Intentional Replantation: A Last Resort Endodontic Procedure

Abstract Background: Intentional replantation (IR) is an endodontic procedure where a tooth is deliberately extracted, treated extraorally (usually with retrograde root-end management), and then reinserted into its socket. Though historically considered a desperate measure, modern refinements in microsurgical techniques, atraumatic extraction, and biocompatible materials have renewed interest in IR as a viable last-resort alternative when conventional endodontic therapy or apical surgery is not feasible. Objective: This article reviews the rationale, indications, techniques, success rates, complications, and future perspectives of intentional replantation in modern endodontics. Methods: A narrative review of literature, clinical studies, and case reports was conducted to evaluate clinical outcomes, advantages, limitations, and evolving strategies in intentional replantation. Results: Intentional replantation demonstrates high survival and success rates (70–95%) when performed under strict protocols, with atraumatic extraction, minimal extraoral time (<15 minutes), and the use of bioactive materials such as MTA and bioceramics. It provides an alternative to extraction and prosthetic replacement, preserving natural dentition. Limitations include risk of root resorption, ankylosis, and periodontal breakdown. Conclusion: Intentional replantation remains a last-resort, tooth-preserving procedure when conventional retreatment and periapical surgery are impractical. With proper case selection and modern techniques, it offers predictable outcomes, serving as a bridge between tooth preservation and tooth loss.