Intentional replantation of periodontally compromised teeth with concentrated growth factors

BACKGROUND: Intentional replantation (IR) has been described as a potential treatment modality for periodontally compromised anterior teeth deemed hopeless, particularly when combined with regenerative biomaterials such as concentrated growth factor (CGF). However, high-level evidence documenting cone-beam computed tomography (CBCT)-based outcomes in such cases remains limited. This paper evaluates the clinical and radiographic outcomes of IR using CGF in anterior teeth with advanced periodontal bone loss over a 1-year follow-up period. METHODS: Ten patients with single-rooted anterior teeth exhibiting advanced periodontal disease underwent atraumatic extraction, extraoral debridement, CGF application to both socket and root surface, and immediate replantation followed by semi-rigid splinting for 4 weeks. Clinical parameters (probing depth [PD], mobility, and gingival index), patient-centered outcomes (pain scores and oral health-related quality of life), and CBCT imaging were assessed at baseline and 12 months postoperatively. RESULTS: All cases showed favorable clinical healing, with significant reductions in mobility and PD. CBCT analysis revealed a mean gain in alveolar bone height of 2.58 ± 0.43 mm from baseline to 12 months. Pain was reduced significantly (mean pain scores (Visual Analog Scale) changed from 6.1 ± 0.7 to 0.6 ± 0.5). Oral Health Impact Profile-14 (OHIP-14) scores improved from 18.9 ± 1.32 to 4.6 ± 0.54. No cases of root resorption or ankylosis were observed. CONCLUSION: Within the limitations of this case study without controls, IR using CGF was associated with clinically stable outcomes and radiographic evidence of bone fill at 1 year in these selected cases. This approach may be considered a potential alternative to extraction in specific clinical scenarios. TRIAL REGISTRATION: NCT06893107; US National Institutes of Health Clinical Trials Registry KEY POINTS: Intentional replantation (deliberate removal of teeth, extraoral treatment, and reinsertion into the same socket) can be considered a conservative approach to preserve anterior teeth with severe periodontal compromise. The addition of concentrated growth factor during this clinical approach resulted in clinical stability and radiographic bone fill at 12 months. Controlled long-term studies are needed before clinical adoption, as the findings from the current small case series are descriptive. PLAIN LANGUAGE SUMMARY: Sometimes, badly damaged front teeth are removed because they seem beyond saving. But what if we could carefully take them out, clean them, add natural healing material, and put them back? In this study, 10 patients with severely loose front teeth due to gum disease had their teeth gently extracted and treated with a substance made from their blood called concentrated growth factor (CGF). The teeth were cleaned, coated with CGF, and replanted immediately. After 1 year, these teeth were not only stable and less painful, but x-rays showed new bone growth around them. The average new bone formation around the tooth was approximately 2.6 mm, which is a strong sign of healing. Patients reported much less pain and a better quality of life compared to before the procedure. Importantly, none of the teeth showed signs of fusing to the bone or breaking down. This method, called intentional replantation (IR) with CGF, may give a second chance to teeth that would otherwise be lost-and could reduce the need for implants in some cases.