Prognosis of intentional replantation for periapical periodontitis teeth: a systematic review and meta-analysis.

BACKGROUND

Intentional replantation (IR) includes extraction, subsequent treatment, and replantation of teeth. It is regarded as a final strategy to preserve teeth affected by periapical periodontitis. This review aims to evaluate the overall prognosis and key prognostic factors of IR for periapical periodontitis teeth.

METHODS

Ten databases (Ovid MEDLINE, Ovid Embase, etc.) and two registers were searched up to June 2024. Two independent review authors selected and identified prognostic studies (both prospective and retrospective studies) involving patients with periapical periodontitis teeth undergoing IR, reporting on success and survival rates, and factors influencing outcomes. Then, two independent review authors extracted the characteristics of the included studies and assessed the bias using the QUIPS tool. Meta-analyses were undertaken wherever appropriate.

RESULTS

A total of 39 studies (49 reports) with 2305 teeth were included in this review. 31 studies were judged as high risk of overall bias while the other eight at moderate risk. For overall prognosis, meta-analyses showed a pooled success rate of 0.78 (95% CI 0.70 to 0.84) and pooled survival rate of 0.89 (95% CI 0.85 to 0.93). For prognostic factors, survival rate ratio (SRR) of age was 0.73 (95% CI 0.53 to 0.99, p = 0.048), and SRR of combined periodontal-endodontic lesions (CPEL) was 0.80 (95% CI 0.67 to 0.95, p = 0.001).

DISCUSSION: Results indicated that age and CPEL were significant factors influencing the success rate of IR, thereby supporting its clinical applicability in managing periapical periodontitis. The 39 cohort studies included in this review provided robust evidence for identifying the overall prognosis and key prognostic factors, which were the primary objectives of this study. However, the absence of large-sample cohort studies (both prospective and retrospective) reduces the reliability of the conclusions drawn in this review. Moreover, the observed variability across studies emphasizes the need for standardized protocols and further research to enhance consistency and reliability.