(TC04) A Double Intentional Replantation for a Multifactorial Problem

Abstract: Intentional replantation (IR) is defined as the deliberate extraction of a tooth, followed by extraoral endodontic manipulation and, its placement back in the socket. The technique has been described as an alternative for the management of endodontic disease that otherwise is not accessible through nonsurgical or surgical treatment, including, cases with external cervical resorption inaccessible with surgery or roots in close proximity to anatomical structures. IR is perceived by many as a treatment of last resort but recent evidence, where strict treatment protocols are followed, has confirmed that intentional replantation is a feasible treatment option in certain cases. Among the treatment considerations for IR protocol is the atraumatic extraction to minimize damage to cementum and PDL fibers, and an extraoral time under 15-minutes with an appropriate storage medium. Furthermore, intentional replantation is a comparatively simple, cost-effective, and predictable treatment under the right conditions or when treatment planned correctly. The goal of this table clinic is to present a case of double IR of teeth #25 and #26. The technique variation included the fact that each tooth has distinct pathoses, where #25 presented extensive external cervical resorption and #26 presented obliterated pulp canal space and a periapical lesion. Additionally, teeth were splinted from #24 to #27 after the IR procedure, with a custom fabricated resin fiber splint to promote stability and favor healing. Both teeth had a questionable prognosis and were planned for extraction before IR was suggested. This case demonstrates a relatively cost-effective treatment option where multifactorial problems are present.