Timing of calcium hydroxide therapy in the treatment of root resorption in replanted teeth in dogs

Abstract The effect of time of the onset of calcium hydroxide (CH) pulpectomy on root resorption of 31 permanent dog incisors was investigated. CH pulpectomy was delayed 4, 9, 14 and 18 days after the teeth were extracted and replanted. Control teeth were replanted 1) without pulpectomy, 2) with a pulpectomy only or 31. with a pulpectomy and CH filling. All teeth were prepared for histologic evaluation 8 weeks after the teeth were replanted. Cross section were examined using a computer microscope and linear (jam) and/or square areas (μm²) of surface (SRR), inflammatory (IRR), and replacement (RRR) root resorption were calculated. From this data the percentage of linear and area resorption was averaged for each group. Duncan multiple range t-test (P<0.05) revealed that teeth in which a pulpectomy with CH filling was done extraorally had significantly greater SRR than the rest of the groups; teeth in which a pulpectomy without CH filling was done extra orally had significantly greater RRR than teeth in which CH pulpectomy was delayed for 18 days; there was no significant difference in SRR. IRR or RRR when CH placement was delayed 4, 9, 14 or 18 days after replantation. Although it was not significant the overall resorption was least when CH pulpectomy was delayed 18 days.     

Local dexamethasone improves periodontal healing of replanted dogs' teeth

Abstract— The purpose of the present investigation was to evaluate histologically the effect of dexamethasone on root resorption in stored and replanted dogs' teeth. Twenty-nine roots from three beagle dogs were endodontically treated to prevent subsequent inflammatory root resorption of pulpal origin. The teeth were extracted and randomly assigned to three groups for 18-h storage. Group 1: control group teeth ( n = 13) were stored in vials containing ViaSpan only; Group 2: topical treatment teeth ( n =10) were stored in vials containing ViaSpan and dexamethasone (16 μg/ml); and Group 3: systemic treatment teeth ( n =6) were stored in bids containing ViaSpan without any additives. Dexamethasone was administered intramuscularly (0.5 mg/kg body weight) 2 days prior to, on the day of, and every other day after extraction and replantation for two administrations. After 12 weeks, the dogs were sacrificed, and the teeth histologically prepared and evaluated according to the analysis of Andreasen. Significant differences were found for complete healing ( P= 0.0583) and inflammatory root resorption ( P= 0.0568) but not for replacement resorption ( P= 0.1952). In addition, comparing local to systemic administration of dexamethasone (Group 2 vs. Group 3), statistically significant differences were found for healing, 85% (Group 2) vs. 67% (Group 3) ( P =0.0125) and inflammatory root resorption, 13% (Group 2) vs. 28% (Group 3) ( P =0.0126). This study indicated that topical use of dexamethasone enhances healing and results in fewer resorption complications.     

Prognosis of replanted primary incisors after injuries

Abstract – Between 1979 and 1997, 58 avulsed primary teeth were treated at the Pedodontic Clinic of Niigata University Dental Hospital. Among these, we replanted six avulsed incisors of four patients and treated two teeth of two patients replanted at other dental clinics. Referring to the clinical records, oral photographs and radiographs, we examined the injury age, cause of injury, condition of tooth storage, length of time until replantation, and also the prognosis after replantation. Three teeth of two cases remained until eruption of their permanent successors, and one tooth of one case remained under observation without extraction. Although the other four teeth of three cases resulted in extraction, no secondary infection was detected due to replantation. The following reasons were suspected for the poor prognosis of the four teeth. One avulsed tooth was not fixed immediately after replantation. One replanted tooth might not have been compatible with the alveolar socket. In the other two teeth, the periodontal vital tissues might have been removed before replantation. It is generally suggested that replantation of primary teeth is not a good option. However, from the present results, it was considered that replantation can be an effectual method when the condition of the avulsed primary tooth is suitable.     

The effect of intracanal Ledermix on root resorption of delayed-replanted monkey teeth

Abstract – Progressive root resorption is one of the common sequelae in replanted teeth, which is detrimental to their long‐term prognosis. Ledermix paste, with its composition of triamcinolone acetonide and demethylclortetracycline, has been shown to inhibit inflammation and the associated hard tissue resorption. This study evaluated the effect of immediate intracanal Ledermix on root resorption of delayed‐replanted monkey teeth. A total of 36 roots were root canal treated. For the experimental group, intracanal Ledermix was placed prior to extraction and replantation after 1‐h bench dry. The positive control group was root filled and replanted after 1 h while the negative control group was root filled and replanted immediately. The monkeys were sacrificed after 12 weeks. The H&E histological tissue specimens were prepared and evaluated using a method modified from that of Andreasen's morphometric analysis, as favorable or complete healing and unfavorable healing, comprising inflammatory root resorption and replacement resorption. The results were analyzed using Kruskal–Wallis and Mann–Whitney U‐tests as well as Wilcoxon signed ranks test. The negative control group produced highly significant favorable healing and unfavorable healing as compared to the Ledermix group (P = 0.000). The Ledermix group only showed significantly higher occurrence of complete healing (35.46%) compared to the positive control group (16.58%) (P = 0.037) but there were no significant differences in the inflammatory root resorption and replacement resorption. Nevertheless, when the latter two unfavorable healing patterns were combined, there was a significantly lower overall unfavorable healing in the Ledermix group (64.54%) when compared to the positive control group (83.43%) (P = 0.037). This unfavorable healing outcome in the Ledermix group, however, was not significantly different from the favorable healing outcome with the same treatment modality (P = 0.110).     

Replantation of 400 avulsed permanent incisors. 4. Factors related to periodontal ligament healing

Abstract 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 12 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.     

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.     

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.     

Avulsed human teeth replanted within 15 minutes — a long-term clinical follow-up study

Abstract Twenty–one avulsed human permanent teeth replanted within 15 min after trauma were followed radiographically for an average of 5 years. Seven teeth did not show any root resorption during the observation period. In 8 teeth shallow resorption cavities were observed, but no signs of progression were observed with increased observation time. In 6 teeth some progressive root resorption was observed with increased observation time. The depth of root resorption cavities was assessed using a radiographic index, and the rate of root resorption was defined as the index change over time. The rate of root resorption was determined. It was concluded that teeth replanted within 15 min after the avulsion have a favourable long-term prognosis.     

Long‐term retention of avulsed maxillary permanent incisors replanted after prolonged non‐physiological storage

Ankylosis and external replacement resorption (ERR) are two typical biological responses to delayed replantation of avulsed teeth in cases where adequate root canal treatment is performed. The patient's growth stage affects the progression of root resorption and the long‐term outcome of the affected teeth. This case report describes the long‐term outcome of an 18.5‐year‐old patient following an accident in which both of his maxillary central incisors were avulsed and replanted after four hours of non‐physiological storage. ERR and ankylosis of teeth 11 and 21 were detected clinically and radiographically during the second year of follow‐up. Sixteen years after replantation, replacement resorption was progressing very slowly, enabling functional tooth retention with favorable esthetics. Young adults, with delayed replantation of avulsed teeth, may benefit from tooth retention with slow ERR.     

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.     

Effectiveness of different intracanal irrigation techniques in removing intracanal paste medicaments

This study aimed to compare the effectiveness of different intracanal irrigation techniques in removing intracanal medicaments prior to obturation. A total of 168 single roots were prepared with ProTaper® rotary files and medicament pastes applied (Ledermix®, Odontopaste®, Doxypaste and Pulpdent®), left in for 2 weeks, then removed using filing followed by one of four methods: irrigation with an open‐ended notched irrigation needle (Appli‐Vac) either at the working length or 5 mm from the canal orifice, or the Max‐I‐probe or EndoActivator® at the working length. Following the removal of medicaments, the roots were split into two and the internal surfaces photographed, for digital image analysis of the overall percentage of residual medicament. With the exception of canals irrigated 5 mm apical to the root canal orifice, all four irrigation techniques achieved an average of 95% for removal of Ledermix®, Odontopaste® and Doxypaste. Calcium hydroxide paste was the most difficult medicament to remove, with no difference between irrigation techniques. Up to 27% of the Pulpdent® material remained after irrigation. No irrigation technique could completely remove all traces of medicaments. The position of the irrigational needle and the type of medicament used are key factors, which influence the effectiveness of irrigation in removing medicaments.     

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.     

Inflammatory resorption: untreated, arrested, prevented

Abstract Three human replantation cases are presented wherein the results are in accord with the literature concerning inflammatory resorption and calcium hydroxide therapy. The cases unintentionally simulate a designed experiment wherein the control case received no treatment and the other 2 were subjected to independent variables such as obturation in the hand and the timing of the calcium hydroxide therapy. The untreated case resulted in loss of the tooth, while manipulation of variables in the other two resulted in retention.     

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.     

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.     

The effect of systemic tetracycline on resorption of dried replanted dogs' teeth

Abstract— The use of systemic penicillin after an avulsion injury has been recommended to decrease the occurrence of resorption complications. Tetracycline antibiotics have been reported to possess anti-resorptive propemes in addition to their anti-microbial actions. The purpose of this study was to evaluate histologically the effect of systemically administered tetracycline and amoxicillin on the inhibition of resorption due to attachment damage after replantation of dogs' teeth. Thuty-one roots from the teeth of four beagle dogs were endodontically treated to inhibit subsequent inflammatory root resorption of pulpal origin. They were then extracted and left to bench dry for 1 h to ensure severe periodontal ligament damage before replantation. For the teeth in the experimental groups, two dogs were given tetracycline hydrochloride and the other two dogs were given amoxicillin, administered orally, on the day of extraction/replantation and for the following 6 days.
The control group were teeth in these animals treated in the same manner but where no antibiotics had been given. After 12–16 weeks, the dogs were sacrificed and histological sections were prepared and evaluated for complete healing, inflammatory and replacement root resorption, and the groups were compared. It was shown that healing in the amoxicillin and the control groups was poor (10.90% and 11.28%, respectively), while for the tetracycline group, 35.45% showed complete healing. Individual teeth with over 50% complete healing sites were considered as having good healing, and sigdicantly more of these teeth were found in the tetracycline group (5 of 11 teeth) compared to the amoxicillin (1 of 11 teeth) or control group (1 of 8 teeth).