Autotransplantation versus Immediate Implant Placement for Replacement of Non-Restorable Posterior Teeth: A Systematic Review and Meta-Analysis.

INTRODUCTION The aim of the present systematic review and meta-analysis was to compare the clinical success rates of immediate dental implants (IMM) and autotransplanted mature teeth (AUT), and to identify patient-related and intraoperative factors that influence short- to mid-term outcomes.

Methods

The study protocol was prospectively registered on PROSPERO (CRD420251077420). A systematic electronic search adhering to the 2020 PRISMA guidelines was conducted across PubMed, ScienceDirect, and the Cochrane Library for studies published up to April 2026. Cohort studies reporting clinical success and/or survival rates for IMM and AUT with a minimum follow-up of 12 months were eligible. Methodological quality was assessed using the Newcastle-Ottawa scale. Publication bias was evaluated using Egger's regression test. Pooled success rates were estimated using a random-effects model, and mixed-effects meta-regression was used to assess the independent influence of clinical moderator variables.

Results

Thirteen studies (7 IMM, n=153; 6 AUT, n=189) were analyzed. At 12 months, the pooled success rate was 97.0% (95% CI: 93.7% - 100.0%) for IMM and 95.9% (95% CI: 90.1% - 100.0%) for AUT; the difference was not statistically significant (P = .880). At 36 months, the IMM group maintained a success rate of 97.0%, whereas the AUT group demonstrated a decline to 90.3% (95% CI: 77.2% - 100.0%), which also did not reach statistical significance (P = .217). No evidence of publication bias was detected at either interval (Egger's regression test: 12-month IMM: P = .755; AUT: P = .748; 36-month IMM: P = .755, AUT: P = .676). The provision of cuspal coverage was identified as a significant prognostic factor at 36 months (P = .015). Patient sex, age, and molar position did not significantly influence success rates (P > .05). A marginal negative association was observed with the use of wire splints at 12 months (P = .081).

Conclusions

Both immediate implant placement and autotransplantation of mature teeth demonstrate high short- to mid-term success rates with no statistically significant difference observed between them and may represent viable treatment options for posterior teeth replacement. The provision of an indirect restoration with cuspal coverage is associated with higher 36-months success rates for autotransplanted teeth.

Significance

Immediate implants and autotransplanted mature teeth demonstrate similar short- to mid-term success rates, supporting autotransplantation as a viable, biologically conservative alternative for posterior tooth replacement. However, the treatment modality should be based according to patient characteristics, donor tooth availability, anatomical considerations, clinician expertise, and restorative requirements.