1. Check for root fracture first
A vertical root fracture can make repeated infection likely. If the root is intact and sufficient tooth structure remains, other options may still be reviewed.
2. Assess root canal retreatment
Missed canals, old filling materials, and persistent infection can be removed and disinfected under magnification.
3. Consider an apical approach
When access through the crown is limited, apicoectomy can remove infected tissue at the root tip and seal the end.
4. Use intentional replantation selectively
In carefully selected cases, the tooth may be removed with minimal trauma, treated outside the mouth, and replanted.
The goal is a reasonable long-term choice
Preservation is a priority, but it should be compared with expected function, retreatment burden, and alternatives.