The Experiences and Outcomes of Tooth Auto-Transplantation at Leeds Dental Institute

Aims: (1) To evaluate the outcomes of auto-transplanted teeth and identify the prognostic factors that were associated with the outcomes. (2) To explore patients, their parents and interdisciplinary dental team experiences with tooth auto-transplant. Methods: Multiple methods including quantitative and qualitative studies were conducted. The first study was quantitative. A retrospective case note review of tooth auto-transplant cases was undertaken using a specific data extraction form. The second qualitative study involved face to face semi-structured interviews conducted both prospectively and retrospectively with patients, their parents and clinicians. Results: The triangulation between the two studies (the qualitative and the quantitative) and among the different participants groups within the qualitative study generated five superordinate themes which were outcomes, struggles, coping strategies, support, and satisfaction. The first (quantitative) study included 135 dental records (164 transplanted teeth). The mean age at auto-transplantation was 13.8 years. The median observation period was 3 years (IQR = 3, 2-5 years). The overall transplant success rate was 75.3% and the survival rate was 90.2%. Failures were seen in 24.7% of the auto-transplanted teeth due to unfavourable periodontal outcomes including replacement root resorption in 13% of transplants, infection related resorption in 4.9%, both resorption types in 4.3% and alveolar bone loss in 2.5%. The second (qualitative) study involved 23 patients, 22 parents and 10 clinicians. The data revealed that tooth auto-transplantation is a lifelong pathway and includes multiple struggles, mainly the appearance, disturbance in the continuity of the dental care and some failures. The findings showed that clinical, social and emotional support were provided. Every time patients and parents received enough support along the pathway, they coped better with their struggles and they subsequently became more satisfied with the care given. Their degree of satisfaction was influenced by the dental appearance and the care provided. They expressed high levels of satisfaction when the appearance was improved and when they felt that clinicians understood their concerns and expectations via appropriate communication and vice versa. Conclusions: The combination of quantitative and qualitative studies provided breadth and depth of understanding to tooth auto-transplant outcomes, treatment pathway and care deficiencies. Thus, enabling recommendations for areas for improvements to achieve better outcomes for patients.