Long-term outcomes of two surgical protocols for the autotransplantation of mandibular third molars: a randomized controlled trial

Objective: This randomized clinical trial aimed to compare the mid-term (5-year) prognosis of mandibular third molar autotransplantation between two surgical protocols: conventional autotransplantation and immediate pulpectomy autotransplantation. Materials and Methods: Forty patients with unrestorable molars and suitable impacted third molars were randomized into two equal groups. Group I ( n = 20) underwent conventional autotransplantation, while Group II ( n = 20) received extra-alveolar pulpectomy (performed on the extracted donor tooth before transplantation). Primary outcomes were 5-year tooth survival, tooth mobility, root resorption, and periapical pathology. Results: The overall 5-year survival rate was 92.5%. Survival was 95% in the conventional autotransplantation group and 90% in the immediate pulpectomy autotransplantation group, with no statistically significant difference (log-rank test, P > 0.05). All cases of periapical pathology (10%) occurred in the conventional autotransplantation group, while root resorption (15%) was equally distributed. No significant differences were found for any secondary outcomes. Conclusion: Autotransplantation of mandibular third molars demonstrates excellent 5-year survival. Selecting between conventional autotransplantation and immediate pulpectomy autotransplantation. involves a clinical balance. Immediate autotransplantation preserves periodontal ligament vitality but may necessitate later endodontic treatment, whereas prior pulpectomy ensures endodontic stability. Both approaches are clinically sound, and the decision can be individualized according to surgical conditions without affecting mid-term survival.