Intentional Replantation Of Maxillary Second Molar For Odontogenic Maxillary Sinusitis

This case report demonstrates successful treatment of both apical periodontitis and odontogenic maxillary sinusitis caused by gutta-percha overextension in tooth 27 through intentional replantation. A 20-year-old female presented with left upper posterior teeth discomfort during occlusal biting for a 2-week duration, accompanied by left-sided nasal congestion and facial tenderness.Diagnosis revealed periapical periodontitis of tooth 27 and left maxillary sinusitis. Cone-beam computed tomography (CBCT) images indicated 3–5 mm gutta-percha overextension in the mesio-buccal, disto-buccal, and palatal roots.Additionally, significant mucosal hyperplasia was noted in the left maxillary sinus.The tooth was atraumatically extracted in collaboration with an oral surgeon. Subsequent procedures included root apex resection under dental microscopy, ultrasonic retro-preparation, and retro-filling with iRoot BP Plus (Innovative BioCeramix Inc.,Vancouver, BC, Canada) .The replanted tooth showed no symptoms after 16 months, with periapical X-ray revealing no root resorption and CBCT demonstrating resolution of maxillary sinusitis. Extrusion of filling materials into the maxillary sinus can lead to various symptoms. In cases where materials exceed the apical foramen, traditional root canal retreatment may be challenging. Surgical intervention near the maxillary sinus poses risks of complications. Multidisciplinary treatment with a dental microscope can facilitate minimally invasive extraction of the affected tooth, prompt removal of infection, and enhance the success of intentional replantation. When root canal retreatment and apical surgery cannot be carried out, intentional replantation can be considered.