The present clinical report introduces a novel surgical procedure, the apical tooth replantation with surgical intrusion technique (ATR-SIT), for managing teeth with a hopeless prognosis compromised with a severe endoperiodontal lesion, pathologic tooth migration, and gingival recession. Two cases are presented that manage teeth diagnosed with a hopeless prognosis. ATR-SIT involves tooth extraction, extraoral root debridement, root surface conditioning, apicoectomy, retrograde filling, and the application of enamel matrix derivatives prior to reimplantation. Following reimplantation, the teeth are covered with a combination of autogenous bone chips and bone substitute materials, then covered with resorbable membranes. After ATR-SIT, the patients received either orthodontic treatment or tooth-supported fixed dental prostheses. The described ATR-SIT effectively improved the initially hopeless prognosis of the teeth and maintained periodontal health over time, evidenced by favorable clinical and radiographic outcomes. ATR-SIT might be a potential alternative to extraction of hopeless teeth in patients with stage IV periodontitis.