics. These find-
ings are not in complete accordance with
clinical experience from dental traumatoiogy
(Andreasen I98lc). However, it is known
from experimental traumatology that RR is a
sequel of limited or extended damage to the
periodontal ligament on the root surface
(Andreasen t981c). Both ectopia of donor
tooth and extraoral peroperative endodontic
treatment could cause damage, through
trauma during removal ofthe graft and, in the
case of peroperative endodontics, drying of
parts of the periodontal ligament. The
majority of the peroperatively root-filled
teeth were transplanted in the earlier years of
the 25-year period, at a time when the
importance of avoiding drying was not
known. It should also be noted, that RR in
the present study could not be related to fixa-
tion type or fixation time of the transplant.
Recently, it has been suggested from animal
studies that rigid fixation or long fixation
periods of traumatized or experimentally
autotransplanted teeth could induce RR
(Andreasen 1975, Kristerson & Andreasen
1983).
Inflammatory resorption
A high frequency of graft loss is seen in the
group of transplants with IR; the intensity of
graft loss was found to be considerably higher
than in the RR group. Thi s is in accordance
with the biological nature of this type of
resorption (Andreasen & Hjorting-Hansen
1966) and with the clinical experience from
dental traumatology (Andreasen 1981c).
It appears from experimental and clinical
traumatology (Atidreasen 198la, b, c), as well
as from previous experimental and clinicai
Resorption of autotransplanted human teeth 129
Studies of autotranspiantation of teeth, that
IR is closely related to necrc^is of the pulp
(MtKS 1%8, Oksala 1974, Skogiund 1980,
Kristerson & Kvint 1981, Reade & Hail
1982). Inflammatory resorption can often be
controlled by endodontic therapy, and the
present study showed a similar tendency of
arrest of IR by endodontics. However,
peroperative endodantic therapy should be
avoided, at least with the technique used in
the early sixties causing loss of nearly ail
transplants. This is in accordance with the
results of Andreasen et al. (1970). However,
the tooth type used in both studies was fully
developed molars, a tooth type and a devel-
opmental stage known to be at high risk
of resorption (Tables I and II). The high
frequency of IR may not be a consequence of
the endodontic treatment, but can be due to
other biological causes or different surgical
technique.
The extensive number of associations
tested in the present analysis implies that
significatit relationships could arise by chance
alone and without any biological background
(t5pe 1 errors). With caution for this, and
with the reservation that the heterogeneity of
the material detnands, it can be concluded
that autotranspiantation of hutnan teeth can
be carried out with a long-lasting result
without root resorption, if it is based
on limited indications and witii a proper
surgical and clinical/radiological follow-up
technique.
Another clinicat finding from the present
study was that the radiographic diagnosis of
IR should be made as early as possible, so
that early postoperative endodontic therapy
can be performed to arrest or eliminate this
type of resorption (Cvek 1973). In all cases,
RR appeared to be irreversible and beyond
any ktiown treatment.
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