Intentional replantation of the maxillary molar via partial osteotomy

In clinical practice, some patients complain of persistent discomfort or pain during or after root canal treatment. In cases wherein non-surgical retreatment is infeasible, the last available option that can be considered to save the tooth would be periradicular surgery or intentional replantation (IR). Since maxillary molars are anatomically close to the maxillary sinus, the apical surgery may perforate the floor of the maxillary sinus. On the other hand, with IR, tooth fracture may occur while extracting the tooth if the root is curved or if the buccal cortical bone is particularly thick. To help minimize such risk, we chose IR with partial osteotomy performed on the buccal side of the left maxillary first molar and extraction of both the alveolar bone and the tooth. Osteotomy enabled the tooth extraction without causing damages such as fracture to the roots and offered partial protection of the periodontal ligament. Here, we present a case wherein the root apex of a maxillary molar was physically close to the bottom of the maxillary sinus and the buccal cortical bone was thick. IR with partial osteotomy was successful in alleviating symptoms of persistent discomfort and pain.