Intentional Replantation Reveals The Real Orgin Of Molar Apical Infection

In this case, the pre-treatment etiology of the endodontically involved maxillary molar was undetermined. One year after initial root canal treatment, the tooth developed recurrent infection through an unidentified pathway. Intentional replantation revealed calculus extension into the furcation area, creating a periodontal-derived infection route. Following complete debridement, the periapical bone defect showed excellent healing at 15-month follow-up. A 34-year-old male presented with left posterior swelling for 1 week. Despite two prior RCTs (last 1 year ago) post-orthodontics, #26 exhibited a fistula with CBCT showing periapical radiolucency extending from #27 to #26. After extracting impacted #28, persistent infection prompted intentional replantation of #27, revealing that calculus extended from the distal root surface to the external surface of the pulp chamber floor. Following calculus removal, apicoectomy, and retrofill, teeth were replanted. At 15 months, complete healing was confirmed clinically (no fistula/mobility) and radiographically (bone density restoration). Microsurgical endodontic procedures in second molars present significant technical challenges due to anatomical constraints and limited visual access. While enabling evaluation of the apical region, these techniques cannot assess the entire root structure, potentially leading to missed diagnosis of the true etiology in cases of indeterminate odontogenic infection.Intentional replantation allows comprehensive examination of the entire root surface, providing more direct and complete identification of the underlying pathology. IR identified and resolved the infection source, yielding successful outcomes. While IR is a potential solution for post-RCT disease, long-term success needs further validation.