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Intentional Reimplantation for a Large Periapical Cyst Using Dual Forms of Platelet-rich Fibrin, Chitosan, and
Naina Kumar1, Y Rajmohan Shetty1, R Manju1
1Department of Pediatric and Preventive Dentistry, AB Shetty Memorial Institute of Dental Sciences, NITTE (Deemed to be University), Mangaluru, Karnataka, India.
Aim And Background:
This case report evaluates the effectiveness of intentional reimplantation (IR) in managing large periapical cysts, highlighting the role of regenerative biomaterials, such as leukocyte- and platelet-rich fibrin (L-PRF), injectable platelet-rich fibrin (i-PRF), chitosan, and Biodentine™.
Case Description:
A 14-year-old female presented with swelling in the right mandibular first molar (tooth #46) that had been previously endodontically treated. Radiographic evaluation revealed a large periapical cystic lesion measuring 3 × 2 mm. Triple antibiotic paste was administered during multiple treatment visits; however, no improvement was observed. Intentional reimplantation was selected as an alternative to conventional surgical approaches. Treatment included repeat root canal therapy, atraumatic extraction, thorough enucleation of the cyst, and immediate reimplantation. Regenerative biomaterials, including L-PRF and i-PRF, were utilized to promote healing, whereas chitosan and Biodentine™ enhanced sealing and regeneration. The 12-month follow-up radiographic and clinical assessments confirmed complete cyst resolution, with no symptom recurrence and full restoration of tooth functionality.
Conclusion:
Intentional reimplantation combined with advanced regenerative biomaterials successfully treated a large periapical cyst in an endodontically treated tooth. This minimally invasive approach offers a promising alternative for cases that are unresponsive to conventional endodontic or surgical treatments.
Clinical Significance:
This report underscores the clinical relevance of combining regenerative techniques with intentional reimplantation to provide effective management for persistent periapical pathology.
How To Cite This Article:
Kumar N, Shetty YR, Manju R. Intentional Reimplantation for a Large Periapical Cyst Using Dual Forms of Platelet-rich Fibrin, Chitosan, and Biodentine™: A Case Report. Int J Clin Pediatr Dent 2026;19(4):537-541.