Intentional Tooth Replantation with Platelet-rich Fibrin for the Management of Failed Root Canal Treatment

Abstract This article reviews the clinical application and biological rationale of intentional tooth replantation (ITR) supplemented with autologous platelet-rich fibrin (PRF) for the management of failed root canal treatment. ITR, a procedure involving the planned extraction and immediate reinsertion of a tooth, is presented as a viable alternative to conventional re-treatment or extraction and implant placement, particularly for teeth with complex anatomical challenges or where surgical access is difficult. A structured review of the literature was conducted to assess the biological mechanisms of PRF, specifically injectable PRF and advanced PRF, and their synergistic role in promoting periapical and periodontal healing. The use of PRF provides a rich source of growth factors and a fibrin scaffold, which are crucial for the regeneration of the periodontal ligament and surrounding bone. The review discusses the procedural steps, from atraumatic extraction to ex vivo root-end management and stabilisation, highlighting the critical factors for success, such as minimal extra-oral time and meticulous technique. A comparison with alternative treatments is provided, revealing that ITR with PRF offers a cost-effective, minimally invasive approach with favourable long-term prognoses. The findings suggest that this combined regenerative approach can lead to predictable and successful outcomes, preserving natural dentition and alveolar bone structure.