Surgical management of lateral lesions with intentional replantation in single-rooted mandibular first premolars with radicular groove

Abstract

Background

The authors’ aim was to describe 2 endodontically treated mandibular first premolars with apical and mesiolingual radiolucencies on radiographs with different approaches that were resolved with intentional replantation.

Case Description

In case 1, a 58-year-old man reported biting sensitivity on endodontically treated mandibular first premolar with good quality restorations. A periapical radiograph (PAX) and cone-beam computed tomography (CBCT) image revealed 2 low-density areas located at the apical and mesiolingual aspects of the root. A radicular groove accessory canal was noted on the mesial root surface during intentional replantation. The patient has been asymptomatic. At a 3-year follow-up, complete healing was observed on PAX and CBCT images. In case 2, a 40-year-old woman reported pinching pain of her mandibular right quadrant that returned a few months after initial root canal treatment. Radiographs revealed periapical radiolucency at the apexes of the mandibular first premolar with a missed lingual canal. Nonsurgical retreatment was performed in 2 visits with calcium hydroxide dressing. Two months later, endodontic microsurgery was performed owing to ongoing symptoms. In addition, CBCT images showed extensive bone loss on the mesiolingual aspect of the root. Intentional replantation was performed 2 weeks later because she had intolerable pain. A radicular groove accessory canal was observed on the mesial root surface during the procedure. The patient reported substantial relief of pain. The radiolucencies healed by the 25-month follow-up as observed on PAX and CBCT images.

Practical Implications

Intentional replantation is recommended in mandibular first premolars with a mesiolingual lesion that cannot be accessed easily with endodontic microsurgery and after conservative retreatment has been performed.