Intentional Replantation For Severe Apical Periodontitis Near Maxillary Sinus

This case highlights the successful management of a tooth with severe apical periodontitis after Post-core restoration adjacent to the maxillary sinus using intentional replantation, preserving the tooth and avoiding sinus complications. A 27-year-old female patient presented with fistula and swelling in the maxillary posterior region. Radiographs revealed severe apical periodontitis in tooth 25, with close proximity to the maxillary sinus. After failed conventional root canal therapy, intentional replantation was performed. The tooth was carefully extracted, root-end resection and retrograde filling (IrootBP) were done, and the tooth was reimplanted. Postoperative care included antibiotics and follow-up assessments. Intentional replantation proved effective in resolving the infection while maintaining tooth function. The case underscores the technique’s viability for teeth near critical anatomical structures when other treatments fail. At 12-month follow-up, the tooth was functional with resolved periapical pathology .Key learning points include meticulous handling to avoid sinus perforation and the importance of patient follow-up. This approach offers a conservative alternative to extraction and implant placement. The findings support intentional replantation as a valuable alternative to extraction and implant placement, emphasizing its role in maintaining dentition and reducing surgical risks near the maxillary sinus. This approach aligns with the growing emphasis on tooth preservation and patient-centered care, offering clinicians a predictable solution for complex endodontic-periapical pathologies. Further long-term studies could solidify its position in standardized protocols.