Use of hydroxyapatite in tooth replantation radiographically followed up for 14 years: a case report

Abstract –  A lateral incisor was replanted 4 h after trauma. The tooth subsequently developed external root resorption treated with calcium hydroxide initially and with a hydroxyapatite root filling subsequently. Radiographs of the replanted tooth were obtained to follow up the patient for 14 years.     

Delayed tooth replantation in rats: effect of systemic antibiotic therapy with amoxicillin and tetracycline

Systemic antibiotic therapy (SAT) has usually been recommended after tooth replantation, but its actual value has been questioned. As there are no reports in the literature about its influence on tooth replantation, the aim of this study was to evaluate the influence of systemic administration of antibiotics (amoxicillin and tetracycline) at the different phases of the repair process (7, 15, 30 days) in delayed rat tooth replantation. Ninety Wistar rats (Rattus norvegicus albinus) had their maxillary right incisors extracted and bench‐dried for 60 min. The dental papilla, enamel organ, pulp tissue, and root surface‐adhered periodontal ligament were removed, and the teeth were replanted. The animals received no antibiotics (n = 30) or were medicated systemically with amoxicillin (n = 30) and tetracycline (n = 30), and were euthanized after 7, 15, and 30 days. Regardless of the evaluation period, the acute inflammatory infiltrate was less intense and root resorption presented smaller extent and depth in the group treated with amoxicillin. The results suggest that SAT has a positive influence on the repair process in delayed tooth replantation and that amoxicillin is an excellent treatment option.     

Tooth avulsion and replantation — A review

Abstract The major causes of post-replantation tooth loss are inflammatory root resorption and root resorption associated with ankylosis. Recent studies have concentrated on delineating the cellular interactions in the pulp and periodontium in order to more fully understand the various factors affecting the prognoses of such teeth. The aim of this report is to discuss the nature of the pathology responsible for tooth loss following avulsion and to review recent replantation and attachment studies.     

Emdogain® does not prevent progressive root resorption after replantation of avulsed teeth: a clinical study

Abstract –  Emdogain^® has been shown in clinical and experimental studies to promote regeneration of all periodontal tissues: cementum with anchoring fibres, a functional, periodontal ligament and alveolar bone in connection with treatment of marginal periodontitis.
The intention of this study was to analyse whether this regenerative capacity upon the periodontal ligament also worked in a trauma situation where a significant number of PDL cells have been eliminated because of unphysiologic storage or actual damage during avulsion or replantation. Furthermore if ankylosis sites already established because of earlier replantation after avulsion could be surgical removed and application of Emdogain^® could revert the ankylosis stage to a normal PDL situation. The first treatment situation was tested in seven patients with a total of 16 avulsed teeth with varying time of extra oral storage. The teeth were extra-orally endodontically treated and the root and socket covered with Emdogain^® before replantation. All teeth demonstrated subsequent ankylosis, primarily diagnosed by a percussion test. The second treatment situation where an ankylosis was already established constituted of seven patients with a total of 11 teeth because of previous replantation after avulsion. These teeth were all extracted, the ankylosis sites removed and the root and socket treated with Emdogain^®. After 6 months all teeth showed recurrence of ankylosis. It is concluded that Emdogain^® was not able to prevent or cure ankylosis.     

Relationship between clinical–radiographic evaluation and outcome of teeth replantation

Abstract –  The aim of this retrospective study was to evaluate clinical and radiographic results related to avulsed and replanted teeth in patients who sought treatment at the Dental Trauma Center of the Dental School of Piracicaba, State University of Campinas, Piracicaba, SP, Brazil. One hundred replanted teeth were studied from 48 individuals (18 females and 30 males, with a mean age of 15 years and 9 months). Post-replantation factors (clinical and radiographic) were observed. The clinical aspects evaluated were crown discoloration, pulp necrosis, mobility changes, presence of fistulae and tooth infra-position. Radiographic examination aimed to identify replacement and inflammatory root resorptions, pulp canal obliteration and the presence of radiolucent areas. Depending on clinical and radiographic findings, results were classified as: complete success, acceptable success, uncertain success or failure. During anamnesis, other factors such as stage of root formation, period extra-alveolar, storage medium, type of splintation, and period after replantation time were recorded. The data obtained were statistically analyzed in order to determine the relationship between the post-replantation factors and outcome of teeth replantation. Linear logistic regression revealed that the majority of replanted teeth were associated with root resorptions and its occurrence duplicated proportionally as the time after replantation increased. Based on these findings, replantation procedures must be submitted to an accurate follow-up, as the success of replanted teeth, which already tends to be limited, may be even more jeopardized if cases are not controlled.     

Avulsion and replantation of a primary incisor tooth

Avulsion of a primary tooth is a serious dental trauma, and the guidelines of the International Association of Dental Traumatology and textbooks in paediatric dentistry do not recommend replantation. Such management can result in severe damage to the supporting structures, and together with avulsion itself is commonly associated with developmental disturbances of the permanent tooth. We report the case of replantation in a 9‐month‐old child with a successful outcome, in a unique situation where conditions were optimal and careful long‐term follow up was possible.     

自体富血小板纤维蛋白用于延迟牙再植1例

富血小板纤维蛋白(PRF)是一种立体三维网状结构的第二代血小板浓缩物,它能够调节炎症,促进组织愈合。并且能够缓慢持续释放多种生长因子。大量文献报道PRF可以促进口腔软硬组织的愈合,但尚未将其应用于临床牙再植的治疗中。本文联合自体PRF颗粒对1例撕脱2 h且干燥保存的离体牙进行延迟再植、复位固定及后续牙髓治疗。随访1年,脱位牙恢复良好,达到牙周膜性愈合,没有出现牙根吸收,且牙槽骨高度得到恢复。     

Age and Timing of Pulp Extirpation as Major Factors Associated with Inflammatory Root Resorption in Replanted Permanent Teeth

Introduction

External root resorption (ERR) is a serious complication after replantation, and its progressive inflammatory and replacement forms are significant causes of tooth loss. This retrospective study aimed to evaluate the factors related to the occurrence of inflammatory ERR (IERR) and replacement ERR (RERR) shortly after permanent tooth replantation in patients treated at the Dental Trauma Clinic at the School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil.

Methods

Case records and radiographs of 165 patients were evaluated for the presence, type, and extension of ERR and its association with age and factors related to the management and acute treatment of the avulsed tooth by using the logistic regression model.

Results

The patient's age at the moment of trauma had a marked effect on the ERR prevalence and extension. The patients older than 16 years at the moment of trauma had less chance of developing IERR and RERR (77% and 87%, respectively) before the pulp extirpation, regardless of the extension of the resorption. The patients older than 11 years of age at the moment of trauma showed the lowest indices of IERR (P = .02). Each day that elapsed between the replantation and the pulp extirpation increased the risk of developing IERR and RERR by 1.2% and 1.1%, respectively, and also raised the risk of severe IERR by 0.5% per day.

Conclusions

The risk of mature teeth developing severe IERR before the onset of endodontic therapy was directly affected by the timing of the pulpectomy and was inversely proportional to age. Systemic antibiotic therapy use had no effect on the occurrence and severity of IERR in mature teeth. The occurrence of RERR before the onset of endodontic treatment stimulates further investigations of the early human host response to trauma and subsequent infection.     

Apexification of a replanted tooth using mineral trioxide aggregate

Abstract –  The most important factors determining periodontal healing after replantation of an avulsed tooth are the extra oral period and the media in which the tooth is preserved before replantation. This case report describes an adequate periodontal healing of an avulsed immature tooth replanted after 20 min of extra alveolar dry time. Vitality was not regained and after disinfection of the pulp space mineral trioxide aggregate was used as the root filling. Follow-up confirmed complete healing periradicularly.     

Investigation of the children referred to a dental hospital with avulsed permanent incisor teeth

Abstract The management of children referred to a dental hospital because of avulsed permanent incisor teeth was considered in a retrospective study. The group consisted of 49 children between the ages of 6 and 14 years. Most of the children (60%) had their avulsed teeth stored dry while only 7% had them stored in milk, and 19% in saliva. Following avulsion the majority of the children attended a dental surgeon or general hospital. Twenty-three children contacted health care personnel within 30 minutes but only 13 had their teeth replanted in this time period. Thirty-six children had 46 incisors replanted. No relationship was demonstrated between the place or personnel who replanted the teeth, and a successful outcome.     

Effect of bisphosphonates and gallium on dentin resorption in vitro

Abstract Replacement resorption may follow the replantation of an avulsed tooth. Currently there is no effective treatment for replacement resorption. The purpose of this study was to investigate the effect of bisphosphonates and gallium nitrate, which have been shown to reduce bone resorption, on cells which resorb dentin. Osteoclast-like cells were obtained by culturing cells from prenatal chick tibeas. These cells were seeded onto slices of human dentin which had been soaked in either saline (control), or solutions of 10^–5 M 1-hydroxyethylidene-1, 1-bisphosphonic acid (EHBP), 10^–6 M dichloromethylene bisphosphonic acid (Cl₂MBP), or 10^–6 M gallium nitrate. Resorption was measured by counting the number of resorptive lacunae produced by the cells. Results indicated that the experimental groups did not differ significantly from each other, but each exhibited significantly reduced resorption compared with saline controls (p<0.01). These results suggested that the experimental treatment reduced dentinal resorption by the osteoclast-like cells, and that these agents might be useful to prevent or at least postpone replacement resorption in avulsed teeth.     

Survival of avulsed permanent maxillary incisors in children following delayed replantation

Abstract The purpose of this study was to identify the variables that significantly influenced the survival of incisors replanted after extended extraalveolar duration at The Hospital for Sick Children, Toronto, Canada, between June 1988 and December 1993. Survival analysis was used to identify variables that significantly influence the retention of replanted incisor teeth. Survival was defined as the time that elapsed between the replantation of an avulsed incisor and the time it was finally lost. Information on 9 variables was collected for 3H patients (25 males; 13 females) and 52 replanted permanent maxillary incisors. The mean extraalveolar duration for the sample was 123 min. The mean follow-up interval was 942 days (range: 364–2126 days). Incisors replanted with open apices had a significantly decreased survival compared with teeth with mature apices (P=0.04; relative risk 4.2). There was also a significant association between increased survival and obturation of the root canal with gutta-percha and sealer P=0.006 relative risk 10.0). A trend towards improved survival of replanted incisors was found for children older than I 1 years old at the time of replantation (P= 0.09; relative risk 2.8). These results are consistent with previous studies and may assist clinicians and parents in the decision-making process associated with the management of avulsed teeth in children.     

人牙周膜成纤维细胞来源外泌体对大鼠延期牙再植术后牙根吸收的调控作用

目的: 探讨健康的人牙周膜成纤维细胞（hPDLFs）来源外泌体对大鼠延期牙再植术后牙根吸收的作用及其可能机制。方法: 分离提取hPDLFs来源的外泌体并鉴定。选择30只6周龄雄性SD大鼠,随机分为对照组和外泌体组,建立上颌第一磨牙延期牙再植术模型,牙脱位30 min后植回牙槽窝。对照组牙周膜局部注射40 μL汉克斯平衡盐溶液（HBSS）,实验组牙周膜局部注射40 μL含外泌体的HBSS。术后1、2、4周收样,苏木精-伊红（H-E）染色观察牙根表面吸收陷窝,抗酒石酸酸性磷酸酶（TRAP）染色观察破骨细胞数量,免疫组织化学染色观察牙周膜内骨保护素（OPG）的表达。采用SPSS 17.0软件包对数据进行统计学处理。结果: 鉴定表明提取的细胞外囊泡为外泌体。与对照组相比,hPDLFs来源的外泌体减少了延期牙再植术后牙根吸收陷窝的数量,降低TRAP阳性破骨细胞的表达（P<0.05）,促进牙周膜内OPG的表达（P<0.05）。结论: 延期牙再植术后,hPDLFs来源的外泌体减少了破骨细胞的数量,促进牙周膜内OPG表达,减少了再植术后的牙根吸收。     

Histometric study of root resorption on human premolars following experimental replantation

Abstract – A histometric method was applied for evaluation of root resorption in 57 experimentally replanted teeth and 22 controls. Representative axiobuccolingual sections were selected for measurement of resorptions at a magnification of × 40. The frequency of root resorption in the control teeth was low. In replanted teeth marked resorptive activity elicited by the trauma appeared after 2 wk. The extent of active resorptions increased until the third postoperative week. On an average 14% of the root periphery was affected at this stage. After the sixth postoperative week progressive cement deposition took place in the resorption lacunae. Incidental ankylosis of the periodontal membrane also occurred from this observation time but there was no increase among the long-term groups.     

全脱位牙延期再植根面牙周膜不同去除方法的比较

目的:研究全脱位牙延期再植前去除其根面坏死牙周膜的有效方法.方法:取35颗因正畸需要拔除的健康右下颌第一前磨牙,室温下干燥保存超过1h,随机平均分为5组.①阴性对照组;②机械去除组:用手术刀片刮除根面坏死牙周膜;③化学去除组1以1％NaClO溶液浸泡实验牙5 min;④化学去除组2以2％NaClO溶液浸泡实验牙5 min;⑤化学去除组3以1％NaClO溶液浸泡实验牙10 min.然后用扫描电镜和组织学切片观察评价各组间牙周膜残留和牙骨质剥脱情况,采用SAS 8.02软件包对数据进行统计学分析.结果:牙周膜残留方面,阴性对照组显著高于机械去除组和3个化学去除组(P＜0.05),机械去除组显著高于3个化学去除组(P＜0.05),但3个化学去除组之间无显著差异.牙骨质缺损方面,机械去除组显著高于阴性对照组和3个化学去除组(P＜0.05);阴性对照组和3个化学去除组之间无显著差异.结论:在本实验条件下,机械去除法既无法去净根面坏死牙周膜,又会导致根面牙骨质层破坏.化学去除法能在有效去除根面牙周膜的同时,很好地保持牙骨质层的完整性,较机械去除法更佳,是一种较理想的方法.