Intentional Replantation Of A Mandibular Second Molar: A Case Report

Intentional replantation is a viable option for preserving tooth when conventional nonsurgical endodontic retreatment and apical surgery have no effect. A 32-year-old female presented with chewing pain related to the mandibular second molar which was previously treated with root canal therapy. Clinical examination revealed the tooth with crown restoration, percussion pain and mild mobility. Cone beam CT showed high-density images in the root canal system, a distal defect, and low-density images in the periradicular area. The teeth were intentionally extracted. Root-end preparation was performed by using ultrasonic tips after root‐end resection. Root‐end cavities were filled with iRoot BP Plus, and reimplantated. 3 months after treatment, the patient was asymptomatic and the tooth was grade zero mobile, with evident healing of the periapical lesion. In this case, the root canal infection was due to inadequate distal sealing. Nonsurgical retreatment could not effectively control inflammation and provide adequate closure of the upper root canal due to the subgingival location of the defect. Apical microsurgery was unsuitable due to the limitations in anatomical location. Intentional replantation was chosen as the optimal treatment approach, as it allows for control of tooth infection in an extraoral environment and avoid damage to the adjoining delicate anatomic structures. Intentional replantation provide a valid treatment option for prolonging the survival of this tooth in this case, while long term effects need to be verified.