Successful Management of an Immature Necrotic Tooth via Intentional Replantation Following Regenerative Endodontic Procedure Failure: A Case Report.

AIM: To present the successful management of an immature necrotic tooth through intentional replantation (IR) following the failure of a regenerative endodontic procedure (REP), highlighting IR as a viable alternative in complex cases.

CASE PRESENTATION: A 9-year-old patient presented with necrotic tooth 45 complicated by right mandibular cellulitis. After initial infection management, REP was attempted following European Society of Endodontology (ESE) guidelines. Despite adherence to protocol, REP failed, as evidenced by persistent symptoms and a recurring fistula. IR was chosen given the unfavourable conditions for apexification and the patient's young age. During atraumatic extraction, the root fractured at a pre-existing defect, necessitating a modified reimplantation approach. The canal was treated ex vivo and sealed with calcium silicate-based cement (CSBC) before reimplantation.

RESULTS

At a 36-month follow-up, the tooth remained functional and symptom-free, with no signs of reinfection.

CONCLUSIONS

While REPs are promising for managing necrotic immature teeth, failures necessitate alternative strategies. This case highlights IR as a viable treatment, preserving function and aesthetics when regenerative efforts are unsuccessful. Careful case selection, meticulous execution, and long-term follow-up are crucial for optimizing outcomes.