Intentional Replantation For Palatogingival Groove With Severe Endodontic-Periodontal Lesion

Palatogingival grooves (PGGs) predispose teeth to combined endodontic-periodontal lesions, creating therapeutic challenges. This report presents intentional replantation (IR) as an alternative to extraction for PGG-affected teeth with complex pathologies. A 31-year-old female presented with a maxillary lateral incisor (tooth #7) with a PGG extending to the apex, severe periodontal destruction (9 mm probing depth), and a mid-root buccal perforation. Radiographic findings revealed interconnected palatal and apical radiolucencies. Following root canal therapy and perforation repair, IR was performed. The tooth was atraumatically extracted. Under dental operating microscope, 3 mm of apex was resected, the palatogingival groove was removed, a 3 mm retrograde preparation was completed. Both the palatogingival groove and the root apex were filled with bioceramic materials (iRoot BP plus, Innovative Bioceramix). The replanted tooth was splinted elastomerically for 2 weeks. At 1-year follow-up, periodontal parameters normalized, periapical healing was evident, and gingival architecture was preserved. Then the crown discoloration was managed with internal bleaching. While IR is generally contraindicated in periodontally compromised teeth, this case supports its feasibility when PGGs act as primary etiological pathways and conventional surgical access is restricted. The preserved alveolar bone and gingival tissues mitigate future implant complexity, even if external root resorption occurs. IR combined with bioceramic reconstruction provides a transitional strategy for severe PGG-related lesions, prioritizing tissue preservation while maintaining options for definitive therapy. This approach expands indications for IR in complex endodontic-periodontal cases.