Abstract
Background: Tooth autotransplantation represents a biologically favourable treatment option for replacing missing or non-restorable teeth in paediatric patients. However, its long-term prognosis and variability in reported success rates warrant a high-quality synthesis of the available evidence. Methods: A systematic review was conducted following the PRISMA 2020 guidelines. A comprehensive search of PubMed, Scopus, Web of Science, and Cochrane CENTRAL was performed up to May 2024 for clinical studies on autotransplantation of immature permanent teeth in patients under 18 years. Study selection, data extraction, and risk-of-bias assessment (using ROBINS-I and JBI tools) were performed independently by two reviewers. Aggregated success and survival proportions with 95% confidence intervals were calculated through descriptive quantitative synthesis. Results: Three retrospective studies, comprising 404 transplanted teeth, were included in the analysis. The aggregated success proportion was 85.4% (95% CI: 74.4-92.1%), and the aggregated survival proportion was 94.2% (95% CI: 85.0-97.9%), with a mean follow-up ranging from 12 to 168 months. A key finding was that all included studies consistently reported the use of immature donor teeth ((1)/(2)-(3)/(4) root formation) and short-term flexible splinting, which appears to be a critical factor for these successful outcomes. Conclusions: Autotransplantation of developing teeth in paediatric patients demonstrates high survival (≈94%) and favourable success (≈85%), with minimal inter-study variability. When performed with immature donor roots and short-term flexible splinting, the procedure provides a predictable biological alternative to prosthetic or implant rehabilitation in growing individuals. However, the limited number of eligible studies highlights the need for future multicentre prospective research to standardise protocols and confirm long-term outcomes in paediatric populations.