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To investigate the long-term outcome of treatment of missing maxillary incisor teeth by transplantation of premolars, with special reference to aesthetics and patient satisfaction.Twenty subjects who had undergone transplantation of premolars to the maxillary incisor area were recalled for follow-up varying between 12 and 22 years post-surgery. Twelve subjects presented for examination, including radiography and three subjects participated only by answering questions. Three reference groups—general practitioners, orthodontists, and lay people—evaluated the aesthetic results from photographs. Patient satisfaction was evaluated by interviews and OHIP-14.The mean age at transplantation was 12.3 years: 1 subject had been 20 years old and 11 were in the range of 9–14 years. Twelve to 22 years after autotransplantation, 5 subjects could not be reached: of the 15 who could be contacted, the survival rate was 15 out of 15. In the 12 subjects who presented for clinical examination, 11 out of the 12 transplants were assessed as successful. Nine transplants were restored with crowns and five had been recontoured with composite build-ups. In one patient, no restorative treatment had been undertaken. The subjects were satisfied with the aesthetic result.Autotransplantation of premolars is an appropriate method for treatment of missing maxillary anterior teeth. Subjects with a transplanted tooth to the maxillary anterior region perceive their oral health as good long term.