Salvaging A Hopeless Tooth: Intentional Replantation To Rescues Lateral Incisor

Intentional replantation (IR) was used to successfully treat a maxillary lateral incisor (#22) that had failed periodontal therapy and conventional endodontic retreatment because to deep palatogingival groove and chronic apical periodontitis. A 32-year-old man who had previously received root canal therapy (RCT) presented with recurrent swelling of 22. A clinical examination showed a distobuccal periodontal pocket (PD)=6 mm, a sinus tract, I° mobility, and a lingual groove that extended 4 mm subgingivally. Radiographs indicated bone loss, periapical radiolucency, and insufficient root canal filling. IR was carried out following the failure of nonsurgical retreatment and periodontal therapy (PD increased to 8 mm). The tooth showed no movement, sinus tract closure, PD decrease (2–3 mm), and periapical healing during the 2.5-year follow-up. Deep spiral pockets and severe distal/palatal bone loss indicated complex root anatomy that went beyond radiography observations. The palatal flap was difficult to access, and apical surgery carried the risk of removing too much bone. By eliminating these drawbacks and successfully treating both endodontic and periodontal pathology, IR offered a workable substitute. If atraumatic extraction and a short extraoral duration (less than 15 minutes) are possible, IR can be a reliable alternative for teeth with complex anatomy when nonsurgical retreatment or apical surgery is not feasible. The promise of IR as a primary treatment, rather than a last option, is demonstrated by this example.