A Systematic Review of the Survival of Teeth Intentionally Replanted with a Modern Technique and Cost-effectiveness Compared with Single-tooth Implants

Published:October 20, 2017DOI:


      • First systematic review on survival rate of teeth intentionally replanted with a modern technique and first cost-effectiveness analysis of intentionally replanted teeth.
      • Survival rate of intentionally replanted teeth is 89.1%.
      • Intentional replantation is more cost-effective than a single-tooth implant.
      • When nonsurgical and surgical retreatments are not possible, intentional replantation is an alternative to extraction and replacement with a single-tooth implant.



      The aim of this study was to investigate the survival rate of teeth intentionally replanted with a modern technique and to compare their cost-effectiveness with that of single-tooth implants.

      Materials and Methods

      Four databases were systematically searched for articles that met inclusion criteria published between January 1966 and February 2017. Overall survival rate of intentional replantation was determined through a meta-analysis using a random-effects model. Cost of different procedures was determined from the 2016 American Dental Association Dental Fees Survey. Cost-effectiveness analysis was performed for different treatment modalities.


      Six studies met the inclusion criteria. Meta-analysis resulted in a survival rate of 89.1% (95% confidence interval, 83.8%–94.4%). Compared with a single-tooth implant, intentional replantation was more cost-effective even when custom post/core and crown are also needed.


      The meta-analysis revealed a high survival rate for intentional replantation. Although the survival rate of implants is higher, intentional replantation is a more cost-effective treatment modality. Intentional replantation should be a treatment option discussed with patients, especially because an implant can still be placed if intentional replantation is unsuccessful.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Endodontics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Salehrabi R.
        • Rotstein I.
        Endodontic treatment outcomes in a large patient population in the USA: an epidemiological study.
        J Endod. 2004; 30: 846-850
        • Ng Y.L.
        • Mann V.
        • Gulabivala K.
        A prospective study of the factors affecting outcomes of non-surgical root canal treatment: part 2: tooth survival.
        Int Endod J. 2011; 44: 610-625
        • Sjogren U.
        • Hagglund B.
        • Sundqvist G.
        • et al.
        Factors affecting the long-term results of endodontic treatment.
        J Endod. 1990; 16: 498-504
      1. American Association of Endodontics. Guide to Clinical Endodontics. Surgical Endodontics. Available at: Accessed March 14, 2017.

        • Weine F.S.
        The case against intentional replantation.
        J Am Dent Assoc. 1980; 100: 664-668
        • Abid W.K.
        Post-surgical outcomes and prognosis of intentionally replanted lower posterior teeth.
        Al-Rafidain Dent J. 2010; 10: 332-340
        • Choi Y.
        • Bae J.
        • Kim Y.
        • et al.
        Clinical outcome of intentional replantation with preoperative orthodontic extrusion: a retrospective study.
        Int Endod J. 2014; 47: 1168-1176
        • Cho S.Y.
        • Lee Y.
        • Shin S.J.
        • et al.
        Retention and healing outcomes after intentional replantation.
        J Endod. 2016; 30: 909-915
        • Torabinejad M.
        • Dinsback N.A.
        • Turman M.
        • et al.
        Survival of intentionally replanted teeth and implant-supported single crowns: a systematic review.
        J Endod. 2015; 41: 992-998
        • Grossman L.I.
        Intentional replantation of teeth.
        J Am Dent Assoc. 1966; 72: 1111-1118
        • Kaplan S.D.
        • Tanzilli J.P.
        • Raphael D.
        • et al.
        A comparison of the marginal leakage of retrograde techniques.
        Oral Surg Oral Med Oral Pathol. 1982; 54: 583-585
        • Kim S.
        • Kratchman S.
        Modern endodontic surgery concepts and practice: a review.
        J Endod. 2006; 32: 601-623
        • Emmertsen E.
        • Andreasen J.O.
        Replantation of extracted molars. A radiographic and histological study.
        Acta Odontol Scand. 1966; 24: 327-346
        • Peer M.
        Intentional replantation–a ‘last resort’ treatment or a conventional treatment procedure? Nine case reports.
        Dent Traumatol. 2004; 20: 48-55
        • Bender I.B.
        • Rossman L.E.
        Intentional replantation of endodontically treated teeth.
        Oral Surg Oral Med Oral Pathol. 1993; 76: 623-630
        • Kingsbury Jr., B.C.
        • Wiesenbaugh Jr., J.M.
        Intentional replantation of mandibular premolars and molars.
        J Am Dent Assoc. 1971; 83: 1053-1057
        • Jang Y.
        • Lee S.J.
        • Yoon T.C.
        • et al.
        Survival rate of teeth with a C-shaped canal after intentional replantation: a study of 41 cases for up to 11 years.
        J Endod. 2016; 42: 1320-1325
        • Al-Quran F.A.
        • Al-Ghalayini R.F.
        • Al-Zu'bi B.N.
        Single-tooth replacement: factors affecting different prosthetic treatment modalities.
        BMC Oral Health. 2011; 11: 34
        • Kim S.G.
        • Solomon C.
        Cost-effectiveness of endodontic molar retreatment compared with fixed partial dentures and single-tooth implant alternatives.
        J Endod. 2011; 37: 321-325
        • Pennington M.W.
        • Vernazza C.R.
        • Shackley P.
        • et al.
        Evaluation of the cost-effectiveness of root canal treatment using conventional approaches versus replacement with an implant.
        Int Endod J. 2009; 42: 874-883
        • Schwendicke F.
        • Stolpe M.
        Direct pulp capping after a carious exposure versus root canal treatment: a cost-effectiveness analysis.
        J Endod. 2014; 40: 1764-1770
        • Neyeloff J.L.
        • Fuchs S.C.
        • Moreira L.B.
        Meta-analyses and Forest plots using a microsoft excel spreadsheet: step-by-step guide focusing on descriptive data analysis.
        BMC Res Notes. 2012; 5: 52
      2. American Dental Association. Data Trends in Dentistry 2017. Available at: Accessed September 16, 2017.

        • Jung R.E.
        • Zembic A.
        • Pjetursson B.E.
        • et al.
        Systematic review of the survival rate and the incidence of biological, technical, and aesthetic complications of single crowns on implants reported in longitudinal studies with a mean follow-up of 5 years.
        Clin Oral Implants Res. 2012; 23: 2-21
        • Jung R.E.
        • Pjetursson B.E.
        • Glauser R.
        • et al.
        A systematic review of the 5-year survival and complication rates of implant-supported single crowns.
        Clin Oral Implants Res. 2008; 19: 119-130
        • Koenig K.H.
        • Nguyen N.T.
        • Barkhordar R.A.
        Intentional replantation: a report of 192 cases.
        Gen Dent. 1988; 36: 327-331
        • Raghoebar G.M.
        • Vissink A.
        Results of intentional replantation of molars.
        J Oral Maxillofac Surg. 1999; 57: 240-244
        • Hayashi M.
        • Kinomoto Y.
        • Takeshige F.
        • et al.
        Prognosis of intentional replantation of vertically fractured roots reconstructed with dentin-bonded resin.
        J Endod. 2004; 30: 145-148
        • Wang Z.
        • Heffernan M.
        • Vann W.F.
        Management of a complicated crown-root fracture in a young permanent incisor using intentional replantation.
        Dent Traumatol. 2008; 24: 100-103
        • Özer S.Y.
        • Ünlü G.
        • Değer Y.
        Diagnosis and treatment of endodontically treated teeth with vertical root fracture: three case reports with two-year follow-up.
        J Endod. 2011; 37: 97-102
        • Frank A.L.
        • Torabinejad M.
        Diagnosis and treatment of extracanal invasive resorption.
        J Endod. 1998; 24: 500-504
        • Al-Hezaimi K.
        • Naghshbandi J.
        • Simon J.H.
        • et al.
        Successful treatment of a radicular groove by intentional replantation and Emdogain therapy: four years follow-up.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009; 107: 82-85
        • Cho S.Y.
        • Lee S.J.
        • Kim E.
        Clinical outcomes after intentional replantation of periodontally involved teeth.
        J Endod. 2017; 43: 550-555
        • Garrido I.
        • Abella F.
        • Ordinola-Zapata R.
        • et al.
        Combined endodontic therapy and intentional replantation for the treatment of palatogingival groove.
        J Endod. 2016; 42: 324-328
        • Peñarrocha M.
        • García B.
        • Martí E.
        • et al.
        Intentional replantation for the management of maxillary sinusitis.
        Int Endod J. 2007; 40: 891-899
        • Heydecke G.
        • Locker D.
        • Awad M.A.
        • et al.
        Oral and general health-related quality of life with conventional and implant dentures.
        Community Dent Oral Epidemiol. 2003; 31: 161-168
        • Machtei E.E.
        • Mahler D.
        • Oettinger-Barak O.
        • et al.
        Dental implants placed in previously failed sites: survival rate and factors affecting the outcome.
        Clin Oral Implants Res. 2008; 19: 259-264
        • Wang F.
        • Zhang Z.
        • Monje A.
        • et al.
        Intermediate long-term clinical performance of dental implants placed in sites with a previous early implant failure: a retrospective analysis.
        Clin Oral Implants Res. 2015; 26: 1443-1449
        • Chrcanovic B.R.
        • Kisch J.
        • Albrektsson T.
        • et al.
        Survival of dental implants placed in sites of previously failed implants.
        Clin Oral Implants Res. 2016; 0: 1-6
        • Quaranta A.
        • Perrotti V.
        • Piattelli A.
        • et al.
        Implants placed in sites of previously failed implants: a systematic review.
        Implant Dent. 2014; 23: 311-318
        • Malmgren B.
        Ridge preservation/decoronation.
        J Endod. 2013; 39: S67-S72
        • Steiner D.R.
        Timing of extraction of ankylosed teeth to maximize ridge development.
        J Endod. 1997; 23: 242-245
        • Andreasen J.O.
        • Andreasen F.M.
        • Bakland L.K.
        • et al.
        Traumatic dental injuries: a manual.
        2nd ed. Blackwell, Massachusetts1994
        • Davarpanah M.
        • Szmukler-Moncler S.
        Unconventional implant treatment: I. Implant placement in contact with ankylosed root fragments. A series of five case reports.
        Clin Oral Implants Res. 2009; 20: 851-856
        • Szmukler-Moncler S.
        • Davarpanah M.
        • Davarpanah K.
        • et al.
        Unconventional implant placement part iii: implant placement encroaching upon residual roots–a report of six cases.
        Clin Implant Dent Relat Res. 2015; 17: 396-405
        • Herrera H.
        • Leonardo M.R.
        • Herrera H.
        • et al.
        Intentional replantation of a mandibular molar: case report and 14-year follow-up.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006; 102: 85-87
        • Benenati F.W.
        Intentional replantation of a mandibular second molar with long-term follow-up: report of a case.
        Dent Traumatol. 2003; 19: 233-236
        • Chandra R.V.
        • Bhat K.M.
        Twenty-year follow-up of an unconventional intentional replantation.
        J Can Dent Assoc. 2006; 72: 639-642
        • Andreasen J.O.
        • Borum M.K.
        • Jacobsen H.L.
        • et al.
        Replantation of 400 avulsed permanent incisors. 4. Factors related to periodontal ligament healing.
        Dent Traumatol. 1995; 11: 76-89
        • Fugazzotto P.A.
        A comparison of the success of root resected molars and molar position implants in function in a private practice: results of up to 15-plus years.
        J Periodontol. 2001; 72: 1113-1123
        • Ferrari M.
        • Cagidiaco M.C.
        • Grandini S.
        • et al.
        Post placement affects survival of endodontically treated premolars.
        J Dent Res. 2007; 86: 729-734