If you've lost a tooth and have a healthy wisdom tooth or extra premolar, you may not need a synthetic implant. Tooth autotransplantation moves a healthy tooth from its current location into the gap — giving you back a real tooth with a natural periodontal ligament and the ability to grow with the jaw (critical for adolescents). At AQUA, Dr. Mohammad Assaggaf leads the surgical phase with Dr. Obadah Austah (endodontic phase) and Dr. Mohanad Atwa (final restoration) — using a CBCT-driven protocol with a 3D-printed replica of the donor tooth.
The ideal case combines three criteria. The donor tooth: a wisdom tooth or extra premolar with two-thirds to three-quarters root development (a partially open apex = highest success rate), intact periodontal ligament, and no canal calcification. The recipient site: adequate alveolar bone width and height to accommodate the donor root, healthy gingiva, and proper vertical clearance. The patient: good oral hygiene, non-smoker, not on IV bisphosphonates or recent jaw radiation. The most common scenario: an adolescent who lost a front tooth in trauma and has a healthy wisdom tooth available.
We begin with a 3D CBCT scan of both the donor tooth and the recipient site, then 3D-print a plastic replica of the donor (Verweij technique). On surgery day: we prepare the recipient socket using the printed replica BEFORE extracting the actual donor — this reduces the tooth's out-of-mouth time to under 60 seconds, which is the single most important factor in preserving the periodontal ligament. We atraumatically extract the donor, place it in the new site at a slight sub-occlusal position, and apply a semi-rigid splint for 7–14 days. Endodontic follow-up at 4–6 weeks; final restoration at 6–12 months.
Tooth autotransplantation isn't a single procedure — it's a sequence across three specialties. Dr. Mohammad Assaggaf leads the surgical phase — he's the first author of a 2025 study in the Healthcare journal on Saudi dentists' awareness of this technique. Dr. Obadah Austah handles the endodontic phase: when the donor has a closed apex (mature root), we perform prophylactic root canal therapy at week 2–4 to prevent pulp necrosis — a delicate decision requiring consultant endodontist judgment. Dr. Mohanad Atwa completes the prosthetic phase: zirconia crown or veneer depending on the case. This three-specialty integration under one roof is what raises success rates from 80% to 95%+.
We will frankly decline this procedure in these situations: untreated severe periodontitis, active smoking (3× higher failure rate), IV bisphosphonate or denosumab therapy (osteonecrosis risk), recent head and neck radiation, no suitable donor tooth available, inadequate alveolar bone at the recipient site, or genetic syndromes affecting bone healing. In these cases we recommend a synthetic implant or alternative prosthetic options — and being upfront about alternatives is part of our protocol.
Long-term research (Andreasen and 10-year follow-ups) shows: open-apex donor (adolescent): 97.3% 5-year survival, 96.6% 10-year. Closed-apex donor with prophylactic root canal: 80–90% 5-year. Full timeline: surgery in one day, splint removal at 7–14 days, endodontic check at week 4–6, initial bone healing at 3 months, prosthetic rehabilitation eligible at 6–12 months. The transplanted tooth retains sensation and the ability to grow with the jaw — two advantages no synthetic implant can offer.
The cost of tooth autotransplantation varies case-by-case because it combines three phases (surgery, prophylactic root canal if needed, final restoration) and depends on donor tooth complexity and recipient site condition. Your initial evaluation visit includes a CBCT scan and a fully transparent three-phase quote before any decision. Contact us to book your initial evaluation for an accurate quote for your case.
We perform a precise 3D CBCT scan of both the donor tooth and the recipient site. This reveals root anatomy, apex status, bone density, and anatomical relationships to the inferior alveolar nerve and maxillary sinus.
We convert the CBCT data into a true-to-life 3D-printed plastic replica of the donor tooth. This replica (Verweij technique from the Netherlands) is the key to minimizing the donor tooth's extra-oral time on surgery day.
On surgery day, we use the printed replica to drill and shape the recipient site precisely — before we touch the actual donor tooth. By the time the recipient socket is ready, everything is prepared for the transplant.
We atraumatically extract the donor tooth — preserving the periodontal ligament — and immediately place it into the prepared recipient socket at a slight sub-occlusal position. Total extra-oral time: under 60 seconds. This interval is what separates success from failure.
A semi-rigid splint is placed for 7–14 days to stabilize the tooth while allowing physiological micro-movement that stimulates periodontal-ligament healing. Endodontic follow-up at week 4–6 to assess pulp vitality and perform prophylactic root canal therapy if needed. Final restoration at 6–12 months.
Yes, when the procedure is successful. Because the transplanted tooth retains its natural periodontal ligament, proprioception (the sensing of bite pressure) and physiological micro-mobility are preserved. This is an advantage no titanium implant can offer, because implants fuse directly to bone without any ligament.
Per Andreasen long-term studies and 10-year follow-ups: an open-apex donor tooth (adolescent or young adult) shows 97.3% 5-year survival and 96.6% 10-year survival. A closed-apex donor with prophylactic root canal therapy shows 80–90% 5-year survival. Outcomes depend on protocol discipline and patient selection.
It's possible but not ideal. The textbook case is a patient with a healthy wisdom tooth that has a partially open root apex, typically between 14 and 22 years of age. Adults over 30 need closer evaluation because the donor tooth's apex is usually closed and prophylactic root canal therapy after transplantation is required. Healthy gums, non-smoker status, and adequate bone at the recipient site are non-negotiable.
The surgery itself takes 60–90 minutes in a single visit. The actual transplantation of the tooth from its original site to the new socket happens in under 60 seconds (the single most important success factor). A semi-rigid splint is worn for 7–14 days. Endodontic follow-up at week 4–6. Final restoration with a crown or veneer at 6–12 months post-procedure.
Yes — a titanium implant remains a fallback option if autotransplantation fails. Failure (when it occurs) typically presents within the first year as ankylosis or root resorption. Even when the tooth is lost, the recipient-site bone has usually improved, making subsequent implant placement easier, not harder.
Because the single most important factor for success is shortening the donor tooth's extra-oral time. Every second the tooth spends in the air, living periodontal-ligament cells die. In conventional protocols, the surgeon extracts the tooth first then prepares the recipient site (5–10 minutes). In the Verweij protocol, we 3D-print a replica of the tooth before surgery, prepare the recipient site using the replica, then extract and transplant the actual tooth in under 60 seconds.