Anatomical Analysis of Maxillary Third Molars with Cone-Beam Computed Tomography: Implications for Autotransplantation Operation

Purpose Maxillary third molars (MTMs) are frequently utilized as donor teeth in autogenous tooth transplantation (ATT). This study aimed to characterize and grade MTMs’ CBCT features to inform ATT operation. Methods This retrospective CBCT analysis evaluated 800 MTMs from 537 patients regarding tooth morphology, root canal configuration, and impaction status. A CBCT-based binary complexity grading for MTM autotransplantation was established, and its clinical relevance to the operative difficulty of ATT and its adjunctive procedures (root canal treatment, RCT) was analyzed in 26 ATT cases using both a subjective five-point scale and operation time. Results Predominant characteristics of MTMs included: 1-rooted morphology (65.63%), Vertucci’s Type-I canal configuration (76.17%), root canal curvature 10°- 30° (35.44%), and non-impaction status (77.75%). Mean root length was 10.66 ± 1.56 mm, canal length 16.95 ± 1.79 mm, crown-to-root ratio 1:1.8, and maximum root cross-sectional area (CSA) 60.21 ± 13.08 mm². Significant clinical relevance (P < 0.05) was found between atraumatic tooth extraction and root number, impaction direction, and depth of MTMs; between recipient-site preparation and cervical buccolingual width, mesiodistal width, root number, and maximum root CSA; between RCT and the canal configuration and curvature; and between ATT operation time and impaction depth and root number. Conclusions MTM CBCT characteristics exhibit significant anatomical variation and are relevant to ATT complexity. The CBCT-based binary complexity grading for MTM autotransplantation predicts procedural difficulty and would facilitate comprehensive preoperative evaluation for ATT.