Severe Palatoradicular Groove: Intentional Replantation & 2-Segment Restoration

A 28-year-old female presented with a 2-week history of occlusal pain in the right maxillary lateral incisor (#12). Diagnosis confirmed a palatogingival groove with combined endodontic-periodontal pathology. Treatment involved microscope-assisted root canal therapy (RCT) and intentional replantation with two-segment restoration to seal the root groove and eliminate infection. Clinical examination revealed percussion pain (++), a subgingival palatal groove (PD=7mm), and radiographic evidence of root surface invagination, apical periodontal ligament widening, and bony defects. Post-RCT, intentional replantation was performed: minimally traumatic extraction, 3mm apical resection, retrograde preparation/obturation (3mm each), and two-segment restoration (flowable resin coronally from CEJ; bioceramic sealer apically). The tooth was stabilized with a periodontal splint for 2 weeks. Two-year follow-up demonstrated favorable healing. Palatogingival grooves predispose to dual pathology. This case achieved corono-radicular compartmentalization via intentional replantation and dual-seal restoration, balancing functional preservation and tissue regeneration. Apicoectomy ensured precise infection control, while bioceramics facilitated periodontal/bone repair. Intentional replantation combined with two-segment restoration offers a predictable approach for severe palatogingival groove cases, though long-term monitoring remains essential.