[Intentional replantation for the treatment of palatal radicular groove with endo-periodontal lesion in the maxillary lateral incisor: a case report]

Abstract

Palatal radicular groove leads to severe endo-periodontal lesion in lateral incisors. The groove occurs on the labial and lingual root surfaces, while the localized periodontal pocket develops along the lingual groove length. The complicated root canal system, extensively destroyed bone lamella, and persistent fistula pose a challenge for root canal therapy, tooth retention, and thorough infection control inside and outside of the root canal. Combining microscopic root canal therapy with intentional replantation and nano-biomaterial application facilitates infection control, tooth retention, and formation of newly periodontal attachment.

Keywords: endo-periodontal lesion; intentional replantation; microscopic root canal therapy; palatal radicular groove.

图 1. 术前检查

Fig 1 Preoperative examination A：术前口内照，唇侧牙槽黏膜见窦道（箭头）；B：探针指示舌侧沟；C：舌侧沟相对应处存在局限性深牙周袋；D：根管治疗前X线片；E：CBCT水平位，凹陷与髓腔相通连（箭头）；F：CBCT冠状位示双根管影像（箭头）；G：CBCT矢状位。

图 2. 根管治疗术

Fig 2 Root canal therapy A：开髓前上橡皮障；B：插入初尖锉口内照；C：插入初尖锉X线片；D：插入主尖口内照；E：试主尖X线片；F：预备后根管口，M、D分别代表近远中根管口；G：髓室底为“C”形；H：根充完成口内照；I：根充后X线片；J：复合树脂充填。

图 3. 意向性牙再植术

Fig 3 Intentional replantation A：腭侧观；B：唇面观；C：亚甲蓝染色后；D：涡轮机金刚砂车针及超声清理根面腐质后；E：截根后超声工作尖逆向预备根管3 mm；F：iRoot BP根尖倒充填；G：iRoot BP封闭唇面沟；H：iRoot BP封闭舌侧沟；I：植回牙槽窝夹板固定后咬合检查；J：术后即刻X线片。

图 4. 术后随访

Fig 4 Postoperative follow-up A：术后4月唇侧窦道愈合；B：术后4月腭侧沟探诊深度减少至约3 mm；C：术后4月X线片示根尖区透射影缩小，根尖新骨形成；D：术后6月X线片示根尖区新骨进一步形成，密度与周围骨组织接近，根尖周可见牙周膜逐渐恢复。