Patient sought care complaining of pain and swelling in the gingiva by palatine. On clinical examination, it was observed gingival edema and periodontal probing of 9mm depth in the region. Palpation and percussion tests were negative and vitality was positive, with a more exacerbated response in relation to the other teeth, therefore, as a pulp diagnosis, asymptomatic irreversible pulp inflammation. Radiographic and tomographic examination revealed images compatible with external cervical resorption. The proposed treatment was endodontic and surgical with restoration of the resorbed area, by intentional reimplantation.
In: Bueno et al. v. 7 (2018): Annals 8th Congress of FOA - UNESP:
Intentional reimplantation is an alternative treatment for tooth preservation. It consists of the least traumatic exodontia possible, extraoral procedure and reimplantation in the alveolus. Patient A.R.M., 40 years old, female, attended the Endodontics Department of the Araçatuba Dental School - UNESP complaining of pain after 6 months of endodontic treatment on tooth 37. The radiographic examination showed overburation, absence of periapical lesion and a cemented crown with intraradicular fiberglass pins. Endodontic retreatment was discarded due to the risk of perforation or root fracture during the removal of the pins, associated with the impossibility of removing the extravasated material. The parendodontic surgery was discarded due to the difficulty of access and the possibility of implantation was presented, but it was not accepted due to the high cost. Therefore, intentional reimplantation was proposed. The tooth was extracted and immediately wrapped in gauze dampened with saline solution, allowing the roots to be observed for fractures. Then, apicectomy was performed, followed by backpreparation with a high rotation drill under irrigation with saline solution and retrobturation with white mineral trioxide aggregate (MTA). After the extraoral procedures, the tooth was immediately reimplanted into the alveolus and stabilized with 4-0 suture. After one year, the patient returned for clinical and radiographic control, in which the absence of symptoms to vertical percussion was observed. After 10 years, the radiographic image revealed apical repair, with no evidence of root resorption or periapical lesion. On clinical examination there was absence of pain and mobility confirming the success of the treatment, suggesting intentional reimplantation a valid alternative. This technique can help keep a tooth functioning rather than replace it with a prosthesis or dental implant.
