Document Type : Case Report
Authors
1
Oral and Maxillofacial Surgery Department, School of Dentistry, Baqiyatallah University of Medical Sciences, Tehran, Iran
2
Endodontist, Tehran, Iran
3
Oral and Maxillofacial Surgeon, Tehran, Iran
4
Department of Endodontics, School of Dentistry, Baqiyatallah University of Medical Sciences, Tehran, Iran
10.30491/tm.2026.587840.1947
Abstract
Introduction: Fracture of endodontic instruments represents a significant clinical challenge, particularly in emergencies where infection and severe pain are present. When nonsurgical retreatment and apical surgery are not feasible, intentional replantation may serve as a valuable tooth-salvage option.
Case Presentation: A 60-year-old female presented with severe spontaneous pain (Visual Analog Scale [VAS] 9/10) in a mandibular second molar associated with an inadequate root canal filling and a fractured endodontic instrument in the mesial root. Emergency palliative care was initiated on the day of presentation, including a nonsurgical retreatment attempt, chemomechanical debridement to the extent possible, and intracanal medicament placement. This resulted in rapid symptom resolution (VAS reduced to 2/10 within 24 hours). Subsequently, at a scheduled follow-up visit, the fractured instrument was confirmed to be irretrievable. Given the persistence of the etiological factor and anatomical constraints precluding surgical endodontic access, intentional replantation was selected as the definitive elective treatment. The tooth was extracted atraumatically, and extraoral root-end management was performed, including removal of the fractured instrument, apical resection, and retrograde filling with Cold Ceramic. Histopathologic examination of the periapical tissue confirmed a diagnosis of periapical granuloma. The tooth was immediately replanted with suture splinting for 2 weeks, and occlusion was adjusted. Postoperatively, the patient experienced complete symptom resolution, and no complications were observed. At 6-month follow-up, clinical and radiographic examination revealed favorable short-term healing with evidence of bone regeneration.
Conclusion: Intentional replantation can be an effective tooth-salvage procedure in cases of symptomatic apical periodontitis complicated by a fractured endodontic instrument when conventional retreatment and apical surgery are not feasible. However, it should be clearly distinguished from emergency palliative care, which addresses the acute symptoms, whereas intentional replantation is an elective definitive procedure. Longer-term follow-up is necessary to confirm the long-term prognosis of the replanted tooth.
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