Abt In The Management Of Chronic Apical Periodontitis Following Transplantation

This case demonstrates the efficacy of the apical barrier technique in controlling post-transplant apical infection. A 24-year-old female underwent autotransplantation of tooth #38 (with root resection and retrograde iRoot BP filling) to replace extracted #37 due to severe caries. After 2 asymptomatic years, occlusal pain emerged. Radiography revealed 4 mm periapical radiolucency from inadequate apical sealing. Microscopic root canal re-preparation (ISO 70), calcium hydroxide disinfection, and iRoot BP apical barrier placement were performed, followed by warm gutta-percha backfill and composite restoration. At 3-month follow-up, the periapical lesion significantly reduced, demonstrating effective healing. This highlights bioactive barrier repair and microscopy-guided techniques as minimally invasive strategies to salvage transplanted teeth with apical pathology. Apical sealing failure in a transplanted tooth was attributed to root canal anatomical variations and delayed endodontic intervention. Secondary treatment utilized microscopic debridement, calcium hydroxide disinfection, and bioactive iRoot BP to establish an apical barrier, combined with warm gutta-percha backfill for enhanced sealing and periapical regeneration. This case underscores the necessity of routine postoperative evaluation of apical integrity and prioritization of bioactive barrier repair over extraction to preserve transplanted teeth. Long-term follow-up confirms bone regeneration, demonstrating that advanced techniques (microscopy) and bioactive materials provide minimally invasive, biologically harmonious solutions for complex apical pathologies, balancing functional recovery and tissue healing. Future protocols should emphasize timely endodontic intervention and standardized apical sealing protocols to optimize transplant success rates.