Platelet-rich Fibrin assisted Intentional Replantation in Children with Two-year Clinical Outcomes: A Case Series

Intentional replantation (IR) is a strategic treatment modality involving the deliberate extraction and reinsertion of a tooth following extraoral endodontic management. It is particularly valuable in cases where conventional retreatment or periapical surgery is contraindicated or has previously failed. This case series (n = 3) presents three children managed with IR and contemporary biomaterials to enhance periapical healing. Regenerative adjuncts, including platelet-rich fibrin, chitosan, and xenograft bone grafts, were placed to support hard and soft tissue repair. Teeth were atraumatically extracted, followed by retrograde sealing using Biodentine, and subsequently replanted with minimal extraoral time. Stability was ensured using custom acrylic splints. At the 24-month follow-up, all cases exhibited resolution of periapical pathology, preservation of periodontal architecture, and maintenance of functional integrity, although one case displayed slight radiographic evidence of external resorption. These findings emphasize that, when executed with meticulous treatment planning and the use of bioactive materials, IR can serve as a predictable, conservative, and biologically sound approach for preserving natural dentition in growing patients.