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Meta-Analysis
. 2025 Jul 26;25(1):1258.
doi: 10.1186/s12903-025-06583-1.

Prognosis of intentional replantation for periapical periodontitis teeth: a systematic review and meta-analysis

Baotian Zhang #  1 , Liandi Cheng #  1 , Xiangjin Deng #  1 , Yutao Xiong  1 , Wei Liu  1 , Wei Zeng  1 , Wei Tang  2 , Chang Liu  3
Affiliations
Meta-Analysis

Prognosis of intentional replantation for periapical periodontitis teeth: a systematic review and meta-analysis

Baotian Zhang et al. BMC Oral Health. .

Abstract

Background: Intentional replantation (IR) includes extraction, subsequent treatment, and replantation of teeth. It is regarded as a final strategy to preserve teeth affected by periapical periodontitis. This review aims to evaluate the overall prognosis and key prognostic factors of IR for periapical periodontitis teeth.

Methods: Ten databases (Ovid MEDLINE, Ovid Embase, etc.) and two registers were searched up to June 2024. Two independent review authors selected and identified prognostic studies (both prospective and retrospective studies) involving patients with periapical periodontitis teeth undergoing IR, reporting on success and survival rates, and factors influencing outcomes. Then, two independent review authors extracted the characteristics of the included studies and assessed the bias using the QUIPS tool. Meta-analyses were undertaken wherever appropriate.

Results: A total of 39 studies (49 reports) with 2305 teeth were included in this review. 31 studies were judged as high risk of overall bias while the other eight at moderate risk. For overall prognosis, meta-analyses showed a pooled success rate of 0.78 (95% CI 0.70 to 0.84) and pooled survival rate of 0.89 (95% CI 0.85 to 0.93). For prognostic factors, survival rate ratio (SRR) of age was 0.73 (95% CI 0.53 to 0.99, p = 0.048), and SRR of combined periodontal-endodontic lesions (CPEL) was 0.80 (95% CI 0.67 to 0.95, p = 0.001).

Discussion: Results indicated that age and CPEL were significant factors influencing the success rate of IR, thereby supporting its clinical applicability in managing periapical periodontitis. The 39 cohort studies included in this review provided robust evidence for identifying the overall prognosis and key prognostic factors, which were the primary objectives of this study. However, the absence of large-sample cohort studies (both prospective and retrospective) reduces the reliability of the conclusions drawn in this review. Moreover, the observed variability across studies emphasizes the need for standardized protocols and further research to enhance consistency and reliability.

Keywords: Endodontics; Evidence-based medicine; Meta-analysis; Periapical periodontitis; Systematic review; Tooth ankylosis; Tooth replantation.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA 2020 flow diagram for this evidence mapping review: contains the identification, screening, inclusion, and exclusion of studies and reasons for exclusion
Fig. 2
Fig. 2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study
Fig. 3
Fig. 3
Time-varying pooled survival rate: pooled survival rates within different time points across included studies
See this image and copyright information in PMC

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