Before You Extract: Intentional Replanta...

When should you attempt to save the root filled molar that everyone else thinks is doomed?

What are the key steps to safely remove, treat, and replant a tooth without causing fractures or resorption?

And how do you manage patient expectations and post-op care to maximize success?

In this episode, Dr. Samuel Kratchman and Dr. Shivakar join Jaz to explore intentional tooth replantation—a procedure that rarely gets the spotlight but can completely change treatment options for challenging cases.

They cover everything from case selection and imaging, to managing crowns and fragile teeth, to simple tools and techniques that make this procedure predictable and accessible.

They also dive into patient communication, consent, and how to include this procedure as part of your everyday dental armamentarium, giving you the confidence to consider it when the right case comes along.

Key Takeaways:

• Intentional replantation is a viable alternative to extraction.
• The success rate of intentional replantation is documented at 88-89%.
• Patient education is crucial for successful treatment outcomes.
• The periodontal ligament must be kept moist during the procedure.
• Imaging is essential for understanding tooth anatomy before replantation.
• The procedure can be performed atraumatically with proper technique.
• Replantation can be a last chance for teeth that are difficult to replace with implants.
• A mindset shift is needed in dentistry to prioritize saving natural teeth. Apical infections are often linked to the root tip and surrounding tissue.
• A good coronal seal is essential before any restorative work.
• Common complications include ankylosis and resorption.
• Inflammation can aid in the extraction process by serving the ligament.
• Post-operative care is vital for successful recovery.

Highlights:

• 00:00 Teaser
• 00:48 Introduction
• 03:27 Pearl: PDL is everything 
• 04:54 Interview with Dr. Shivakar Mehrotra
• 07:03 Interview with Dr. Samuel Kratchman
• 11:01 Terminologies and Success Rates of Replantation
• 16:03 Indications of Replantation
• 22:29 Evaluating Radiographs and Clinical Factors
• 28:48 Case Studies and Practical Applications
• 30:51 Midroll
• 34:12 Case Studies and Practical Applications
• 38:08 Management of Apical Infection
• 40:35 Curveball Scenario: Combined Endodontic and Restorative Challenge
• 45:57 Replantation Success Rates and Complications
• 51:06 Radiographic Signs and Extraction Techniques
• 56:03 Postoperative Care and Instructions
• 59:49 Final Thoughts and Resources
• 01:02:14 Outro

🚨 First replantation case coming up? Do your homework! 🚨

Before you touch that tooth:
📖 Read the published protocols

• INTENTIONAL REPLANTATION by Dr. Samuel Kratchman
• Retention and Healing Outcomes after Intentional Replantation

🔍 Review systematic reviews

• Clinical outcome of intentional replantation with preoperative orthodontic extrusion: a retrospective study by Cho et al
• A Systematic Review of the Survival of Teeth Intentionally Replanted with a Modern Technique and Cost-effectiveness Compared with Single-tooth Implants by Anshul Mainkar 

Keep the learning going! Check out PDP061: Surgical Extrusion for ‘Hopeless’ Teeth.

#PDPMainEpisodes #EndoRestorative #OralSurgeryandOralMedicine

This episode is eligible for 1 CE credit via the quiz on Protrusive Guidance. 

This episode meets GDC Outcomes C.

AGD Subject Code: 070 ENDODONTICS (Surgical treatment)

Aim: To understand the indications, technique, and outcomes of intentional replantation for teeth with failed endodontic treatment, emphasizing atraumatic removal and predictable long-term success.

Dentists will be able to –

1. Identify teeth suitable for intentional replantation based on anatomy, root morphology, and prior treatment.

2. Explain the procedural workflow, including atraumatic extraction, extraoral root-end management, and replantation techniques.

3. Counsel patients effectively on prognosis, risks, and postoperative care.