Endodontic diagnosis for tooth #2-7: previously treated, symptomatic apical periodontitis.  Intra-oral examination reveals a wide, 6 to 8mm clinical attachment loss (i.e. probing defect) distal to tooth #2-7 and loss of distal contact due to enamel fracture.  A CBCT scan shows intact buccal and palatal bone and a significantly shortened palatal root due to external inflammatory root resorption.

Intentional replantation procedure allows us to control all the contributing factors to endodontic failure in this case: ruling out the presence of root fracture, removing the subgingival calculus as a result of loss of enamel, removing theĀ resorbing granulation tissue, eliminating possible established extra-radicular infection or biofilm, sealing the root-ends without the need for retreatment and possible further extrusion of obturation material into the lesion, preserving the intact buccal and palatal cortical bone through eliminating the need for apical surgery (Risks: proximity to Greater Palatine nerve and artery, inadequate palatal root length, possible loss of palatal cortical bone post-surgery).

The final radiograph shows the periapical healing after 1 year. Patient is asymptomatic, the tooth is functional with great periodontal health post-restoration, awaiting a crown. Extraction/implant option can wait for now.

Dr. Mahmoud Ektefaie @ vanendo

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