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.     

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.     

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.     

高压氧用于年轻恒牙再植术的临床研究

目的 探讨年轻恒牙脱位再植后,高压氧（ｈｙｐｅｒｂａｒｉｃ ｏｘｙｇｅｎ,ＨＢＯ）治疗对牙髓牙周损伤修复的作用。方法 对６９例年轻恒前牙脱位患者的１３８颗患牙行再植术,术后分为ＨＢＯ组和对照组,ＨＢＯ组给予ＨＢＯ治疗１０ｄ,对照组不给予ＨＢＯ治疗,进行对照。结果 ＨＢＯ组和对照组的牙再植总成功率分别为９７．２６％和７０．７７％,二者差异有显著性（Ｐ〈０．０５）;１年后失牙情况;ＨＢＯ组１颗（１．３     

根尖闭合型恒牙完全脱位再植术的临床研究

[摘要] 目的 研究分析不同固定方式、固定时间和牙髓摘除、根管充填的时机对外伤性根尖闭合型完全脱位牙再植术后愈合方式和远期存留率的影响。方法 收治56位患者83颗外伤性根尖闭合型完全脱位牙再植治疗,随机分为两组：常规治疗组采用传统治疗方法;改良治疗组采用再植后弹性固定2~3周,2周时去髓并用Vitapex（碘仿氢氧化钙糊剂）根充,1月时常规根管充填,随访观察5年,比较两组再植牙术后愈合方式及近、远期存留情况。结果 改良治疗组再植牙术后牙周膜愈合率高于常规治疗组,骨性粘连率与炎症性吸收率低于常规治疗组,有显著性差异(P<0.05);两组再植牙术后1年、2.5年的存留率,改良治疗组略高于常规治疗组,但无显著性差异(P>0.05);5年存留率,改良治疗组(86.50%)优于常规治疗组(67.50%),有显著性差异(P<0.05)。结论 对于根尖闭合型完全脱位牙再植术,改良治疗方法可促进再植牙牙周膜愈合,减少牙根吸收的发生,提高远期疗效。[关键词] 完全脱位;再植;固定;根管治疗     

全脱位上切牙再植后临床疗效研究

目的评价上切牙全脱位再植后的临床疗效。方法 20颗全脱位上切牙其中10颗未脱离口腔环境。另外10颗脱离口腔环境,轻度污染。就诊时间距外伤时间在40～50 min,脱位切牙消毒处理后,再植复位,结扎并固定,4周后进行根管治疗。分别于6、12、24个月复查,复查项目包括摄X线片、龈沟深度和牙龈指数。结果脱离口腔环境全脱位患牙的龈沟深度6,24个月复查结果之间有统计学差异;牙龈指数6、12、24个月相互之间均有统计学差异。结论未脱离口腔环境全脱位牙预后较好。     

Factors affecting the time of onset of resorption in avulsed and replanted incisor teeth in children

Abstract – Resorption is the main reason for loss of replanted teeth. The outcome examined in this study is the timing of the onset of resorption. The effect of dichotomised dry and wet time intervals as well as the presence of additional crown damage and of contamination were determined. Of 84 replanted teeth, 67.5% developed resorptions. Twenty-eight had detectable additional crown damage with a more rapid onset being seen in these cases ( P =0.009). The critical limit for dry time was 15 min ( P =0.038) and significant differences persisted for greater limits also. Serial analysis of the association between the time of onset of root resorption and dichotomised wet time variables failed to yield any significant associations. There was visible contamination detected in 32 teeth and these exhibited a more rapid onset of resorption than the other cases ( P =0.030). Teeth with inflammatory root resorption (12.8%) had a more rapid onset of resorption than those that developed replacement resorption (54.7%) ( P <0.001). It is concluded that the risk of early resorption is increased in teeth that have additional damage or have contamination, or are kept in dry conditions for longer than 15 min.     

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.     

Effect of enamel matrix derivative (EMDOGAIN®) upon periodontal healing after replantation of permanent incisors in Beagle dogs

Abstract – This study histologically assessed the effect of enamel matrix derivative (EMDOGAIN^®) on periodontal healing in re-implanted teeth in nine Beagle dogs. Incisors in dogs were re-implanted after 15, 30 and 60 min of dry storage with and without the application of EMDOGAIN. The pulps were removed in all teeth. In groups 1 and 2, dog teeth were splinted and the dogs sacrificed after 8 and 12 weeks, respectively. In group 3, dog teeth were not splinted and sacrifice took place after 12 weeks. The histological parameters studied were healed PDL, surface, inflammatory and replacement resorption. Univariable and multivariable analysis of data was performed. Increased incidence of healed PDL was inversely proportional to extraalveolar time. No significant differences were noticed between splinted and non-splinted teeth. The EMDOGAIN group showed a higher incidence of healed PDL, while controls showed a higher incidence of ankylosis. The effect of EMDOGAIN was more pronounced at the 12-week interval.     

Tooth replantation after traumatic avulsion: a report of 10 cases

Abstract  – This report compares the manner in which the avulsed tooth was handled at home versus at school, and presents the different outcomes of the replanted teeth in both groups. Eighteen of 32 avulsed teeth were not replanted, and four replanted teeth could not be followed. Thus, the material comprised 10 avulsed permanent incisors of 10 traumatized children, aged between 8 and 13 years, who were treated at the Pediatric Dental Clinic of Niigata University Dental Hospital. Half of the patients avulsed the tooth at school and the other half at or near home. Of the five teeth avulsed at school, three were kept under wet conditions. The time until their replantation ranged between 0.5 and 3.5 h. Their outcomes were fairly good, except for one incisor that was extracted about 3 years later owing to the undesirable replantation procedures by the dentist. Of the avulsed teeth at or near home, three were left under dry conditions. Their time until replantation ranged scattered between 0.5 and 12 h. Of these, two incisors preserved under wet conditions survived without significant root resorption. These results suggested that information about the way to keep the avulsed tooth was relatively well known to school nurse-teachers compared with parents. Depending on the kind of lay people, it appears that it is necessary to select the best way to convey information about the management of avulsed permanent teeth.     

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.     

Avulsed permanent teeth: a review of the literature and treatment guidelines

Abstract Dental trauma represents one of the few situations where dentists are called upon to make unscheduled diagnostic and treatment decisions in an area that is outside their routine experience. Since patients who sustain an avulsion present infrequently, except in child-oriented or emergency-based practices, clinicians often make diagnostic and management decisions based upon their previous rare treatment experiences. Clinicians also rely on published guidelines for this aspect of their practice and expect these standards to be up-to-date and based on current research information. None of the current protocols has been tested by a prospective longitudinal outcome study in humans. Nevertheless, current guidelines have become the standard for clinical practice around the world. An effort must be made to develop treatment protocols that are based upon the biological mechanisms that underlie periodontal wound healing.     

Management of an avulsed primary incisor

Abstract— The case describes the management of an avulsed maxillary central primary incisor of a 3 1/2-year-old girl. The tooth was retained in the oral cavity for 30 min. After replantation it was splinted for 17 days. At day 11 the root canal was completely instrumented and obturated with a calcium hydroxide paste. The l-year follow-up documented no pathologic clinical or radiographic findings. One and a half years after the trauma the tooth was extracted since a fistula and extensive external inflammatory resorption had developed. The permanent successor erupted along with its neighboring central incisor without any complications 6 months later. Conventional approaches for treating avulsed permanent teeth could also be applied to avulsed primary incisors to preserve them for a certain period without the additional risk of damaging their developing permanent successors.     

18例创伤性脱位牙再植效果观察和相关因素分析

目的：探讨脱位牙再植的效果和相关影响因素.方法： 18例（24个牙）完全性牙脱位行再植手术的病人,其中9例发生于学校,学校老师携带前来就诊2例,家属携带就诊16例,就诊时限0.5～11h,保存方式：冷水或盐水保存5例,口含保存3例,干置4例,脱位后弃置返回寻找保存于盐水6例.常规植入治疗,随访1～1.5年.结果： 13例存活,5例因牙根广泛吸收被拔除,成功率为72%.四种保存方式最终因牙根广泛吸收而拔除者中冷水保存1例,干置2例,弃置＋盐水2例.就诊时间在2.5h以下,除冷水保存有1例拔除外,均存活保留.结论： 脱位牙再植的成功与就诊时间和保存方式有明显关系,而患者家属和学校教师的口腔保健治疗意识是影响这两个因素的主要原因.     

Resumed tooth development following avulsion of a permanent central incisor

A case is presented in which an upper right central incisor was avulsed because of trauma at age six. At the time of trauma it was suspected that the pulp had remained in the socket although the tooth had been lost. No attempt was made to treat the socket, remove the pulp, or replant the tooth. Follow-up radiography showed that, despite initial apparent complete loss of the calcified portion of the tooth, root development proceeded to completion.     

Replantation after extended dry storage of avulsed permanent incisors: report of a case

Abstract –  A 15-year-old boy lost his maxillary right and left central incisor teeth in a bicycle accident. He was referred to our clinic 1 week after the injury. The crown-root integrities of both the teeth were not damaged. Although the teeth were stored under dry conditions for 1 week, reimplantation of the teeth was planned to retain the teeth in the mouth for as long a period as possible because of the patient's age. Following the debridement and sterilization of root surfaces in 2.5% NaOCl, root canals were prepared and filled with calcium hydroxide. Then, about 2 mm of the apexes were resected to ensure that the roots easily seated in the alveolar socket and the prepared cavities in root ends were obturated with the amalgam. The teeth were placed into their respective sockets and splinted temporarily. The root canal therapy was completed 5 weeks later. Ankylosis was observed radiographically after 10 months. The patient is now 23 years old and he is still able to use both the central incisors functionally. However, there is a pink appearance on the cervical buccal surface of left central incisor because of progressive replacement resorption. In this case, the new treatment plan is to perform a permanent restoration with dental implants following the extraction of both teeth. Even though the long-term prognosis is uncertain, this treatment technique has provided an advantage for the patient in his adolescent period by maintaining the height of alveolar bone and making the provision of an aesthetically acceptable permanent restoration at a later age possible.     

Root surface treatment using diode laser in delayed tooth replantation: radiographic and histomorphometric analyses in rats

Abstract – Background aim: The aim of this study was to evaluate, by radiographic and histomorphometric analyses, the effects of high‐power diode laser irradiation on the root surfaces of delayed replanted rat teeth. Material and methods: Maxillary right incisors were extracted from 60 Wistar rats and kept dry for 60 min. Subsequently, the root canals were prepared and filled with calcium hydroxide paste. According to the root surface treatment before the replantation, the teeth were assigned to four groups (n = 15): G1 (negative control) – no root surface treatment; G2 (positive control) – treated with 2% sodium fluoride solution; G3 – irradiated with a high‐power diode laser (810 nm, continuous mode, 1.0 W, 30 s); and G4 – irradiated with a diode laser using the same parameters as those used for G3 but in pulsed mode. The rats were euthanized after 15, 30, and 60 days of replantation. The specimens were digitally radiographed and processed for histomorphometric analysis to determine the average root resorption areas and to evaluate the histological events. Results: The percentage of root resorption was in the following order: G1 > G2 > G4 > G3. Both histomorphometric and radiographic analyses showed significantly lower means (P < 0.05) of the occurrence of root resorption in the irradiated groups (G3 and G4) when compared to the control groups (G1 and G2). Replacement resorption and ankylosis were observed in histological sections only after 30 and 60 days; however, such events were not observed in G3. Conclusion: Root surface treatments with high‐powered diode laser irradiation prior to delayed replantation reduced the occurrence of external root resorption compared to no treatment or sodium fluoride treatment at up to 60 days.     

Extraoral endodontic treatment, odontotomy and intentional replantation of a double maxillary lateral permanent incisor: case report and 6-year follow-up

AIM: To describe combined endodontic, surgical and orthodontic treatment of a maxillary lateral incisor fused with a supernumerary. SUMMARY: Double tooth is a dental irregularity consequent to fusion of two or more teeth or dental gemination. The teeth most commonly involved are deciduous, but in 0.1% of cases permanent teeth are affected, in which case aesthetic, functional and periodontal problems can result. This paper reports a clinical case of a double tooth in the position of the maxillary right lateral permanent incisor. Combined orthodontic, endodontic and surgical treatment (intentional replantation) allowed the tooth to be retained without periodontal compromise and with a positive orthodontic result both immediately and 6 years following intervention. *A conservative approach that addresses periodontal, pulpal and tooth tissues, can result in the retention of a double tooth. *Maintenance of the root and alveolar bone in young adults at least until full skeletal maturation should be the main treatment objective.