Intentional replantation of #19.

This 14-year-old patient presented asymptomatically with a draining sinus tract buccal to the mesial root apex of #19. Retreatment was performed, and an additional canal was identified. Three weeks of calcium hydroxide as an intracanal medicament was used prior to obturation.  One month after obturation, a draining sinus tract was again noted in the same location.  No probing defects were detected.  (See images 1-6)

Due to the persistent draining sinus tract and possibility of vertical root fracture, intentional replantation was performed. (See images 7-12)

  1. Pre-operative radiograph

2. Four Thermafil carriers identified

3. Mid-mesial canal identified and instrumented

4. No cracks were detected after staining

5. Post-operative radiograph

6. One month post-operative, with DST present

7. Atraumatic extraction of #19

8. Root-end resection

9. Retro-filling and methylene blue staining

10. Post-surgical radiograph

11. Three month recall

12. One year recall

Intentional replantation is seen as a last resort to save a tooth after other procedures have failed, and therefore is not a common procedure. However, its viability as a treatment option is strongly supported in the endodontic literature. The take home point is this: there is a lot that can be done to save teeth.  The presence of a periapical lesion after initial root canal treatment, and even after non-surgical retreatment, is no reason to pursue extraction and replacement of the tooth.  Endodontic microsurgeries such as apicoectomy, performed by endodontists using modern techniques, have high success rates (over 90%) as reported in the literature.  Occasionally endodontists employ other surgical techniques, such as intentional replantation, to save teeth as well.


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