Intentional Replantation Of Maxillary Second Molar: A Case Report

This report describes a case of intentional replantation for a maxillary second molar with apical lesions involving the maxillary sinus that were refractory to conventional treatment. A 23-year-old female presented with occlusal pain in a root canal-treated maxillary second molar ( post-core crown restoration 5 years). CBCT revealed fused roots with underfilled canals, a separated instrument in the mesiobuccal canal apex, and a fiber post in palatal canal. A large periapical lesion with maxillary sinus floor discontinuity and mucosal thickening was noted. Following atraumatic extraction, apical granulation tissue was removed avoiding socket wall damage. The extracted tooth was held gently by the crown with saline-moistened gauze. Extracorporeal microsurgery included apicoectomy, resected root surface inspection, ultrasonic root-end preparation under continuous saline irrigation, fractured instrument retrieval, and iRoot BP (a hydrophilic calcium silicate-based bioceramic material) retrograde filling. Extracorporeal manipulation time was 23min. The tooth was reinserted into the alveolar socket and sutured. At 17-month follow-up, the patient remained asymptomatic with complete periapical healing and normal maxillary sinus confirmed clinically and radiographically. The presence of restoration, apically separated instrument, and restricted surgical access necessitated intentional replantation as the treatment of choice for tooth preservation. Strictly adhering to modern endodontic surgical principles, minimizing extracorporeal operation time, and using biocompatible root-end filling materials may improve the success rate of intentionally replanted teeth. This case demonstrates intentional replantation as a viable alternative when conventional endodontic retreatment and microsurgery are contraindicated due to anatomical limitations and iatrogenic complications.