Successful Intentional Replantation of a Severely Compromised Tooth Using 3 Types of Phototherapy: A Case Report

Intentional replantation (IR) is an emerging and cost-effective last-resort treatment for persistent apical periodontitis. Adjunctive phototherapy for IR aims to improve the management of challenging cases by enhancing disinfection, stimulating healing and promoting regeneration. We report a novel phototherapy-assisted IR protocol conducted on a compromised lateral incisor with an extensive periapical infection (Ø > 10 mm) in a 68-year-old diabetic male. The IR protocol involved pre- and postoperative photobiomodulation (660 nm, 0.2 J/cm², 60 sec/site), antimicrobial photodynamic therapy of the root surface (660 nm, 0.6 J/cm², 30 sec, methylene blue photosensitizer), and Er:YAG root and socket debridement (2940 nm, 21 J/cm², 30 sec). The total time from extraction to replantation was 14 min 35 sec. The tooth at 3.5-year follow-up remained clinically functional with radiographic resolution of the infection indicating a successful reimplantation. This case report demonstrated that an adjunctive phototherapy IR protocol can effectively treat a compromised tooth with extensive periapical infection.