Intentional replantation with apical periodontal ligament preservation: A case report

Intentional replantation (IR) is a conservative treatment option for compromised teeth when the viability of the periodontal ligament (PDL) can be preserved. Maintaining viable PDL cells and using bioactive agents such as ethylenediaminetetraacetic acid (EDTA), platelet-rich fibrin (PRF), and injectable platelet-rich fibrin (i-PRF) may enhance the regenerative potential of replanted teeth.

A 59-year-old female patient presented with Grade III mobility and extrusion of maxillary tooth #9 following trauma. Clinical examination revealed a probing depth of 10 mm with bleeding on probing. After initial periodontal therapy and root canal treatment, the tooth was atraumatically extracted for IR. The extraoral time was limited to 10 min. Root surface instrumentation and 24% EDTA conditioning were performed only on the cervical and middle thirds of the root, while the apical PDL region was preserved without decalcification or curettage to maintain cell viability. i-PRF and PRF were prepared from the patient's venous blood. i-PRF was applied into the socket to enhance biological activity, and PRF was placed on the buccal aspect to support soft-tissue healing. After replantation, the tooth was stabilized with a rigid splint.

Postoperative pain measured on the visual analog scale was 6 on day 1, 2 on day 3, and 0 on day 7. The initial 10 mm probing depth decreased to 4 mm at 1 month and 3 mm at 3 months, remaining stable throughout the 1-year follow-up. Radiographically, no ankylosis or root resorption was detected. The gingival index decreased from 2 to 0, and the periodontal tissues remained healthy and stable.

This case demonstrates that IR performed with atraumatic extraction, a short extraoral period, and preservation of the apical PDL without decalcification can successfully retain a tooth with advanced mobility. The synergistic use of EDTA, PRF, and i-PRF created a favorable microenvironment for periodontal healing. This biologically oriented protocol represents one of the rare regenerative IR cases in which success was achieved without apical PDL decalcification.

Preservation of viable periodontal ligament tissue is critical for successful intentional replantation. Limited apical socket preparation may facilitate passive reinsertion while minimizing compression of the apical periodontal ligament. Intentional replantation may be considered as a tooth-preserving treatment option in selected cases with trauma-related periodontal damage.

Saving teeth with severe damage is often difficult, especially when there is both gum tissue destruction and a history of dental trauma. In this case report, a severely mobile upper front tooth was treated using intentional replantation, a procedure in which the tooth is carefully removed and then placed back into its socket after treatment. During the procedure, special attention was given to preserving the living tissues attached to the root surface, since these tissues are important for healing. Additional regenerative materials derived from the patient's blood were also used to support recovery. Clinical and radiographic follow-up examinations showed reduced tooth mobility, decreased periodontal pocket depth, and satisfactory healing without signs of root resorption or fusion of the tooth to the bone. This case suggests that intentional replantation may help preserve selected teeth that would otherwise be considered for extraction when careful surgical techniques and appropriate biological support are used.