Digitally Guided Tooth Autotransplantation: A Systematic Review of Clinical, Radiographic and Operative Outcomes

Background/Objectives: Digital guidance of tooth autotransplantation, using cone beam computed tomography (CBCT)-based planning with three-dimensionally (3D) printed donor tooth replicas, surgical guides, navigation or robotics, aims to shorten extra-alveolar time and improve positioning. This systematic review synthesised the clinical, radiographic and operative outcomes of digitally guided autotransplantation and compared them with conventional technique. Methods: Following PRISMA 2020 and PROSPERO registration CRD420261434791, MEDLINE (PubMed and Ovid), Embase, Scopus, Web of Science, CENTRAL and ClinicalTrials.gov were searched from inception to August 2026, with Google Scholar and reference-list screening. Clinical studies of at least five digitally guided transplanted teeth or patients were eligible. Two reviewers independently screened, extracted data and assessed risk of bias (RoB 2, ROBINS-I or the JBI case-series checklist); certainty was rated with GRADE. Results: Twenty-five studies reported in 33 publications (2012–2026; one randomised, eight comparative non-randomised, sixteen single-arm; approximately 1300 patients) were included. All used CBCT- or CT-derived 3D-printed replicas, eleven with printed guides; none used navigation or robotics. In guided arms, survival was 92–100% and success 86–100% at 6 months to 5 years. Extra-alveolar time was under one minute in eleven reports, most donor teeth fitted at the first attempt, and positional deviation from the plan was about 1–2 mm. Compared with the conventional technique, guidance shortened surgical time by 13–15 min in two studies (low certainty) and was associated with higher survival and success and less root resorption in retrospective cohorts at serious risk of bias, whereas the registered controlled trial and a prospective paediatric cohort found no significant clinical difference (very low certainty). Conclusions: Digital guidance improves the operative efficiency and positional control of autotransplantation. Clinical superiority over conventional technique remains unproven; randomised trials with standardised outcomes and follow-up beyond two years are needed.