Intentional Replantation in Dentistry: From Last Resort to Clinical Viability
Carlos Roberto Emerenciano Bueno *
Department of Restorative and Endodontics, Araçatuba School of Dentistry, Sao Paulo State University (FOA/UNESP), Brazil.
Ana Laura Ribeiro Ruiz
Department of Restorative and Endodontics, Araçatuba School of Dentistry, Sao Paulo State University (FOA/UNESP), Brazil.
Gabriele do Amaral
Department of Restorative and Endodontics, Araçatuba School of Dentistry, Sao Paulo State University (FOA/UNESP), Brazil.
Ana Laura Alves da Costa
Department of Restorative and Endodontics, Araçatuba School of Dentistry, Sao Paulo State University (FOA/UNESP), Brazil.
Ana Maria Veiga Vasques
Department of Restorative and Endodontics, Araçatuba School of Dentistry, Sao Paulo State University (FOA/UNESP), Brazil.
Luciano Tavares Angelo Cintra
Department of Restorative and Endodontics, Araçatuba School of Dentistry, Sao Paulo State University (FOA/UNESP), Brazil.
Gustavo Sivieri-Araújo
Department of Restorative and Endodontics, Araçatuba School of Dentistry, Sao Paulo State University (FOA/UNESP), Brazil.
Rogério de Castilho Jacinto
Department of Restorative and Endodontics, Araçatuba School of Dentistry, Sao Paulo State University (FOA/UNESP), Brazil.
João Eduardo Gomes-Filho
Department of Restorative and Endodontics, Araçatuba School of Dentistry, Sao Paulo State University (FOA/UNESP), Brazil.
Eloi Dezan Júnior
Department of Restorative and Endodontics, Araçatuba School of Dentistry, Sao Paulo State University (FOA/UNESP), Brazil.
*Author to whom correspondence should be addressed.
Abstract
Background: Intentional Replantation (IR) has historically been regarded as a last-resort procedure in Endodontics due to concerns regarding root resorption and ankylosis. However, advances in periodontal ligament biology, biomaterials, and microsurgical techniques have improved its clinical predictability.
Objective: The study intends to present a comprehensive chronological review of the literature on intentional tooth replantation, emphasising biological principles, clinical indications, technical evolution, and prognostic factors.
Methods: A narrative literature review was performed using PubMed and SciELO databases, including studies published between the 1980s and 2026, using “intentional tooth replantation" AND/OR "intentional replantation” as search terms. Classical reports, clinical studies, cohort analyses, systematic reviews, and meta-analyses were included. Studies with tooth replantation originated from dental trauma; in vitro and research with animal models were excluded.
Results: The literature demonstrates a progressive evolution of intentional replantation from an empirical and limited approach to a biologically driven and clinically reliable procedure. Contemporary evidence indicates survival rates ranging from approximately 80% to 90%, strongly associated with preservation of periodontal ligament viability, reduced extraoral time (less than 10 minutes), atraumatic handling, and appropriate apical sealing. The incorporation of bioceramic materials, magnification and advanced imaging techniques, such as cone beam tomography, has further enhanced treatment outcomes and predictability.
Conclusion: Intentional replantation is a biologically sound and clinically reliable therapeutic option when properly indicated and executed. It represents a conservative alternative to extraction and implant placement, particularly in patients where preservation of natural dentition is prioritised.
Keywords: Endodontics, intentional replantation, literature review, tooth preservation, periodontal ligament, bioceramic materials