Intentional replantation with I-PRF for periapical healing

Abstract

Introduction: Post-treatment Apical Periodontitis (PAPT) is a frequent cause of endodontic failure, strongly associated with the persistence of intraradicular infection. In cases where conventional retreatment or periapical surgery are contraindicated due to anatomical limitations, Intentional Reimplantation (IR) emerges as a conservative therapeutic alternative. The complementary use of Injectable Platelet-Rich Fibrin (i-PRF) provides an additional benefit, by promoting tissue regeneration through the sustained release of growth factors. Objectives: This report describes the management of an upper second molar (2.7) with PAPT and critical proximity to the maxillary sinus. Methodology: A descriptive report corresponding to a clinical case report aimed at documenting the clinical management and postoperative evolution of a tooth with post-treatment apical periodontitis by intentional reimplantation supplemented with injected platelet-rich fibrin (I-PRF). Results: An IR was performed with extraoral apicoectomy, retrograde obturation with bioceramics and application of i-PRF in the alveolus. The extraoral time was 10 minutes and 20 seconds, respecting the established operating protocols. At six months, clinical and tomographic controls showed significant bone healing, recovery of the periodontal ligament space, and adequate functional integration of the specimen, without recurrence of the lesion. Conclusions: The present case highlights the viability of IR complemented with i-PRF as an effective option to preserve teeth with PAPT in complex situations, where conventional surgery is not feasible, integrating microsurgical techniques and regenerative biomaterials in current endodontic practice. General area of study: Dentistry. Specific area of study: Endodontics. Type of article: Clinical case.