Intentional Reimplantation for a Large Periapical Cyst Using Dual Forms of Platelet-rich Fibrin, Chitosan, and Biodentine™: A Case Report

REPORTsignificant bone loss.Its antimicrobial and biocompatible properties further contribute to successful outcomes. 6dditionally, Biodentine, a bioactive root-end filling material, provides excellent sealing capability and promotes dentinogenesis, 7 complementing the regenerative effects of L-PRF, i-PRF, and chitosan.Together, these materials create an optimal environment for tissue repair and regeneration, thereby increasing IR predictability. IntroductIonIntentional reimplantation (IR) is gaining recognition in endodontics as a practical and minimally invasive treatment for cases where conventional approaches have failed or are unsuitable.This procedure involves atraumatic and deliberate extraction of a tooth, followed by treatment of the periapical pathology and reinsertion into the original socket.While IR was historically considered a last resort, advancements in biomaterials and regenerative techniques have significantly improved its success rates, making it a viable alternative to extraction or complex surgical interventions. 1 The appeal of IR lies in its simplicity and accessibility, as it requires no specialized surgical equipment.It is particularly indicated for persistent periapical pathology unresponsive to retreatment, cases with difficult surgical access, or patients opting to preserve their natural teeth rather than undergoing extraction or implants.However, proper case selection is essential, as IR is contraindicated in teeth with severe periodontal involvement, complex root anatomy, or fractures that compromise structural integrity. 2,3ecent advances have enhanced the potential of IR through the integration of regenerative biomaterials.Leukocyte-and platelet-rich fibrin (L-PRF) acts as a fibrin matrix rich in growth factors, promoting accelerated healing and reducing inflammation. 4Injectable plateletrich fibrin (i-PRF), with its liquid consistency, allows for deeper penetration into defects, enhancing regeneration. 5Chitosan, a versatile biopolymer, serves as a scaffold that supports tissue regeneration and can even substitute for bone grafts in cases of 1-