Background <p>This paper describes a technique that the root-oriented replantation (ROR) of periodontally hopeless teeth (PHT) offers the preservation and restoration of tooth stability and function.</p> Methods <p>Preoperative intraoral three-dimensional (3D) scans and cone beam computed tomography (CBCT) data were imported into the robotic system for virtual surgical planning. During the surgery, the PHT were atraumatically extracted. This was followed by extraoral root surface debridement and retrograde root canal therapy (retro-RCT). The robotic system precisely reconstructed the 3D morphology of the alveolar socket according to the preset planning. The treated teeth were replanted into the reconstructed socket and were stabilized by splinting them to the adjacent teeth. Regular postoperative follow-up was conducted to assess the clinical outcomes. See also the graphical abstract.</p> Results <p>Robotic-assisted socket reconstruction enabled precise positioning of the PHT. The postoperative outcomes demonstrated minimal pain and swelling. At the three-month follow-up, clinical indicators of inflammation showed significant improvement, with resolution of bleeding on probing and suppuration, and reduced probing depths. The teeth regained stability and were restored esthetically and functionally with veneer restoration.</p> Conclusions <p>Robotic-assisted alveolar socket reconstruction and ROR provide an innovative and effective therapeutic strategy for the preservation of PHT. Intraoperatively, retro-RCT enforced a minimally invasive approach and resulted in a thorough root canal filling.</p> Trial registration <p>ChiGTR, the registration number is ChiCTR2300070948. Registered 27 April 2023 retrospectively registered.</p> Graphical Abstract <p></p>