Intentional Replantation for Traumatic Dental Injuries in the Aesthetic Zone: A Trauma‐Oriented Narrative Mini‐Review and Clinical Decision Framework

Intentional replantation (IR) is an established endodontic procedure with potential applications in complex traumatic dental injuries (TDI) of the esthetic zone. This narrative mini-review examines its biological rationale, clinical limitations, and potential indications through a trauma-oriented decision framework. Three injury patterns are considered: crown-root fractures with unfavorable three-dimensional extension; horizontal/oblique root fractures with persistent displacement, occlusal interference, or interfragmentary pathology; and complex multi-fragment injuries requiring extraoral reconstruction, irrespective of canal involvement. IR may be considered when established approaches cannot provide adequate access, predictable repositioning, or stable fragment reconstruction. Selection depends on injury morphology, periodontal conditions, and feasibility of atraumatic extraction, restorative prognosis, residual growth, and available alternatives. The proposed protocol includes preoperative fabrication of a chairside light-cured resin guide to reference the tooth's original position, together with preparation of a flexible splint before extraction. A minimally invasive intrasulcular incision precedes controlled, flapless extraction. During extraoral management, the tooth and detached fragments are protected from dehydration using sterile physiological saline between treatment steps, with ≤ 15 min proposed as an operative target rather than an established biological threshold. The guide assists repositioning following reconstruction; the prepared flexible splint provides immediate stabilization. Endodontic sequencing reflects canal continuity, achievable intraoral isolation, and reconstructive requirements. Treatment is performed intraorally when feasible, whereas canal-disrupting injuries may require extraoral retrograde sealing. Stable reconstruction of certain multi-fragment injuries may necessitate treatment of an initially vital pulp. This framework does not imply superiority over established approaches. Potential benefits must be weighed against additional periodontal ligament (PDL) injury, ankylosis, and replacement resorption. These risks are especially consequential in growing patients, for whom progressive infraocclusion may necessitate further treatment.