In my previous post “What to do with a compromised tooth?” I asked everyone about the options for a tooth which appeared to be compromised on X-rays. Four options were presented: a) endodontic retreatment, b) apical surgery, c) extraction/implant and d) other. Apical surgery won the race and all responders chose one of the first three options given. In this case, the fourth option was chosen: Intentional Replantation.
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 the 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.