The published literature contains no comprehensive studies that compare the outcome of premolar autotransplantation to the maxillary anterior region with natural incisors in the same patients. This article describes the gingival and periodontal conditions around premolars transplanted to the maxillary incisor region, subsequent to restoration. Forty-five premolars autotransplanted to the maxillary incisor region in 40 adolescent patients were evaluated after a mean observation period of 4.0 years. Mean age at surgery was 11.0 years. Established clinical criteria were used to assess tooth mobility, plaque and gingival indexes, probing pocket depth, and percussion. Recession and hyperplasia of interproximal gingival papillae were assessed according to a recently proposed index. Standardized radiography was used to evaluate presence of pathosis, pulp obliteration, root length, and crown-root ratios. Clinical variables for transplants did not differ from those of the natural incisors, except for increased mobility and more plaque in a few transplanted premolars. The interproximal gingival papillae adjacent to all transplanted teeth were normal or slightly hyperplastic. Radiographically, all transplants showed varying degrees of pulp obliteration, but no signs of pathosis. Crown-root ratios were similar for natural and transplanted teeth as were distances from cementoenamel junction to marginal bone. The overall status of the transplanted premolars and surrounding tissues indicated that this treatment modality may be recommended when maxillary incisors are missing in adolescents. In addition, tooth transplantation represents an inherent potential for bone induction and reestablishment of a normal alveolar process.