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Case Reports
. 2018 Winter;13(1):135-138.
doi: 10.22037/iej.v13i1.19369.

Rapid Bone Healing after Intentional Replantation of a Molar with Apical Actinomycosis

Saeed Asgary  1 , Leyla Roghanizadeh  1
Affiliations
Case Reports

Rapid Bone Healing after Intentional Replantation of a Molar with Apical Actinomycosis

Saeed Asgary et al. Iran Endod J. 2018 Winter.

Abstract

Actinomycosis is a rare lesion of the jaws and may present as periapical pathosis; therefore, it is essential to be correctly diagnosed and managed. This case presentation describes management of a tooth with a symptomatic apical periodontitis caused by Actinomyces species supplemented with medicine prescription. A woman was referred for endodontic management of tooth #19. The tooth had a history of previous nonsurgical endodontic retreatment. Clinically, the tooth was very sensitive to percussion. Radiographic evaluation showed a large periapical lesion. Intentional replantation (IR) was planned. The tooth was atraumatically extracted. Without any curettage, through the blood flow coming out of the socket, a small yellowish granule was detected and sent for examination. After root-end preparations, the cavities were filled with calcium-enriched mixture cement and the tooth was carefully replanted. Histopathological assessment proved actinomycosis sulfur granule. According to infectious disease specialist recommendation, low-dose and long-term penicillin V was prescribed. Interestingly, at 2-month follow-up, remarkable bone healing was observed. In the cases of apical actinomycosis, IR in combination with antibiotic therapy, even without the curettage of the lesion, may be successfully employed.

Keywords: Actinomycosis; CEM Cement; Calcium-enriched Mixture; Endodontic; Periapical Periodontitis; Tooth Replantation.

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Conflict of interest statement

‘None declared’.

Figures

Figure 1
Figure 1
A) Diagnostic preoperative radiography of the mandibular left first molar exhibits a large radiolucency around the mesial root and a small one around the distal root; B) Immediate postoperative radiograph after retrograde treatment and intentional replantation; C) 2-month follow-up radiograph showing remarkable bone healing in the periapical region
Figure 2
Figure 2
Bacterial aggregates manifest as structure containing gram-positive branching filamentous
See this image and copyright information in PMC

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