Intentional Replantation of a Mandibular First Molar with Post-Treatment Apical Periodontitis: A Case Report with 12-Month Follow-Up

Intentional replantation (IR) emerges as a critical intervention when non-surgical endodontic treatment fails, and anatomical limits rule out apicoectomy as a viable option.In cases where proximity to the inferior alveolar nerve, association with the maxillary sinus, or a thick buccal cortical plate prevents apicoectomy, IR becomes the preferred treatment method.A fifty-six-year-old female presented to the Ondokuz Mays University Department of Endodontics clinic with persistent discomfort and unresolved swelling in the left mandibular region following unsuccessful root canal treatment performed a year prior.Clinical examination revealed increased probing depths, a draining sinus tract, and localized swelling around tooth 36.A preoperative periapical radiograph confirmed post-treatment apical periodontitis, necessitating IR due to the thick buccal cortical plate.The tooth was atraumatically extracted, an extra-oral apicoectomy was executed, and the root end was prepared and sealed with mineral trioxide aggregate.Subsequently, the tooth was replanted and stabilized with sutures.A three-month follow-up demonstrated resolution of the sinus tract, with the tooth asymptomatic and fully functional at the one-year mark.Despite being overlooked by practitioners and often perceived as complex and unsafe, accumulating evidence supports its efficacy.Considering its cost-effectiveness to dental implants, clinicians should contemplate employing IR before opting for extraction.