Intentional Replantation as the Treatment of Left Mandibular Second Premolar Refractory Periapical Periodontitis: A Case Report

This report aims to assess the feasibility of intentional replantation combined with concentrated growth factor(CGF) membrane treatment for refractory apical periodontitis of the left mandibular second premolar (35), with a 13-month follow-up period.

A 24-year-old female patient underwent root canal treatment for pulpitis of the left mandibular second premolar 3 years ago, and her gum repeatedly swelled and drained pus after the treatment. CBCT revealed that the apical area of 35 was adjacent to mental foramina, and the cyst range was large. There could be issues of poor visual field, trauma, difficulty in apical preparation and backfilling after the apical resection. The left mandibular second premolar (35) was extracted, and the inflammatory tissues in the apical and alveolar fossa were removed, followed by the removal of apical irritants. The extracted premolar was then implanted into the alveolar fossa and fixed.

After a duration of 13 months, the left mandibular second premolar 35 exhibited no clinical symptoms and was able to perform normal masticatory function. There was an absence of gum swelling, pain or mobility; cone beam computed tomography imaging revealed bone regeneration below the root apex with the absence of new lesions, root resorption, or adhesion to the alveolar bone. The periodontal ligament demonstrated healing between the root and alveolar bone, effectively controlling infection, preserving infected teeth and facilitating the formation of new attachments around them.

Intentional tooth replantation has some advantages, like short operation time, less cost, less bone injury, and less limitations in terms of anatomy and location. However, clinicians should consider whether intentional replantation could be performed before dental implantation for the affected teeth with intractable periapical lesions. Nonetheless, its efficacy needs further evaluations through long-term clinical follow-ups.