A Case Of Radicular Groove Treated By Intentional Replantation

Intentional replantation offers a tooth-preserving alternative when root canal treatment and apicoectomy fail, providing aesthetic, economic, and sensory advantages over implants. This case report presents the successful management of a palatogingival groove (PG) in a maxillary lateral incisor using intentional replantation. A 30-year-old woman presented with a 3-month history of occlusal pain in her left maxillary lateral incisor. Physical examination revealed no visible defects but a PG extending to the root surface, with an 11 mm probing depth, Grade I mobility, and a non-vital pulp. Imaging studies demonstrated periapical radiolucency extending along the root groove. 3 months after root canal treatment, the affected tooth showed no significant symptomatic improvement. Intentional replantation was then performed: the apical 3 mm was resected extracorporeally, followed by retrograde filling (iRoot BP Plus) and root groove sealing. The tooth was kept moist with isotonic saline, with <15 minutes of extraoral time. It was then repositioned and stabilized. Follow-up revealed symptom resolution and periapical bone regeneration at 15 months. The primary advantage of intentional replantation lies in its ability to facilitate direct visualization and comprehensive treatment of root surface defects that are otherwise difficult to manage. With the application of dental microscopes and bioceramic materials in endodontic surgery, the success rate of intentional replantation has significantly improved. Key procedural considerations include preserving periodontal ligament viability and minimizing extraoral time. For teeth with refractory periapical lesions, intentional replantation offers a final opportunity to retain the natural dentition.