Objective: this study was directed to evaluate by CBCT the periapical lesion size after intentional replantation of permanent molars after extraction by two different extraction methods. Patients and Methods, a total of 28 failed root canal treated maxillary and mandibular molars were included in this study, the teeth were extracted either by conventional forceps or by periotome assisted extraction, then apicectomy of apical 3mm and retrograde cavity were done by using carbide fissure bur, then filling the retrograde cavity with mineral trioxide aggregate were done, the tooth replanted back into its socket with slight apical pressure and socket compression and splinted for one weak. The CBCT was done immediately post-operative, after one year and after 2 years. Results: significant difference between group 1 and group 2 and also a difference between immediate and 1 and 2 years (p < 0.001). Conclusions: intentional replantation with atraumatic extraction is a valid option with high success rate.