Outcome of intentional replantation of endodontically treated teeth with periapical pathosis: A systematic review & meta-analysis
Objectives: The purpose of the present review was to examine success, survival and failure following intentional replantation of endodontically treated teeth with existing periapical pathosis and to determine the factors that might affect the outcome of replantation in these teeth.
Methods: PubMed NLM, CINAHL Plus (EBSCO), Wiley Cochrane Library, Dental and Oral Science databases were systematically searched for articles that were published between January 1966 and February 2021. Clinical trials, longitudinal studies, case series with >10 cases, at least one year follow-up, and published in the English language were included. Data were extracted to analyze success, survival and failure. Meta-analysis was performed using random-effects computation model employing MedCalc software. Risk of bias was assessed using Newcastle-Ottawa Scale
Results: A total of 189 articles were obtained in the electronic and hand search. After exclusion of ineligible studies and removal of duplicates, thirteen articles were included in the systematic review. Even though most studies carried low risk of bias, there was heterogeneity among studies. The average rate of success following intentional replantation was 77.3%. Inflammatory root resorption was the most frequent complication found in 8.1% of total cases. Meta-analysis revealed the mean weighted survival to be 85.9% (95% CI: 79.6 – 91.2)
Conclusions: Intentional replantation has acceptable success (77.3%) and survival (85.9%) in 5-10 years. Common complications include inflammatory root resorption (2% – 27%) and ankylosis (2.4% – 25%). Variables influencing successful outcome include short extra alveolar dry time, preferably <15 min; root-end resection (2–3 mm) and cavity preparation (3 mm); manipulation of the tooth using the crown only; and use of an appropriate storage media.