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The key factor for successful reimplantation of an avulsed tooth is preserving PDL cell viability, with survival significantly reduced after 15 minutes dry time and unlikely after 60 minutes. Moist storage is preferred, though no ideal medium exists. Milk remains the most practical choice, while coconut water shows promise as an economical alternative with a longer shelf life.Advances in regenerative therapies, especially stem cell-based approaches using DPSCs, SHED, PDLSCs, and SCAP, offer potential to restore periodontal and pulpal tissues even when PDL cells are severely damaged. Techniques such as scaffold-based engineering, bioengineered tooth assembly, and gene therapy have shown promising preclinical results, improving revascularization, PDL regeneration, and reducing root resorption. However, most data are from animal or in vitro studies, and further human trials are needed before routine clinical use.