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Intentional replantation(IR) is a reliable treatment option for maintaining the natural tooth in cases in which conventional endodontic treatment, non-surgical retreatment, and periradicular surgery have failed. However, clinicians may be dissuaded from trying IR because of its reported failures. Among the various causes for IR failure, root resorption and ankylosis are commonly reported. In this report, we introduce a clinical case in which a symptomatic tooth, even after a prior IR, was successfully treated with a second IR. The second IR itself was an opportunity to prove that the first IR had not caused any root resorption or ankylosis, about which most authors have raised concerns. The patient, a 54-year-old man, presented with recurrence of clinical symptoms such as discomfort and a sinus tract 16 months after the first IR. Instead of extraction of the tooth, a second attempt at IR was decided with the patient’s consent. Unlike in the first IR, orthodontic extrusion and the use of the Physics Forcepsⓡ were crucial in the second IR, for the safe extraction of the tooth. Apart from the extraction, the other procedures, including the use of mineral trioxide aggregate (MTA), were similar to those employed in the first surgery. In the first IR, poor adaptation of the MTA at the mesial root-end resulted in a recurrence of a fistula. Although the first IR failed because of MTA leakage, the well-preserved periodontal ligament, through which the delicate extraction was conducted, made the second IR possible. About 2 years after the second IR, the patient showed no clinical problems, and the radiographs revealed significant healing.
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