Intentional reimplantation of a mandibular premolar with severe apical root resorption: a case report demonstrating diagnostic complexity in adjacent teeth

Purpose: This case report aimed to illustrate the clinical application of intentional reimplantation (IR) as a conservative and effective treatment strategy in cases of significant apical root resorption when surgical endodontics poses a risk to adjacent anatomical structures. Furthermore, it addressed the diagnostic challenge concerning the neighboring tooth, underscoring the importance of a comprehensive diagnostic evaluation to accurately differentiate between pathologies and prevent misdiagnosis. Case presentation: A 25-year-old woman presented with tooth #44 that had previously initiated root canal therapy. Cone beam computed tomography was used to verify both internal and external resorption patterns, whereas clinical and radiographic assessments revealed extensive apical resorption. The patient underwent re-implantation after receiving root canal therapy. Tooth #43 presented a diagnostic challenge, as it appeared non-vital based on sensibility testing. However, a positive response was observed during the test cavity preparation. At the 15-month follow-up, tooth #44 showed clinical and radiographic healing with no visible symptoms of ankylosis or resorption. The sensibility test results for tooth #43 returned to normal, validating the initial false-negative findings. Conclusion: With a careful technique, appropriate case selection, and thorough follow-up protocols, intentional reimplantation is a legitimate and reliable tooth-preserving treatment option for complex endodontic failures, especially those involving extensive root resorption. This case also emphasizes the value of a thorough diagnostic approach, particularly in cases where the results of the sensibility test conflict with the radiographic and clinical findings in neighboring teeth.