Iranian Endodontic Journal

Abstract

This case report describes the management of a clinically suspected vertical root fracture (VRF) using intentional reimplantation combined with radicectomy and documents the 36-month outcome with cone-beam computed tomography (CBCT). A 63-year-old man presented with spontaneous pain and intense pain on mastication associated with tooth 46. Clinical examination showed grade II mobility, positive percussion and buccal palpation, and an isolated 10-mm periodontal defect with bleeding and suppuration on the buccal aspect of the mesial root. Periapical radiography showed mesial-root underfilling and a radiolucency extending from the middle third towards the apex. Because preoperative CBCT was not obtained, VRF remained a clinical suspicion until direct visualization after extraction confirmed a fracture confined to the mesial root. Following atraumatic extraction, the fractured mesial root was resected at its cervical third; the apical 3 mm of the distal root were resected, ultrasonically retro-prepared, and sealed with Bio-C Repair. The tooth was replanted after an exact extraoral time of 11 minutes and stabilized with an X-shaped suture. At 2, 18, and 36 months, symptoms had resolved and periodontal, mobility, percussion, palpation, occlusal, and functional findings were favourable. CBCT at 36 months demonstrated complete periapical bone fill consistent with healing and no evidence of ankylosis or root resorption. Intentional reimplantation combined with radicectomy may be considered a tooth-preserving option in carefully selected multi-rooted teeth; this single case does not establish predictable effectiveness.