Expert consensus on intentional tooth replantation

Zhengmei Lin^#¹, Dingming Huang^#², Shuheng Huang^#¹, Zhi Chen³, Qing Yu⁴, Benxiang Hou⁵, Lihong Qiu⁶, Wenxia Chen⁷, Jiyao Li², Xiaoyan Wang⁸, Zhengwei Huang⁹, Jinhua Yu¹⁰, Jin Zhao¹¹, Yihuai Pan¹², Shuang Pan¹³, Deqin Yang¹⁴, Weidong Niu¹⁵, Qi Zhang¹⁶, Shuli Deng¹⁷, Jingzhi Ma¹⁸, Xiuping Meng¹⁹, Jian Yang²⁰, Jiayuan Wu²¹, Lan Zhang², Jin Zhang²², Xiaoli Xie²³, Jinpu Chu²⁴, Kehua Que²⁵, Xuejun Ge²⁶, Xiaojing Huang²⁷, Zhe Ma²⁸, Lin Yue²⁹, Xuedong Zhou³⁰, Junqi Ling³¹

Affiliations

¹ Department of Operative Dentistry and Endodontics, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University & Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China.
² State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
³ State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
⁴ State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shanxi Key Laboratory of Oral Diseases, Department of Operative Dentistry & Endodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, China.
⁵ Center for Microscope Enhanced Dentistry, Beijing Stomatological Hospital, Capital Medical University, Beijing, China.
⁶ Department of Endodontics, School of Stomatology, China Medical University, Shenyang, China.
⁷ College & Hospital of Stomatology, Guangxi Medical University, Nanning, Guangxi, China.
⁸ Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Peking University, Beijing, China.
⁹ Department of Endodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Clinical Research Center for Oral Diseases, National Center for Stomatology, Shanghai Key Laboratory of Stomatology, Shanghai, China.
¹⁰ Department of Endodontics, Jiangsu Key Laboratory of Oral Diseases, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China.
¹¹ Department of Endodontics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
¹² Department of Endodontics, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, China.
¹³ Department of Endodontics, The First Affiliated Hospital of Harbin Medical University & Department of Endodontics, School of Stomatology, Harbin Medical University, Harbin, China.
¹⁴ Department of Conservative Dentistry and Endodontics, Shanghai Stomatological Hospital & School of Stomatology, Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China.
¹⁵ School of Stomatology, Dalian Medical University, Dalian, Liaoning, China.
¹⁶ Department of Endodontics, Stomatological Hospital and Dental School of Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Shanghai, China.
¹⁷ Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China.
¹⁸ Department of Stomatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
¹⁹ Hospital of Stomatology, Jilin University, Changchun, China.
²⁰ Department of Endodontics, The Affiliated Stomatological Hospital of Nanchang University, Nanchang, China.
²¹ Key Laboratory of Oral Disease Research, School of Stomatology, Zunyi Medical University, Zunyi, China.
²² Shandong University, School of Stomatology, Jinan, Shandong, China.
²³ Department of Endodontology, Hunan Xiangya Stomatological Hospital, Central South University, Changsha, China.
²⁴ The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
²⁵ Department of Endodontics, College of Stomatology, Tianjin Medical University, Tianjin, China.
²⁶ Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Shanxi Medical University School and Hospital of Stomatology, Taiyuan, Shanxi, China.
²⁷ Fujian Key Laboratory of Oral Disease & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China.
²⁸ Department of Preventive Dentistry, Hebei Key Laboratory of Stomatology, Hebei Clinical Research Center for Oral Diseases, School and Hospital of Stomatology, Hebei Medical University, Shijiazhuang, Hebei, China.
²⁹ Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Peking University, Beijing, China. kqlinyue@bjmu.edu.cn.
³⁰ State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China. zhouxd@scu.edu.cn.
³¹ Department of Operative Dentistry and Endodontics, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University & Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China. lingjq@mail.sysu.edu.cn.

^# Contributed equally.

PMID: 40025031
PMCID: PMC11873174
DOI: 10.1038/s41368-024-00337-5

Review

Expert consensus on intentional tooth replantation

Zhengmei Lin et al. Int J Oral Sci. 2025.

. 2025 Mar 3;17(1):16.

doi: 10.1038/s41368-024-00337-5.

Authors

Affiliations

¹ Department of Operative Dentistry and Endodontics, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University & Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China.
² State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
³ State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
⁴ State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shanxi Key Laboratory of Oral Diseases, Department of Operative Dentistry & Endodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, China.
⁵ Center for Microscope Enhanced Dentistry, Beijing Stomatological Hospital, Capital Medical University, Beijing, China.
⁶ Department of Endodontics, School of Stomatology, China Medical University, Shenyang, China.
⁷ College & Hospital of Stomatology, Guangxi Medical University, Nanning, Guangxi, China.
⁸ Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Peking University, Beijing, China.
⁹ Department of Endodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Clinical Research Center for Oral Diseases, National Center for Stomatology, Shanghai Key Laboratory of Stomatology, Shanghai, China.
¹⁰ Department of Endodontics, Jiangsu Key Laboratory of Oral Diseases, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China.
¹¹ Department of Endodontics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
¹² Department of Endodontics, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, China.
¹³ Department of Endodontics, The First Affiliated Hospital of Harbin Medical University & Department of Endodontics, School of Stomatology, Harbin Medical University, Harbin, China.
¹⁴ Department of Conservative Dentistry and Endodontics, Shanghai Stomatological Hospital & School of Stomatology, Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China.
¹⁵ School of Stomatology, Dalian Medical University, Dalian, Liaoning, China.
¹⁶ Department of Endodontics, Stomatological Hospital and Dental School of Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Shanghai, China.
¹⁷ Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China.
¹⁸ Department of Stomatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
¹⁹ Hospital of Stomatology, Jilin University, Changchun, China.
²⁰ Department of Endodontics, The Affiliated Stomatological Hospital of Nanchang University, Nanchang, China.
²¹ Key Laboratory of Oral Disease Research, School of Stomatology, Zunyi Medical University, Zunyi, China.
²² Shandong University, School of Stomatology, Jinan, Shandong, China.
²³ Department of Endodontology, Hunan Xiangya Stomatological Hospital, Central South University, Changsha, China.
²⁴ The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
²⁵ Department of Endodontics, College of Stomatology, Tianjin Medical University, Tianjin, China.
²⁶ Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Shanxi Medical University School and Hospital of Stomatology, Taiyuan, Shanxi, China.
²⁷ Fujian Key Laboratory of Oral Disease & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China.
²⁸ Department of Preventive Dentistry, Hebei Key Laboratory of Stomatology, Hebei Clinical Research Center for Oral Diseases, School and Hospital of Stomatology, Hebei Medical University, Shijiazhuang, Hebei, China.
²⁹ Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Peking University, Beijing, China. kqlinyue@bjmu.edu.cn.
³⁰ State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China. zhouxd@scu.edu.cn.
³¹ Department of Operative Dentistry and Endodontics, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University & Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China. lingjq@mail.sysu.edu.cn.

^# Contributed equally.

PMID: 40025031
PMCID: PMC11873174
DOI: 10.1038/s41368-024-00337-5

Abstract

Intentional tooth replantation (ITR) is an advanced treatment modality and the procedure of last resort for preserving teeth with inaccessible endodontic or resorptive lesions. ITR is defined as the deliberate extraction of a tooth; evaluation of the root surface, endodontic manipulation, and repair; and placement of the tooth back into its original socket. Case reports, case series, cohort studies, and randomized controlled trials have demonstrated the efficacy of ITR in the retention of natural teeth that are untreatable or difficult to manage with root canal treatment or endodontic microsurgery. However, variations in clinical protocols for ITR exist due to the empirical nature of the original protocols and rapid advancements in the field of oral biology and dental materials. This heterogeneity in protocols may cause confusion among dental practitioners; therefore, guidelines and considerations for ITR should be explicated. This expert consensus discusses the biological foundation of ITR, the available clinical protocols and current status of ITR in treating teeth with refractory apical periodontitis or anatomical aberration, and the main complications of this treatment, aiming to refine the clinical management of ITR in accordance with the progress of basic research and clinical studies; the findings suggest that ITR may become a more consistent evidence-based option in dental treatment.

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Conflict of interest statement

Competing interests: The authors declare no competing interests.

Figures

**Fig. 1**
Decision-making flowchart for management of teeth with periapical diseases that fail to initial root canal treatment

See this image and copyright information in PMC

References

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Expert consensus on intentional tooth replantation

Affiliations

Expert consensus on intentional tooth replantation

Authors

Affiliations

Abstract

Conflict of interest statement

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References

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Full Text Sources