[Replanting a dead tooth after the healing of the socket. Reference to two cases of autograft dental implants].
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Humans↗
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The avulsed tooth--the best implant.
Successful management of the avulsed tooth begins at the accident site. Correct first-aid care followed by proper management in the dental surgery will significantly improve the prognosis for the avulsed tooth. The major aim following avulsion is the prevention of further damage to the periodontal ligament and, if possible, the maintenance of pulp vascularity. Studies have indicated that variables such as the extra-oral period, the storage medium and the stage of root development of the avulsed tooth significantly influence the final outcome. Endodontic therapy and chemical conditioning of the root surface after an extended extra-oral period has the potential to delay the resorptive processes of a replanted tooth.
Dental Pulp↗
[Replantation and transplantation of teeth and tooth germs].
Replantation as well as the transplantation of autologous and homologous teeth or tooth buds were carries out ot utilize teeth which had been knocked out of their alveolus due to trauma and/or, if indicated, to close diastemas and aesthetically and functionally satisfactory teeth. These procedures are briefly described here and illustrated with a few cases.
Adolescent↗
Treatment of traumatic dental injuries in children.
The major emphasis of this review rests on articles written within the past 12 months. Many of these papers comprise comprehensive surveys of treatment of various aspects of dental trauma in the primary and permanent dentition, as well as epidemiologic studies. There have also been some very good experimental studies that have attempted to standardize luxation injuries as well as tooth replantation in order to study pulpal and periodontal healing in reproducible animal models. However, it can been seen from the reference list that 1 year's production in dental traumatology would not suffice to cover the scope of the treatment needs nor to adequately orient the reader to the progress made with respect to our present knowledge of wound healing following injury and the most recent developments in the restoration of the traumatized dentition. To present an overall view of the philosophy that has evolved concerning wound healing in the dental pulp and periodontium following injury as well as innovations in the treatment of acute dental trauma, this review must of necessity delve back into the mid-1980s and probe forward into publications that are on the way in 1991.
Child↗
Case 3: Replantation of vertically fractured tooth.
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Aged↗
Orthodontic and prosthodontic treatment in dental avulsion cases.
A clinical case of traumatic dental avulsion with endodontics, replantation and bracket fixation is presented. Subsequent follow-up led to extraction of the replanted teeth. The edentulous space was restored with a Maryland bridge. The factors which contribute to a successful tooth replantation as well as choosing the right time to begin orthodontic treatment in the case of tooth avulsion and replantation are described.
Child↗
The biomechanical properties of the healing periodontium of replanted rat mandibular incisors.
One of the most important aspects in tooth replantation seems to be restoration of the tooth support function of the healing periodontal ligament (PDL). We examined the support function, as measured by the mechanical properties, of the healing PDL at 7, 14, and 21 days after replantation of the left mandibular incisor in rats. From each dissected left mandible, a transverse section(650 microm in thickness) of the incisor was cut through an axis near the labial alveolar crest. Each section was intrusively loaded at a rate of 5 mm min(-1), and the shear stress-strain curve for the PDL was analyzed. Mechanical measures of the healing PDL showed gradual improvement after replantation. By 21 days, the mechanical strength returned to 53% of the control value; the extensibility, to 85%; the stiffness, to 61%; and the toughness, to 52%. The healing PDL exhibited reattachment of fibers in the middle region of the PDL, and the birefringent collagen fibers appeared to have regained the functional orientation by 14 days. The ratios occupied by the birefringent collagen fibers in the tooth-related, middle, and bone-related areas of the healing PDL gradually improved and returned to 78, 51, and 48% of the respective control values by 21 days. These results suggest that the support function of the healing PDL is gradually restored and that the biomechanical restoration is closely related to the reorganization and reorientation of collagen fiber bundles in replanted rat incisors.
Analysis of Variance↗
Replantation of 400 avulsed permanent incisors. 4. Factors related to periodontal ligament healing.
400 avulsed and replanted permanent teeth were examined for periodontal ligament (PDL) healing, using standardized radiographic and clinical examination procedures (i.e. percussion test and mobility test). The effect of various clinical factors was examined, such as age and sex of the patient, type of tooth replanted, presence of crown fracture or bone fracture, stage of root development (including apical diameter and length of the pulp), type and length of extra-alveolar storage, clinical contamination of the root surface, type of root surface cleansing procedure, type and length of splinting period and antibiotic therapy. Surface resorption was generally diagnosed after 12 months; while inflammatory resorption and replacement resorption (ankylosis) were usually observed after 1 month and 1-2 months respectively. Most resorptive processes were diagnosed within the first 2-3 years. However, although rarely, even after 5 and 10 years new resorptive processes could be diagnosed. A univariate statistical analysis of 272 teeth revealed 9 factors significantly related to PDL healing. A subsequent multivariate analysis revealed that the following 4 factors had the strongest impact upon PDL healing, in descending order of significance: Stage of root development; length of the dry extra-alveolar storage period; immediate replantation and length of the wet period (saliva or saline storage). Nonphysiological storage, such as homemade saline and sterilizing solutions (chloramine and alcohol) always led to root resorption. Storage in tap water for more than 20 minutes usually led to root resorption. The common denominator for all these factors related to PDL healing appears to be survival of the PDL cells along the root surface. Based on these findings, immediate replantation is recommended irrespective of stage of root development.
Analysis of Variance↗
[Apicectomy and replantation. Report of a clinical case].
The AA. report a case treated with cyst-enucleation, apicaectomy and tooth replantation and then prosthetic management, which they control for the last twenty years, and beyond initial expectations, they could establish an astonishing result indeed.
Adult↗
[Replantation of avulsed immature permanent teeth. Results in 39 cases after an average of 2.5 years].
The aim of this investigation was a critical assessment of the short- and medium-term results of replantation of immature, avulsed permanent teeth. Thirty-nine teeth were investigated after 2.5 years on average. Only 7 teeth (18%) had been replanted within 5 min after avulsion. Sixteen teeth (41%) showed revascularisation or ingrowth of alveolar bone into the pulp. Twenty-two teeth (56%) showed signs of ankylosis, 6 (15%) had been exfoliated or extracted. Seventeen teeth (77% of the ankylotic ones) exhibited an alveolar growth arrest of 1.5 mm per 10 cm body growth. By planimetric assessment, the yearly loss of root dentin by replacement resorption was about 15%. The appearance was compromised in 11 cases (33%) by severe discoloration. In spite of intense therapeutic effort and partial success, the results must be classified as unsatisfactory. In avulsions of immature permanent teeth, replantation therefore has to be considered an intermediate solution. Since the main reason for a failure is extended extra-oral unphysiologic storage, replantation by lay helpers immediately after the accident should be propagated as a first-aid treatment to improve the situation of the replanted tooth. In addition, more attention should be paid to preserving teeth in tissue cultures before replantation.
Child↗
Replantation of 400 avulsed permanent incisors. 2. Factors related to pulpal healing.
Four hundred avulsed and replanted permanent teeth were examined for pulpal healing. In 110 teeth, the apical foramen was either open or half-open. In 16 teeth, the pulps were extirpated prophylactically. Thus, pulpal revascularization was considered possible in 94 teeth. Revascularization occurred in 32 teeth (34%). Pulp necrosis could usually be demonstrated after 3 weeks. Positive pulpal sensibility and radiographis signs of pulp canal obliteration were usually observed after 6 months. The effect of various clinical factors was examined, such as sex, age, type of tooth replanted, stage of root formation, type and length of extra-alveolar storage, clinical contamination of the root surface, type of cleansing procedure of the root surface, type and length of splinting and the use of antibiotics. Finally, the width of the apical foramen and the length of the root canal were measured on radiographs taken at the time of injury. A multivariate statistical analysis revealed that pulpal revascularization was more frequent in teeth with shorter distances from the apical foramen to the pulp horns. Furthermore, that wet storage (saliva and/or saline) for more than 5 min decreased the chance of pulpal revascularization; whereas dry extraalveolar storage had a monotonous effect on pulpal revascularization, i.e. decreasing chance of revasculatization with increasing length of the extraalveolar dry storage. Based on these findings, immediate replantation after brief cleansing in either tap water or saline is recommended.
Age Factors↗
Application of bioactive ceramics for functional surgery in masticatory organs.
Transplanted and replanted autogenous teeth or implanted artificial roots become easily ankylotic. However, if adequate functional loads are applied to them continuously postop with proper fixation, ankylosis can be prevented. The author found this fact through studies on autogenous tooth replantation 20 years ago. Therefore, not only can tooth transplantation, replantation, and artificial root implantation be done successfully with adequate functional loads, but surgical orthodontics as well as plastic operation of jaw deformity can also benefit in the same way. This therapeutic method is called functional surgery. The ankylotic process can be more effectively prevented by applying bioceramic granules. Using these methods, (a) 30 vital teeth in 23 patients were transplanted or replanted. Follow-up duration was 6 to 96 months. (b) Artificial roots made of compact sintered hydroxyapatite (apatite) were implanted under the new concept of functional surgery. In all, 57 artificial roots in 19 patients were implanted and observed for over 5 years. (c) Masticatory skeletal deformities of the viscerocranium were treated with the new concept of functional surgery applying sintered apatite. For this purpose, artificial bone implantation or simple gnathoplasty, tooth transplantation, and artificial root implantation was carried out in 15 patients, after which mastication training was applied with concomitant corrections of function inclination, i.e., oral-perioral habits. In these clinical experiments, excellent favorable results were obtained. The following conclusion was obtained: Introducing the new concept of functional surgery using bioceramics, not only tooth transplantation, as well as artificial root therapeutics, but deformity of the jaw can be steadily treated.
Adult↗
A study of replanted permanent teeth in different age groups.
The purpose of this study was to evaluate the benefits of replanting avulsed permanent teeth in different age groups. Of the 112 replanted teeth, 103 could be examined after 2.5 years on average. The teeth were divided into three groups: immature teeth (group A), mature teeth in children and adolescents (group B), and mature teeth in adults (group C). Concomitant injuries did not differ statistically between the groups. Extra-alveolar time with unphysiologic storage was longer than 15 min in 81 teeth. The results were statistically different for pulpal healing (A >> B > C), loss of marginal bone (C > A), amount of replacement resorption (A and B > C), alveolar growth inhibition (A > B >> C), local gingivitis (B > A and C) and buccal gingival retraction (C > A and B). Only 3 of 23 extracted teeth were lost because of replacement resorption alone. Only 2 of the 23 extracted teeth showed revascularization of the pulp. The results suggested that replanting avulsed teeth should be considered a temporary solution in children and adolescents. In these patients, the benefit of tooth replantation is mainly the time gained to establish an optimal treatment plan. Mature teeth with a necrotic periodontal ligament replanted in children before the pubertal growth spurt seemed to have the poorest prognosis.
Adolescent↗
Re-innervation in the canine periodontal ligament of replanted teeth using an antibody to protein gene product 9.5: an immunohistochemical study.
The re-innervation process in the periodontal ligament of replanted canine teeth was examined by immunohistochemistry for protein gene product 9.5 (PGP 9.5), a general marker for neurons, and by electron microscopy. Within 1 week of replantation, the periodontal fibers had regenerated, filling the narrow spaces between the alveolar bone and the root surface around the cervical and apical regions. Near the root apex, however, no PGP 9.5-immunopositive nerve fibers were found in the regenerated periodontal ligament except for those in the alveolar half of the ligament. At 2 weeks after replantation, many nerve fibers positive for PGP 9.5 had ascended the periodontal ligament from the thick nerve bundles located near the root apex. Fine nerve endings showing complicated ramification were also present in the apical region. By 3 or 4 weeks after replantation, the vascular network was regenerated and principal periodontal fibers were re-established throughout the entire length of the periodontal ligament. The extensively ramified PGP 9.5-immunopositive structures had increased in thickness and density and showed characteristic tree-like profiles by 3 weeks. Electron microscopy confirmed that most of these structures were Ruffini-like endings, and demonstrated that such nerve terminals were almost regenerated by 4 weeks post-replantation. These results indicated that, in the periodontal ligament of replanted canine teeth, the regeneration of the nerve fibers including mechanosensory receptors first showed signs of regeneration by 2 weeks following tooth replantation and proceeded rapidly thereafter. Regeneration of the periodontal ligament including fiber architecture as well as vascular and neural elements was almost complete by 4 weeks after replantation.
Animals↗
[Studies on the vitality of periodontal cells correlated with the duration and medium of extracorporeal storage].
Some decisive factors for the success of tooth replantation such as perfusion conditions or duration of storage were the subject of this biological/functional study. Evidence for a remaining vitality of the periodontal cells was derived from the pattern of cellular oxygen uptake. The use of pure water, dry storage, or even isotonic saline failed to prevent a decrease in aerobic metabolism within one hour. Storage of the teeth in the patient's blood or serum optimally fulfills the requirements for survival of the periodontium over up to 10 hours. Recommendations for the handling of isolated teeth before replantation are given.
Blood↗
The complete endodontic obturation of an avulsed immature permanent incisor with mineral trioxide aggregate: a case report.
The use of mineral trioxide aggregate (MTA) for complete endodontic obturation of an immature maxillary central incisor is reported. The injured tooth of a 9-year-old male was avulsed secondary to a sports-related traumatic event. Early attempts at pulpal revascularization of the replanted tooth proved unsuccessful, as evidenced by radiographic signs of external inflammatory root resorption in the middle to cervical thirds of the root. Calcium hydroxide apexification over a 1-year period promoted cessation of the resorptive process, but was unable to adequately form an apical root canal barrier. Due to the extent of external resorption and the lack of an apical stop, a novel endodontic treatment using mineral trioxide aggregate was utilized. At 865 days post-injury, the tooth remained asymptomatic with clinical and radiographic evidence of periodontal health.
Aluminum Compounds↗
The effects of different splinting times on replantation of teeth in monkeys.
The purpose of the study was to examine histologically the tissue changes affecting the teeth and surrounding structures after using both 7- and 30-day fixation periods on replanted teeth in monkeys. Eight adult male rhesus monkeys were used. The maxillary central and lateral incisors were extracted, treated endodontically, reimplanted, and temporarily immobilized with an interproximal acid-etch splint. The splints were removed at 1 week in half of the teeth and at 30 days in the other half. The monkeys were killed at 7 and 14 days, and at 1, 2, 3, 4, 5, and 6 months postoperatively. The results showed that replanted teeth that were splinted for 7 days recovered uneventfully, whereas the teeth that were splinted for 30 days demonstrated increased areas of root resorption and ankylosis. Thus, it is suggested that after tooth replantation the periodontium will repair rapidly with a shorter time of splinting (7 days). Extended splinting periods (30 days) seem to induce further root resorption and dentoalveolar ankylosis.
Animals↗
Effects of temperature, storage time and media on periodontal and pulpal healing after replantation of incisors in monkeys.
The effect of temperature of various storage media and at varying storage periods upon periodontal ligament (PDL) and pulpal healing after tooth replantation was examined in green vervet monkeys (Cercopithecus aethiops). Mandibular lateral incisors with mature root formation were extracted and kept in dry storage at 22, 4 and -18 degrees C; in saline at 37, 22, 4 and -18 degrees C; or in saliva (i.e. in the buccal vestibule) at 37 degrees C for either 60 or 120 min prior to replantation. The animals were sacrificed 8 weeks after replantation and the replanted teeth examined histometrically. The following histological parameters were registered for each tooth: normal PDL, surface resorption, inflammatory resorption, replacement resorption (ankylosis), downgrowth of pocket epithelium, periapical inflammatory changes, and the extent of vital pulp. A total of 125 replanted teeth were examined. Storage in saliva at 37 degrees C showed a similar amount of normal PDL compared to saline storage for both 60 and 120 min. Saline storage for 60 or 120 min showed no difference in the extent of normal PDL when storage was compared at 37, 22 and 4 degrees C. However, storage at -18 degrees C resulted in significantly less normal PDL than storage at other temperatures. Dry storage for 60 min showed significantly less root resorption at 4 degrees C compared to 22 degrees C. Furthermore, dry storage at -18 degrees C showed significantly less normal PDL than storage at 4 degrees C. When the dry storage period was extended to 120 min, no difference was found between 22, 4 and -18 degrees C. It is concluded that the temperature (above 0 degrees C) of the storage medium is of importance only for dry storage and in such a situation only for shorter extra-alveolar periods, i.e. for 60-min storage and not for 120 min, where extensive destruction of the PDL always takes place. It is suggested that the temperature effect of 4 degrees C could be related to less evaporation from the PDL and thereby less damage to the PDL cells or a strict temperature effect upon cell metabolism. Pulp healing in all the cases was limited to the entrance of the pulp canal, and no significant pattern was found between storage media, time and temperature.
Animals↗