Iranian Endodontic Journal

Abstract

Recurrent disease in a replanted tooth may remain amenable to treatment when the lesion is localized, and its cause is accessible. This report describes microsurgical repair of a mesial mid-root perforation in a previously replanted maxillary left second premolar. A 32-year-old woman was referred after recurrence of a sinus tract and a lateral radiolucency. According to the referral history, the perforation had occurred during cast post preparation. The tooth had subsequently been inadvertently extracted during an attempt to remove the restoration, repaired extraorally with amalgam, and replanted. Cone-beam computed tomography (CBCT) identified a lesion adjacent to the perforation without a visible fracture line, root resorption, or apical radiolucency. Microsurgical treatment comprised flap elevation, removal of granulation tissue and the previous amalgam repair, and sealing of the perforation with a bioceramic putty. An allograft and collagen membrane were placed before flap closure. Histopathological examination confirmed granulation tissue. At one- and five-year follow-up, the tooth remained functional and asymptomatic, with clinically normal periodontal probing and tooth mobility, no metallic percussion tone, and apparent resolution of the lateral lesion on periapical radiographs. No follow-up CBCT was available to confirm complete three-dimensional osseous healing. This case suggests that targeted microsurgical repair may preserve a selected replanted tooth with recurrent perforation-associated disease. The outcome did not establish the superiority of a particular repair material or the independent benefit of regenerative adjuncts.