Intentional Replantation of Single-Rooted and Multi-Rooted Teeth: A Systematic Review
by
, , and
Massimo Pisano
, 
Federica Di Spirito
,
Stefano Martina
,
Giuseppe Sangiovanni
, 
Francesco D’Ambrosio
and
Alfredo Iandolo
* 
Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Via S. Allende, 84081 Baronissi, Italy
*
Author to whom correspondence should be addressed.
Healthcare 2023, 11(1), 11; https://doi.org/10.3390/healthcare11010011
Submission received: 30 November 2022
/
Revised: 17 December 2022
/
Accepted: 18 December 2022
/
Published: 21 December 2022
(This article belongs to the Special Issue Oral Healthcare: Diagnosis, Prevention and Treatment)
Abstract
:The technique of intentional replantation can provide a second chance to save teeth that would be destined for extraction. Therefore, the present systematic review aimed primarily to estimate tooth survival after intentional replantation and secondarily to compare treatment outcomes in single-rooted and multi-rooted teeth. The study protocol was developed before the analysis according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Articles were electronically searched in PubMed/MEDLINE, the COCHRANE library and Google Scholar by two independent reviewers, and those that met the eligibility criteria were included. A statistical analysis using the chi-square test with a p-value of <0.05 was performed on the reported outcomes of intentional replantation. A total of 44 single-rooted replanted teeth with five failures (11.36%) and 42 multi-rooted replanted teeth with six failures (14.28%) were reported in the literature, corresponding to a survival rate of 88.64% and 85.57%, respectively. The overall survival rate for the replantation procedure was 86.7%, indicating that intentional replantation can be considered a safe therapeutic choice, with no statistically significant difference between the survival rates of single-rooted and multi-rooted replanted teeth.
1. Introduction
Intentional replantation (IR) is a multistage surgical procedure based on the controlled extraction of a tooth and its subsequent repositioning in the original socket to perform root surface revision and subsequent endodontic treatment in the extra-oral environment [1].
Since surgical phase IR is considered the most technically delicate phase of the procedure [2], it must be performed with extreme precision and care to improve treatment outcomes and survival rates. Tooth extraction must be as atraumatic as possible to avoid both fractures of the tooth and, most importantly, damage to the periodontal ligament (PDL), which may play a critical role in healing and, consequently, treatment success [3].
Subsequently, the extracted tooth is carefully examined to assess possible fractures or anatomical features that require special attention, such as the presence of additional or accessory canals or multiple foramina [4], and accordingly decide whether to proceed with extra-oral endodontic treatment [5]. At this stage, PDL preservation as well as proper management of the tooth under extra-alveolar environmental conditions, which affect the overall treatment success, are crucial [6,7]. Since it has been found that extra-alveolar remaining in a dry environment longer than 15 min may affect the PDL conditions and consequently increase the risk of dental ankylosis after IR [8], it is recommended to keep the extra-alveolar time as short as possible and to preserve the tooth in a moist environment to improve the predictability of the procedure [9,10].
After extra-oral endodontic treatment, the original tooth socket must be prepared. Complete resection of cystic or granulomatous tissue from the dental alveolus (alveolar curettage) to promote healing of the alveolus is still controversial, as it would be particularly difficult to avoid simultaneous removal or at least damage to the PDL fibers that remained attached to the alveolar walls [11]; consequently, a healing technique for the apical part of the dental alveolus has been proposed, in which the entire inflammatory lesion is removed without affecting the walls of the affected pockets [12,13].
After the preparation of the alveolus, the tooth is carefully inserted with digital pressure in the axial direction of the alveolus. Some authors have suggested applying the patient’s bite to the tooth in case of resistance to replantation [14,15].
In the surgical phase, which involves the same procedure in single-rooted and multi-rooted teeth, the main difference between the two types of teeth is the atraumatic phase of extraction. The presence of intraradicular septa or anatomies with severe curvatures is an anatomical limitation for multi-rooted teeth, which pose greater surgical difficulties in the atraumatic extraction phase [5]. The preservation of the shape of the alveolus is also more complex in multi-rooted teeth. The final splinting of the replanted teeth is still controversial. A variety of splinting methods and materials have been reported, ranging from orthodontic wires to composite resins and sutures [11], with removal periods varying accordingly, from seven to ten days to three to four weeks.
The IR procedure is indicated when neither orthograde treatment nor apical surgery can be performed [1] and when a symptomatic picture of apical periodontitis persists after well-performed endodontic therapy and the orthograde pathway is complex or blocked [16,17]. In addition, IR can be used in cases of incongruent endodontic therapy with excessive filling material beyond the apex and persistence of the apical lesion that cannot be resolved by a surgical approach [18], and when surgical retraction of the endodontic flap is contraindicated due to anatomic or accessibility limitations [19]. In addition, IR may be recommended for external root resorption when it is not possible to reach the apex [20], root perforations [21], root fractures, and complex roots [22]. In addition, IR may also be useful to treat teeth with developmental anomalies, such as fused teeth or teeth with a type C endodontic canal configuration [23].
IR has been proposed as an alternative procedure when endodontic and periapical surgical treatments have been unsuccessful or are contraindicated and when bone preservation is required for subsequent implant placement. Therefore, the present systematic review aimed primarily to estimate the survival rate of single-rooted and multi-rooted teeth after intentional replantation by assessing whether the number of roots could influence this and, secondarily, to compare the treatment results in upper and lower arch teeth.
2. Materials and Methods
The study protocol was developed, according to PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) guidelines [24,25], before the analysis.
The research question was formulated according to the PICO (Population, Intervention, Comparison, Outcome) strategy and the clinical question in the “PICO” format was “What is the survival rate of IR in single and multi-rooted permanent teeth?”, focusing on:
- P (Population): Subjects undergone Intentional Replantation of permanent teeth
- I (Intervention): Intentional Replantation of permanent teeth
- C (Comparison): Single-rooted vs Multi-rooted replanted teeth
- O (Outcome): Intentional Replantation survival rate
2.1. Search Strategy and Study Selection
A literature search was independently conducted by three reviewers (MP, AI, FDS), across PubMed/MEDLINE, Google Scholar, and the COCHRANE library databases and the gray literature, using the following keywords combined by Boolean operators: intentional replantation OR replanted teeth OR replanted tooth AND procedure OR technique.
Citations obtained through the literature search were recorded, duplicates were eliminated using EndNote, and titles and abstracts were independently screened by three reviewers (MP, FDS, GS). Available full-texts, compliant with inclusion and exclusion criteria, detailed below, were also independently reviewed for potentially eligible studies. Any disagreement between the reviewers was solved by discussion and consensus.
The inclusion criteria were:
- Source: studies published in the English language from January 1996 to 1 July 2022;
- Study design: case reports, case series, analytical observational studies, trials;
- Study population: subjects undergone IR (no age nor gender restrictions);
- Study intervention: IR of single-rooted and/or multi-rooted permanent teeth; and
- Study outcomes: IR reported clinical and/or patient-related outcomes.
The exclusion criteria were:
Source: studies published before 1996;
Study intervention: indication to treatment not specified; and
Study outcomes: IR clinical and/or patient-related outcomes not available.
No attempt to contact the authors was performed for missing information or full-text unavailability and, in case of disagreement, the evaluation of the majority was considered (two reviewers out of three).
Search and study selection was conducted for grey literature, as already described.
2.2. Data Extraction
A ten-question data extraction form was currently employed, by three independent reviewers (AI, GS, FDS), to record for each of the included study: source and design; participants’ age and gender; treated teeth; extra-alveolar time stay and environmental conditions management; IR indications, follow-up and reported outcomes, classified as IR success and failure, as reported by the authors in the included studies.
2.3. Data Synthesis and Statistical Analysis
Extracted data were synthesized according to the number of roots of replanted teeth, categorized as single- or multi-rooted.
Frequencies and percentages for categorical data were computed. A chi-square test with Yates correction was used to assess the association between teeth (single-rooted vs. multi-rooted) and dental arch (upper vs. lower). A standard statistical software package (SPSS, version 28.0; SPSS IBM, Armonk, New York, NY, USA) was used. The level of significance was set at p < 0.05.
2.4. Quality Assessment
Included studies were assessed for quality through the JBI (Joanna Briggs Institute) Critical Appraisal Tool, evaluating the risk of bias of the case reports and case series included [26].
3. Results
3.1. Study Selection
A total of 1556 records were retrieved from PubMed/MEDLINE (720 articles), Google Scholar (776 articles) and the COCHRANE library (60 articles). Of these, 904 were excluded because duplicates or the full text were not available. Of the remaining 652 articles, 130 were considered appropriate, but 70 were excluded because the full-text review did not reveal clinical cases treated with the technique IR. Finally, 60 articles were included in the qualitative analysis [27].
The flowchart for study selection is shown in Figure 1.
3.2. Studies Characteristics and Synthesis of the Reported Results
Sixty case reports and case series [28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86], compliant with the eligibility criteria, were included in the present systematic review, and detailed in Table 1; no observational studies or clinical trials were presently retrieved. The results of the risk of bias assessments of the included studies are reported in Table 2.
In total, 106 subjects, 48 males (45.2%) and 54 females (54.8%), between 7 and 86 years of age, with a mean age of 35.8, were treated with IR.
IR was performed on a total of 106 teeth, 56 (51.17%) single-rooted and 50 (48.9%) with multiple roots (Figure 2), with the upper right central incisors (12.2%) and the first mandibular right molars (10.3%) being the most treated, followed by central maxillary left incisor (9.4%), second mandibular right molars (8.4%), second mandibular left molars (8.4%), first mandibular left molars (7.5%), lateral maxillary left incisors (3.7%), first maxillary right premolars (3.7%) and first mandibular left premolars (3.7%) (Figure 3).
Extra-alveolar time stay was reported in 72 of 106 cases, corresponding to an average of 13.01 min. No data on the management of extra-alveolar environmental conditions and healing time could be retrieved.
The reported IR indications were: persistent periapical lesions in 77 (72.6%) cases; crown-root and root fractures in 19 (17.9%) replanted teeth; endodontic failure in 27 (25.5%) replanted teeth, six (22.2%) of them had perforation and 11 (40.7%) had intracanal instrument fracture; periodontitis in 13 (12.2%) cases; root resorption in five (4.7%) teeth and developmental anomaly with fused teeth in one case.
IR results were reported in all studies included in this systematic review. Treatment success was noted in 92 (86.7%) replanted teeth, with a mean follow-up of 26.8 months. Of the 56 (51.2%) single-rooted teeth replanted, six (10.7%) failed, with a survival rate of 89.3% at an average extraoral time of 12.48 min; of the 50 (48.9%) multi-rooted teeth replanted, eight (16%) failed, with a survival rate of 84% at an average extraoral time of 13.34 min (a minimum follow-up time of 3 months was considered). Of the 14 unsuccessful replantations, six had a single root (42% of failures) and eight were multi-rooted (58% of failures). Overall, seven (12.70%) replanted teeth from the upper arch (51.9%) and seven (13.7%) from the lower arch failed.
No statistically significant differences were found in the survival rates of replanted teeth between single- and multi-rooted teeth (p = 0.6) and between the upper and lower arches (p = 0.89).
4. Discussion
The present systematic review aimed, primarily, at the teeth survival rate following intentional replantation and, secondarily, to compare treatment outcomes in single- vs. multi-rooted teeth.
Despite the various IR indications reported in the literature, such as persistent apical periodontitis [16,17,18], incongruous endodontic therapy [17], inaccessible external root resorption [20], root perforations [21], complex root/coronal root fractures [21,22,23], and teeth with developmental anomalies, such as fused teeth, the procedure is considered a “last resort” to preserve natural teeth [1]. This consideration may be mainly due to the high risk of technical errors resulting from the numerous operative phases, which make the procedure highly operator-dependent and may explain the IR heterogeneous survival rates, which range from 80% to 100% in the literature [87]. However, a recent systematic review [88] described a survival rate of 88% IR, which is consistent with the current estimated survival rate of 86.7% IR. It is suggested that these results are closely related to the extra-alveolar time stay of the replanted teeth, which is considered to be a crucial factor as it is directly involved in the preservation of the PDL cells [18,19]. Indeed, the analysis of IR clinical cases included in the present systematic review revealed that the extra-alveolar time ranged from a minimum of 4 min [66,67,68,69,70,71,72,73,74,75,76,77,78,79,80] to a maximum of 30 min [35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60]. In particular, Jang et al. [89] reported higher survival rates for teeth replanted within 15 min compared with teeth replanted after an extra-alveolar time of more than 15 min. Nevertheless, high survival rates were also reported in cases with an extra-alveolar time > 15 min. Remarkably, however, the teeth in these cases were stored in a moist environment to preserve the viability of the PDL cells [3,7,8,11,12,13,18,19,90], suggesting that extra-alveolar stay time should be considered in the context of tooth conservation approaches. In this context, it has been previously suggested [8,10,91] that preservation of the tooth in an extra-oral humid environment, such as water, saline, and saliva, may positively influence the results of IR, making the procedure more predictable and thus supporting the hypothesis that the periodic submersion of the tooth in a bath of Hank’s balanced salt solution during the root resection phase may be the best approach to avoid root desiccation [91].
Moreover, high variability in root resection methods, filling materials, and socket manipulation were also noted. Although the length of root resection was rarely reported in the studies analyzed, most authors described a mean resection length of 1 to 3 mm [6]. Several restorative materials were listed in the reports, including mainly dental amalgam, followed by recently proposed intermediate restorative materials such as SuperEBA, MTA, and Endocem, and finally eugenol cement based on zinc oxide and glass ionomer [47]. Various approaches have also been found to manipulate the alveolus prior to tooth reinsertion. These include simple blood clot aspiration using suction instruments and/or irrigation with saline solution, as well as curettage of the alveolus with surgical instruments [22], which, however, may damage the fibers of the periodontal ligament still adhering to the alveolar walls, and affect, in turn, the success of IR, as mentioned above. Therefore, the recorded results show how the manipulation of the alveolus can have a crucial impact on the results of IR, which remains highly controversial [7,87]. According to Wu et al., if the reimplanted teeth are diagnosed with an acute or chronic apical abscess on preoperative examination, the risk of failure is 2.7 times higher than for teeth diagnosed with other conditions. This is because the presence of infection combined with chronic inflammation would lead to the destruction of the periodontal bone and PDL cells damage [92].
When the survival rates of IR were compared between single-rooted and multirooted teeth, no statistically significant differences were found. Therefore, it can be concluded that the number of roots of the replanted teeth has no significant influence on the results of the IR procedure. Nevertheless, special attention must be paid to the possible anatomical variations of the treated tooth root, especially pronounced curvatures. Therefore, Cone Beam Computed Tomography (CBCT) can be an essential tool in the diagnosis of anatomical variants, fractures, or discontinuities, which were previously based on a conventional, less sensitive 2D examination. However, because CBCT has only recently been introduced to support IR surgical planning, there are few case reports to date describing an IR planning phase using 3D reconstructions [93]. In addition, other recently introduced technologies, including ultrasonic devices and microscopy, may also both minimize the extra-alveolar time stay and improve treatment outcomes by reducing the duration of the IR procedure, invasiveness, and failure rates [94].
The main limitations of the study may be the exclusion of some databases (i.e., Scopus, LILACS, and EMBASE) from the electronic search and the inclusion of only case reports or case series, which are intrinsically characterized by low evidence and positive findings, that, along with the lack of data on the methods used to preserve the teeth in an extra-oral environment during the procedure, the heterogeneous approaches used to manipulate the alveolar socket, and the follow-up periods recorded, may make the interpretation of the results challenging. However, to the authors’ knowledge, this is the first study to investigate the possible role of the number of roots of the replanted teeth on treatment outcomes and to compare the survival rates of IR between single-rooted and multi-rooted teeth, even though the exact number of roots of multi-rooted teeth is not considered.
The results presented make it clear that IR can be considered a safe and predictable treatment for both single-rooted and multi-rooted teeth as long as all procedural phases are performed correctly [95]. Moreover, it seems evident that the success of IR also depends on the appropriateness of the treatment indications, suggesting the need for a comprehensive and multidisciplinary approach in complex cases [96,97] and supporting, once again that the choice of therapeutic strategy, even considering alternative procedures such as surgical extrusion and dental autotransplantation [98,99,100,101], should be based on the specific characteristics of each clinical case.
5. Conclusions
From the retrieved data, a survival rate of 86.7% was currently estimated for intentional replantation, and no statistically significant difference was found between single-rooted and multi-rooted replanted teeth, the survival rate of single-root implanted teeth was 89.3% while for multi-rooted reimplanted teeth it was 84%.
The reported results suggest that intentional replantation can be considered a safe therapeutic choice for both single-rooted and multi-rooted teeth, with a high survival rate and predictability, provided it is performed correctly and in accordance with basic biological principles, especially with regard to extra-oral environmental time.
Author Contributions
Conceptualization, A.I. and M.P.; methodology, A.I. and F.D.S.; validation, S.M., G.S. and F.D.; investigation, M.P., F.D.S. and G.S.; data curation, S.M. and F.D.S.; writing—original draft preparation, A.I. and M.P.; writing—review and editing, F.D.S., G.S. and F.D.; supervision, A.I. All authors have read and agreed to the published version of the manuscript.
Funding
This research received no external funding.
Institutional Review Board Statement
Not applicable.
Informed Consent Statement
Not applicable.
Data Availability Statement
Medline/PubMed, Cochrane databases and Google Scholar.
Conflicts of Interest
The authors declare no conflict of interest.
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Figure 1.
Study selection flowchart.
Figure 2.
Type of teeth.
Figure 3.
Percentages of treated teeth.
Table 1.
Included studies characteristics: source, study participants’ gender and age; treated teeth, extra-alveolar time stay, and extra-alveolar environmental conditions management; IR indication(s), outcomes and follow-up. Abbreviations: y.o., years old; MR, multi-rooted; SR, single-rooted; IR, Intentional Replantation.
Table 1.
Included studies characteristics: source, study participants’ gender and age; treated teeth, extra-alveolar time stay, and extra-alveolar environmental conditions management; IR indication(s), outcomes and follow-up. Abbreviations: y.o., years old; MR, multi-rooted; SR, single-rooted; IR, Intentional Replantation.
| Source | Participants’ Gender Age | Treated Teeth | Extra-Alveolar Time Stay | Extra-Alveolar Conditions Management | IR Indication(s) | IR Outcomes | IR Follow-Up |
|---|---|---|---|---|---|---|---|
| Tang 1996 [28] | Male 29 y.o. | 3.6 MR | - | - | Iatrogenic root furcation perforation | Survival | 17 months |
| Poi 1999 [29] | Male 30 y.o. | 4.5 SR | - | - | Instrument separation/Root perforation | Survival | 8 years |
| Aqrabawi 1999 [30] Case 1 | Female 46 y.o. | 3.7 MR | 15 min | - | Endodontic failure/Apical periodontitis | Survival | 5 years |
| Aqrabawi Case 2 | Female 38 y.o. | 3.7 MR | 20 min | - | Endodontic failure/Apical periodontitis | Survival | 5 years |
| Benenati 2003 [31] | Female 45 y.o. | 4.7 MR | - | - | Pain | Survival | 16 years |
| Fariniuk 2003 [32] | Male 11 y.o. | 1.1 SR | - | - | Crown-root fracture | Survival | 3 years |
| Ward 2004 [33] | Female 68 y.o. | 3.4 SR | 15 min | - | Apical periodontitis | Survival | 18 months |
| Shintani 2004 [34] | Male 7 y.o. | 3.1 SR | 10 min | - | Apical periodontitis with coronal fracture | Survival | 5 years |
| Peer 2004 Case 1 [19] | Male 47 y.o. | 3.5 SR | - | - | Apical periodontitis | Survival | 30 months |
| Peer 2004 Case 3 | Male 70 y.o. | 3.2 SR | - | - | Apical periodontitis/sinus tract | Survival | 4 years |
| Peer 2004 Case 4 | Male 40 y.o. | 3.7 MR | - | - | Apical periodontitis/sinus tract | Failure | 7 years |
| BarattoFilho 2004 [35] | Male 36 y.o. | 2.7 MR | 15 min | - | Apical periodontitis/Instrument separation | Survival | 5 years |
| Cotter 2006 [36] | Female 47 y.o. | 3.1 SR | 5 min | - | Apical periodontitis | Survival | 1 years |
| Herrera 2006 [37] | Female 56 y.o. | 4.6 MR | 30 min | - | Apical periodontitis/endodontic failure | Survival | 14 years |
| Martins [38] | Female 15 y.o. | 2.1 SR | 10 min | - | Traumatic avulsion | Survival | 3 years |
| Penarrocha 2007 [39] | Female 20 y.o. | 2.6 MR | 5 min | - | Odontogenic maxillary sinusitis | Survival | 2 years |
| Demir 2007 [40] | Male 45 y.o. | 4.1 SR | - | - | Severe periodontitis | Survival | 1 year |
| Sivolella 2008 [41] | Male 9 y.o. | 1.2 SR | 20 min | - | Double tooth | Survival | 6 years |
| Wang 2008 [42] | Female 8 y.o. | 1.1 SR | 15 min | - | Complicated crown-root fracture | Failure | 3 months |
| Al-Hezaimi 2009 [43] | Female 15 y.o. | 1.2 SR | - | - | Pulp necrosis with suppurative apical periodontitis | Survival | 4 years |
| Bittencourt 2009 [44] | Male 9 y.o. | 2.1 SR | - | - | Complicated crown-root fracture | Survival | 2 years |
| Ozer 2010 [45] Case 1 | Male 36 y.o. | 1.1 SR 1.2 SR | (1.1) 12 min (1.2) 16 min | - | Vertical root fracture | Survival | 2 years |
| Ozer Case 2 | Female 25 y.o. | 2.2 SR | 18 min | - | Vertical root fracture | Survival | 2 years |
| Ozer Case 3 | Male 32 y.o. | 1.3 SR | 24 min | - | Vertical root fracture | Survival | 2 years |
| Hsiang Lu 2011 [46] | Male 50 y.o. | 4.6 MR | 13 min | - | Apical periodontitis | Survival | 3 months |
| Unver 2011 [47] | Female 41 y.o. | 1.4 MR | 25 min | - | Vertical fracture | Survival | 36 months |
| Kim 2011 [48] Case 1 | Female 23 y.o. | 1.1 SR 2.1 SR 2.2 SR | - | - | Complicated crown-root fractures | Failure Survival Survival | 90 months |
| Kim 2011 Case 2 | Female 27 y.o. | 2.1 SR | - | - | Complicated crown-root fracture | Survival | 24 months |
| Moura 2012 [49] | Female 11 y.o. | 1.1 SR | - | - | Complicated crown-root fracture | Failure | 2 years |
| Dogan 2013 [50] | Female 9 y.o | 2.1 SR | 28 min | - | complicated crown-root fracture | Survival | 3 years |
| Shin 2013 [51] | Male 39 y.o. | 4.6 MR | 17 min | - | Apical periodontitis | Survival | 9 months |
| Yuan 2013 [52] | Female 11 y.o. | 2.1 SR | - | - | Complicated crown-root fracture | Survival | 3.5 years+ |
| Nagappa 2013 [53] Case 1 | Female 18 y.o. | 1.1 SR | - | - | Severe periodontitis | Failure | 3 months |
| Nagappa Case2 | Male 24 y.o. | 2.1 SR | - | - | Severe periodontitis | Survival | 14 months |
| Kumar 2013 [54] | Male 26 y.o. | 2.2 SR | 8 min | - | Apical periodontitis/endodontic failure | Survival | 1 year |
| MoradiMajd 2012 [55] | Female 44 y.o. | 3.5 SR | - | - | Apical periodontitis/necrotic tooth | Survival | 1 year |
| Subay 2014 [56] | Female 45 y.o. | 4.3 SR | 14 min | - | Apical periodontitis/Instrument separation | Survival | 24 months |
| Asgary 2014 [57] Case 1 | Male 25 y.o. | 4.6 MR | 14 min | - | Apical periodontitis | Survival | 23 months |
| Asgary Case 2 | Male 45 y.o. | 3.4 SR | 10 min | - | Apical periodontitis | Survival | 30 months |
| Asgary Case 3 | Male 41 y.o. | 4.7 MR | 8 min | - | Apical periodontitis | Survival | 24 months |
| Asgary Case 4 | Male 23 y.o. | 4.6 MR | 12 min | - | Apical periodontitis | Survival | 15 months |
| Asgary Case 5 | Female 46 y.o. | 4.7 MR | 8 min | - | Apical periodontitis | Survival | 27 months |
| Asgary Case 6 | Female 31 y.o. | 4.7 MR | 9 min | - | Apical periodontitis | Survival | 12 months |
| Asgary Case 7 | Female 30 y.o. | 1.4 MR | 10 min | - | Apical periodontitis | Failure | 18 months |
| Asgary Case 8 | Female 36 y.o. | 3.6 MR | 13 min | - | Apical periodontitis | Survival | 14 months |
| Asgary Case 9 | Male 48 y.o. | 4.7 MR | 14 min | - | Apical periodontitis | Survival | 16 months |
| Asgary Case 10 | Female 24 y.o. | 4.6 MR | 14 min | - | Apical periodontitis | Survival | 8 months |
| Asgary Case 11 | Female 43 y.o. | 2.6 MR | 14 min | - | Apical periodontitis | Survival | 17 months |
| Asgary Case 12 | Male 34 y.o. | 3.4 SR | 12 min | - | Apical periodontitis | Survival | 15 months |
| Asgary Case 13 | Female 29 y.o. | 3.6 MR | 10 min | - | Apical periodontitis | Survival | 11 months |
| Asgary Case 14 | Male 63 y.o. | 3.6 MR | 14 min | - | Apical periodontitis | Survival | 12 months |
| Asgary Case 15 | Male 31 y.o. | 1.7 MR | 13 min | - | Apical periodontitis | Survival | 10 months |
| Asgary Case 16 | Female 46 y.o. | 4.6 MR | 14 min | - | Apical periodontitis | Survival | 8 months |
| Asgary Case 17 | Female 40 y.o. | 4.6 MR | 12 min | - | Apical periodontitis | Failure | 8 months |
| Asgary Case 18 | Female 27 y.o. | 4.7 MR | 13 min | - | Apical periodontitis | Survival | 20 months |
| Asgary Case 19 | Female 41 y.o. | 3.6 MR | 10 min | - | Apical periodontitis | Survival | 12 months |
| Asgary Case 20 | Male 37 y.o. | 4.7 MR | 10 min | - | Apical periodontitis | Survival | 9 months |
| Asgari 2014 [58] | Female 28 y.o. | 1.4 MR 1.5 SR | 8 min | - | Apical periodontitis | Survival | 2 years |
| MoradiMajd 2014 [59] | Female 44 y.o. | 4.5 SR | - | - | Iatrogenic perforation | Failure | 1 year |
| Penarrocha Diego 2014 [60] | Male 51 y.o. | 1.7 MR | 30 min | - | Follicular cyst | Survival | 12 months |
| Tsesis 2014 [61] | Female 20 y.o. | 4.7 MR | 8 min | - | Paraesthesia | Survival | 4 years |
| Keceli 2014 [62] | Female 20 y.o. | 3.2 SR | 6 min | - | Severe periodontitis | Survival | 15 months |
| Pruthi 2015 [63] | Male 28 y.o. | 1.1 SR | 15 min | - | External root resorption | Survival | 18 months |
| DeeptiDua 2015 [64] | Male 23 y.o. | 1.1 SR | 20 min | - | Complicated crown-root fracture | Survival | 3 years |
| Forero-Lopez 2015 [65] | Male 25 y.o. | 1.2 SR | 8 min | - | Apical periodontitis | Survival | 3 months |
| Garrido 2016 [66] | Female 50 y.o. | 1.1 SR | 4 min | - | Endo-periodontal disease | Survival | 1 year |
| Abu-Hussein Muhamad 2016 [67] | Female 45 y.o. | 1.7 SR | 20 min | - | Apical periodontitis/Instrument separation | Survival | 15 years |
| Oishi 2017 [68] | Male 7 y.o. | 1.1 SR | - | - | Transverse root fracture/Endo-periodontal disease | Survival | 5 years |
| Grzanich 2017 [69] Case 1 | Female 64 y.o. | 3.1 SR | - | - | Apical periodontitis/Instrument separation | Survival | 28 months |
| Grzanich Case 2 | Male 35 y.o. | 1.4 MR | - | - | Apical periodontitis/endodontic | Survival | 2 years |
| Grzanich Case 3 | Female 86 y.o. | 1.8 SR | - | - | Apical periodontitis/vertical root fracture | Survival | 2 years |
| Faghihian 2017 [70] | Male 10 y.o. | 1.1 SR | 4 min | - | complicated crown-root fracture | Survival | 18 months |
| Maniglia-Ferreira 2017 [71] | Male 7 y.o. | 1.1 SR | 15 min | - | Traumatic avulsion | Survival | 3 years |
| Thaore 2017 [72] | Male 23 y.o. | 3.7 MR | 10 min | - | Apical periodontitis/Instrument separation | Survival | 1 year |
| Asgari 2018 [73] | Female 22 y.o. | 4.6 MR | 7 min | - | Apical periodontitis | Survival | 2 months |
| Zafar 2018 [74] | Female 30 y.o. | 2.6 MR | 15 min | - | Apical periodontitis/Instrument separation | questionable | 4 weeks |
| Saeed Kazi 2018 [75] | Male 35 y.o. | 4.7 MR | 10 min | - | Root perforation | Survival | 4 months |
| Krug 2019 [76] | Male 37 y.o. | 1.1 SR | 12 min | - | External cervical resorption | Survival | 2.5 years |
| Deshpande 2019 [77] | Female 23 y.o. | 1.6 MR | 10 min | - | Apical periodontitis/Instrument separation | Survival | 2 years |
| Teng Kai Ong 2019 [78] | Male 27 y.o. | 1.7 MR | 15 min | - | Symptomatic periradicular periodontitis | Failure | 10 months |
| Hao Yan 2019 [79] case1 | Male 37 y.o. | 2.2 SR | 7 min | - | Apical periodontitis | Survival | 18 months |
| Hao Yan 2019 case2 | Male 30 y.o. | 1.2 SR | 6 min | - | Apical periodontitis | Survival | 15 months |
| Hao Yan 2019 case3 | Female 27 y.o. | 1.2 SR | 6 min | - | Apical periodontitis | Survival | 12 months |
| Cunliffe 2020 [80] Case 1 | Male 33 y.o. | 4.1 SR | 15 min | - | Instrument separation/Root perforation | Survival | 6 months |
| Cunliffe Case 2 | Female 45 y.o. | 3.4 SR | 15 min | - | Apical periodontitis with missed anatomy | Failure | 3 months |
| Cunliffe Case 3 | Female 52 y.o. | 4.6 MR | 15 min | - | Apical periodontitis with over-filled | Failure | 3 months |
| Cunliffe Case 4 | Female 57 y.o. | 4.4 SR | 4 min | - | Apical periodontitis/pain | Survival | 1 year |
| Cunliffe Case 5 | Female 42 y.o. | 3.6 MR | - | - | Apical periodontitis | Survival | 3 months |
| Cunliffe Case 6 | Male 64 y.o. | 2.1 SR | 15 min | - | External root resorption | Survival | 4 months |
| Cunliffe Case 7 | Female 76 y.o. | 3.7 MR | - | - | Apical periodontitis with sclerosed canals | Failure | 1 year |
| Cunliffe Case 8 | Male 53 y.o. | 3.7 MR | - | - | Pulpal floor perforation | Survival | 3 months |
| Cunliffe Case 9 | Male 50 y.o. | 2.1 SR | - | - | Internal root resorption | Survival | 15 months |
| Cunliffe Case 10 | Female 64 y.o. | 3.7 MR | 15 min | - | Instrument separation | Survival | 6 months |
| Cunliffe Case 11 | Female 45 y.o. | 3.7 MR | - | - | Apical periodontitis with over-filled | Survival | 28 months |
| Cunliffe Case 12 | Male 45 y.o. | 4.5 SR | - | - | Apical periodontitis | Survival | 9 months |
| Cunliffe Case 13 | Female 39 y.o. | 3.6 MR | - | - | Apical periodontitis with procedural errors | Failure | 3 months |
| Asgary 2019 [81] | Female 28 y.o. | 3.7 MR | 10 min | - | Apical periodontitis/endodontic failure | Survival | 1 year |
| Fujii 2020 [82] | Female 30 y.o. | 1.6 MR | 15 min | - | Instrument separation | Survival | 1 year |
| Ganapathy 2020 [83] | Male 10 y.o. | 2.1 SR | - | - | Complicated crown-root fracture | Survival | 2 years |
| Lodha 2020 [84] | Female 28 y.o. | 4.6 MR | 10 min | - | Apical periodontitis/Instrument separation | Survival | 8 months |
| Yang 2021 [85] | Male 20 y.o. | 1.5 SR | 15 min | - | Apical periodontitis with internal root resorption and root fracture | Survival | 2 years |
| Shekhawat 2021 [86] | Male 13 y.o. | 3.6 MR | 15 min | - | Apical periodontitis | Survival | 12 months |
Table 2.
JBI Critical Appraisal Tool. Abbreviations: JBI Joanna Briggs Institute; “Q1–Q11 indicate questions 1 to 11 based on the JBI risk assessment”. Questions: “1. Is the review question clearly and explicitly stated? 2. Were the inclusion criteria appropriate for the review question? 3. Was the search strategy appropriate? 4. Were the sources and resources used to search for studies adequate? 5. Were the criteria for appraising studies appropriate? 6. Was critical appraisal conducted by two or more reviewers independently? 7. Were there methods to minimize errors in data extraction? 8. Were the methods used to combine studies appropriate? 9. Was the likelihood of publication bias assessed? 10. Were recommendations for policy and/or practice supported by the reported data? 11. Were the specific directives for new research appropriate?”. x: no; √: yes; ?: questionable.
Table 2.
JBI Critical Appraisal Tool. Abbreviations: JBI Joanna Briggs Institute; “Q1–Q11 indicate questions 1 to 11 based on the JBI risk assessment”. Questions: “1. Is the review question clearly and explicitly stated? 2. Were the inclusion criteria appropriate for the review question? 3. Was the search strategy appropriate? 4. Were the sources and resources used to search for studies adequate? 5. Were the criteria for appraising studies appropriate? 6. Was critical appraisal conducted by two or more reviewers independently? 7. Were there methods to minimize errors in data extraction? 8. Were the methods used to combine studies appropriate? 9. Was the likelihood of publication bias assessed? 10. Were recommendations for policy and/or practice supported by the reported data? 11. Were the specific directives for new research appropriate?”. x: no; √: yes; ?: questionable.
| Source | Q1 | Q2 | Q3 | Q4 | Q5 | Q6 | Q7 | Q8 | Q9 | Q10 | Q11 | %Yes | Risk |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Tang 1996 | x | √ | √ | √ | x | √ | √ | √ | ? | x | x | 55% | moderate |
| Poi 1999 | x | ? | x | x | x | √ | √ | √ | x | x | x | 27% | high |
| Aqrabawi 1999 | √ | √ | ? | x | x | √ | √ | √ | x | x | ? | 45% | high |
| Benenati 2003 | x | √ | √ | x | √ | √ | √ | √ | ? | x | x | 55% | moderate |
| Fariniuk 2003 | √ | √ | √ | x | x | √ | √ | √ | ? | x | x | 55% | moderate |
| Ward 2004 | x | √ | √ | x | x | √ | √ | √ | ? | x | √ | 55% | moderate |
| Shintani 2004 | x | √ | √ | √ | x | √ | √ | √ | x | x | ? | 55% | moderate |
| Peer 2004 | √ | √ | √ | ? | x | √ | √ | √ | x | x | x | 55% | moderate |
| BarattoFilho 2004 | √ | ? | √ | √ | √ | √ | √ | √ | √ | x | √ | 81% | low |
| Cotter 2006 | x | x | √ | √ | x | √ | √ | √ | √ | x | ? | 55% | moderate |
| Herrera 2006 | √ | √ | ? | x | x | √ | √ | √ | ? | x | x | 45% | high |
| Martins | √ | √ | x | ? | x | √ | √ | √ | x | x | ? | 45% | high |
| Penarrocha 2007 | √ | √ | √ | √ | ? | √ | √ | √ | √ | x | √ | 81% | low |
| Demir 2007 | √ | ? | √ | √ | √ | √ | √ | √ | √ | x | √ | 81% | low |
| Sivolella 2008 | x | ? | x | x | x | √ | √ | √ | x | x | x | 27% | high |
| Wang 2008 | x | x | √ | √ | x | √ | √ | √ | ? | x | √ | 55% | moderate |
| Al-Hezaimi 2009 | x | ? | √ | √ | x | √ | √ | √ | √ | x | x | 55% | moderate |
| Bittencourt 2009 | x | x | √ | √ | x | √ | √ | √ | √ | x | ? | 55% | moderate |
| Ozer 2010 | x | x | √ | √ | x | √ | √ | √ | ? | x | √ | 55% | moderate |
| Hsiang Lu 2011 | x | ? | √ | √ | x | √ | √ | √ | √ | x | x | 55% | moderate |
| Unver 2011 | √ | √ | ? | √ | √ | √ | √ | √ | √ | x | √ | 81% | low |
| Kim 2011 | √ | √ | x | ? | x | √ | √ | √ | x | x | ? | 45% | high |
| Moura 2012 | √ | √ | ? | x | x | √ | √ | √ | x | x | ? | 45% | high |
| Dogan 2013 | x | x | ? | x | x | √ | √ | √ | x | x | x | 27% | high |
| Shin 2013 | x | x | √ | √ | x | √ | √ | √ | ? | x | √ | 55% | moderate |
| Yuan 2013 | x | x | √ | √ | x | √ | √ | √ | ? | x | √ | 55% | moderate |
| Nagappa 2013 | x | x | √ | √ | x | √ | √ | √ | ? | x | √ | 55% | moderate |
| Kumar 2013 | √ | √ | √ | √ | ? | √ | √ | √ | √ | x | √ | 81% | low |
| Moradi Majd 2014 | x | x | √ | x | √ | √ | √ | √ | ? | x | √ | 55% | moderate |
| Subay 2014 | x | √ | x | √ | x | √ | √ | √ | √ | x | ? | 55% | moderate |
| Asgary 2014 | x | x | √ | √ | x | √ | √ | √ | ? | x | √ | 55% | moderate |
| Asgari 2014 | x | ? | x | x | x | √ | √ | √ | x | x | x | 27% | high |
| Moradi Majd 2014 | x | x | √ | x | √ | √ | √ | √ | ? | x | √ | 55% | moderate |
| Penarrocha Diego 2014 | x | √ | x | √ | x | √ | √ | √ | √ | x | ? | 55% | moderate |
| Tsesis 2014 | x | x | √ | √ | x | √ | √ | √ | ? | x | √ | 55% | moderate |
| Keceli 2014 | x | x | ? | x | x | √ | √ | √ | x | x | x | 27% | high |
| Pruthi 2015 | x | √ | x | √ | x | √ | √ | √ | √ | x | ? | 55% | moderate |
| Deepti Dua 2015 | x | x | √ | √ | x | √ | √ | √ | ? | x | √ | 55% | moderate |
| Forero-Lopez 2015 | x | ? | x | x | x | √ | √ | √ | x | x | x | 27% | high |
| Garrido 2016 | x | x | √ | x | √ | √ | √ | √ | ? | x | √ | 55% | moderate |
| Abu-Hussein Muhamad 2016 | x | √ | x | √ | x | √ | √ | √ | √ | x | ? | 55% | moderate |
| Oishi 2017 | x | x | √ | x | √ | √ | √ | √ | ? | x | √ | 55% | moderate |
| Grzanich 2017 | x | ? | x | x | x | √ | √ | √ | x | x | x | 27% | high |
| Faghihian 2017 | √ | √ | √ | √ | ? | √ | √ | √ | √ | x | √ | 81% | low |
| Maniglia-Ferreira 2017 | √ | √ | ? | X | x | √ | √ | √ | x | x | ? | 45% | high |
| Thaore 2017 | x | x | √ | x | √ | √ | √ | √ | ? | x | √ | 55% | moderate |
| Asgari 2018 | x | √ | x | √ | x | √ | √ | √ | √ | x | ? | 55% | moderate |
| Zafar 2018 | √ | √ | x | ? | x | √ | √ | √ | x | x | ? | 45% | high |
| Saeed Kazi 2018 | x | x | √ | x | √ | √ | √ | √ | ? | x | √ | 55% | moderate |
| Krug 2019 | √ | √ | √ | √ | x | √ | √ | √ | √ | ? | √ | 81% | low |
| Deshpande 2019 | √ | √ | √ | ? | √ | √ | √ | √ | √ | x | √ | 81% | low |
| Teng Kai Ong 2019 | √ | √ | x | ? | x | √ | √ | √ | x | x | ? | 45% | high |
| Hao Yan 2019 | √ | √ | ? | x | x | √ | √ | √ | x | x | ? | 45% | high |
| Cunliffe 2020 | √ | √ | √ | √ | ? | √ | √ | √ | √ | x | √ | 81% | low |
| Asgary 2019 | √ | x | √ | ? | x | √ | √ | √ | x | x | ? | 45% | high |
| Fujii 2020 | x | √ | x | √ | x | √ | √ | √ | √ | x | ? | 55% | moderate |
| Ganapathy 2020 | x | x | x | x | ? | √ | √ | √ | x | x | x | 27% | High |
| Lodha 2020 | x | x | ? | x | x | √ | √ | √ | x | x | x | 27% | high |
| Yang 2021 | x | √ | x | √ | x | √ | √ | √ | √ | x | ? | 55% | moderate |
| Shekhawat 2021 | √ | √ | √ | √ | ? | √ | √ | √ | √ | x | √ | 81% | low |
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Pisano, M.; Di Spirito, F.; Martina, S.; Sangiovanni, G.; D’Ambrosio, F.; Iandolo, A. Intentional Replantation of Single-Rooted and Multi-Rooted Teeth: A Systematic Review. Healthcare 2023, 11, 11. https://doi.org/10.3390/healthcare11010011
AMA Style
Pisano M, Di Spirito F, Martina S, Sangiovanni G, D’Ambrosio F, Iandolo A. Intentional Replantation of Single-Rooted and Multi-Rooted Teeth: A Systematic Review. Healthcare. 2023; 11(1):11. https://doi.org/10.3390/healthcare11010011
Chicago/Turabian StylePisano, Massimo, Federica Di Spirito, Stefano Martina, Giuseppe Sangiovanni, Francesco D’Ambrosio, and Alfredo Iandolo. 2023. "Intentional Replantation of Single-Rooted and Multi-Rooted Teeth: A Systematic Review" Healthcare 11, no. 1: 11. https://doi.org/10.3390/healthcare11010011
APA StylePisano, M., Di Spirito, F., Martina, S., Sangiovanni, G., D’Ambrosio, F., & Iandolo, A. (2023). Intentional Replantation of Single-Rooted and Multi-Rooted Teeth: A Systematic Review. Healthcare, 11(1), 11. https://doi.org/10.3390/healthcare11010011
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