During the last 33 years, the workflow of of autotransplantation of teeth has internationally in general followed the workflow of J.O. Andreasen at the University hospital of Copenhagen, described in 1991, and considered to be the gold standard of tooth transplantation since then.

Major recent long-term studies including life-table analysis, meta- and umbrella-analysis of controlled data materials in most major series of autotransplantation of teeth (including more than 4000 transplantations, followed up to 47 years), have revealed a series of relevant prognostic factors of various significance on the long term “survival” and “success” of tooth transplantations.

With the limitations in comparison of such different data materials demand, some of the factors with potentially significant impact on long-term survival will be presented, including: Root development of the graft, tooth type, endodontic treatment, antibiotics, experience of the surgeon, private practice vs. university clinics vs. hospital setting, pre- and postoperative orthodontic treatment, and other factors of relevance to the long term satisfactory survival and function of transplanted teeth.

Complications like ankylosis, necrosis of the obliterated pulp and invasive cervical resorption has been demonstrated to be diagnosed after many years in long-term follow up after transplantation to the maxillary front. The latest retrospective study of the Copenhagen cohort up to 37 years, it is possible to treat even obliterated pulp with endodontics, We found ankylosis in 16%, a complication that hitherto eventually lead to loss of the grafted tooth. However, by modification of the Andreasen-gold standard of workflow, even ankylosis of premolars transplanted to the anterior maxilla can be avoided, as reported by the Rotterdam transplantation team, achieving predictable long lasting satisfactory results to the patients.

Our experience show that even cryopreserved teeth can be autotransplanted with documented clinical function and normal pulp and periodontal ligament similar to fresh grafts for up to 34 years after autotransplantation, following initial cryopreservation of the tooth graft for 5 years before transplantation.