Replantation of 45 avulsed permanent teeth: a 1-year follow-up study

Abstract –  Thirty-four patients with 45 avulsed and replanted permanent teeth were followed for 1 year. All teeth were soaked in tetracycline before replantation. In addition, enamel matrix derivative was used in teeth with dry storage times exceeding 30 min. Splinting was carried out with a non-rigid titanium splint and was limited to 7–10 days. Within that period, root canal treatment was begun in all teeth with a closed apex, whereas teeth with an open apex and ideal post-traumatic storage were not instrumented. All patients were given tetracycline systematically for 10 days. The survival rate of replanted avulsed permanent teeth was 95.6% at the 1-year follow-up. In 82.2%, root canal treatment was performed. Pulp survival was never observed, but three teeth had pulp canal obliteration. Normal periodontal healing was observed in 57.7% of teeth; 42.3% of teeth showed external root resorption (28.9% replacement resorption, 6.7% infection-related resorption, 6.7% surface resorption). The occurrence of replacement resorption correlated with the period of extraoral dry storage. Compared with other clinical studies on avulsed and replanted teeth, the present study reports a higher percentage of periodontal healing. The favorable treatment outcome may be associated with a strict protocol to enforce endodontic treatment, the use of topical and systemic tetracycline, and the relatively high number of ideally stored teeth following avulsion. In contrast, the present study has a follow-up period limited to 1 year.     

Measurement of ridge alterations following tooth removal: a radiographic study in humans

Objective: The aim of this study was a radiographic mesiodistal analysis of the shape of the bone crest 3 months after tooth removal. Material and methods: One hundred single tooth extractions were performed on 100 patients because of orthodontic or prosthetic causes. Bite blocks were used for two radiographs: one on the day of extraction and the other after healing of the socket, 3 months later. These X‐rays were used to determine: (1) the most apical distance of alveolar ridge resorption, with baseline as the line between bone‐to‐teeth contact (the greatest distance in bone resorption height) and (2) the mesiodistal distance (MDD) and mesial and distal angles arising after bone tissue modeling. Results: Significant differences (P<0.05) emerged between the MDDs of multiple‐ [8 mm, 95% confidence interval (CI): 6.09, 9.90] and single‐root teeth (5.60 mm, 95% CI: 4.80, 6.50). However, mesial or distal angles or the most apical distance of alveolar ridge resorption did not differ (mean distance in height=4.32 mm, 95% CI: 3.85, 4.78; mean angle=24°). Conclusions: In this study, the post‐extraction mesiodistal bone distance between teeth adjacent to the edentulous ridge depends on the size of the edentulous space. Nevertheless, the distance does not affect the distance in bone loss height. The distance of bone resorption height reaches a balance at the midpoint, which we consider indicative of stable healing. This resorption process must be considered when placing dental implants in fresh extraction sockets, especially in aesthetic sites, because the implant surfaces could be exposed after 3 months. To cite this article:
Moya‐Villaescusa MJ, Sánchez‐Pérez A. Measurement of ridge alterations following tooth removal: a radiographic study in humans.
Clin. Oral Impl. Res. 21 , 2010; 237–242.
doi: 10.1111/j.1600‐0501.2009.01831.x     

Replantation of 400 avulsed permanent incisors. 1. Diagnosis of healing complications

Abstract A material of 322 patients with 400 avulsed and replanted permanent teeth were followed prospectively in the period from 1965 to 1988 (mean observation period=5.1 yrs). The age of the patients at the time of replantation ranged from 5 to 52 yrs (mean =13.7 yrs and median =11.0 yrs). Standardized patient records were used through the entire period in order to obtain valid data concerning the extent of injury and treatment provided. At the follow–up period, pulpal and periodontal healing were monitored by clinical examination, mobility testing and standardized radio–graphic controls. Thirty–two of the replanted teeth (8%) showed pulpal healing. When related to teeth with incomplete root formation, where pulpal revascularization was anticipated (n = 94) the frequency of pulpal healing was 34%. Periodontal ligament healing (i.e. with no evidence of external root resorption) was found in 96 teeth (24%). Gingival healing was found in 371 teeth (93%). During the observation period, 119 teeth (30%) were extracted. Tooth loss was slightly more frequent in teeth with incomplete root formation at the time of replantation than in teeth with completed root formation.     

The effect of saline storage before replantation upon dry damage of the periodontal ligament

Abstract The effect of 30 min of saline storage before replantation of teeth, which had been dried out for 30 min, was studied in 10 Green Vervet monkeys (Cercopithecus aethiops). Maxillary central incisors were extracted and dried out for 30 min, after which 1 incisor was replanted and the other transferred to a saline solution for 30 min before replantation. No splinting or endodontic treatment was carried out. The teeth were examined after 8 wk. Histometric analysis showed identical extent of root resorption in the 2 groups, with ankylosis being the dominant resorption type, and with very limited pulpal repair in either group. It is concluded that saline storage under the experimental conditions chosen had no effect on development of root resorption or pulpal repair, presumably because 30 min dry storage had inflicted close to maximal damage on the periodontal ligament at the root surface. On the other hand, it is of clinical importance that a certain delay in the replantation procedure does not influence periodontal and pulpal healing, as long as the tooth is kept in saline storage. This suggests that replantation under these conditions can be reserved for dental professionals, rather than favoring immediate replantation by anyone ‘on-the-spot’.     

Effect of treatment delay upon pulp and periodontal healing of traumatic dental injuries – a review article

Abstract – Based on an analysis of the literature concerning parameters influencing the prognosis of traumatic dental injuries, few studies were found to have examined possible relationships between treatment delay and pulpal and periodontal ligament healing complications. It has been commonly accepted that all injuries should be treated on an emergency basis, for the comfort of the patient and also to reduce wound healing complications. For practical and especially economic reasons, various approaches can be selected to fulfill such a demand, such as acute treatment (i.e. within a few hours), subacute (i.e. within the first 24 h), and delayed (i.e. after the first 24 h). In this survey the consequences of treatment delay on pulpal and periodontal healing have been analyzed for the various dental trauma groups. Applying such a treatment approach to the various types of injuries, the following treatment guidelines can be recommended, based on our present rather limited knowledge of the effect of treatment delay upon wound healing. Crown and crown/root fractures : Subacute or delayed approach. Root fractures : Acute or subacute approach. Alveolar fractures: Acute approach (evidence however questionable). Concussion and subluxation : Subacute approach. Extrusion and lateral luxation : Acute or subacute approach (evidence however questionable). Intrusion : Subacute approach (evidence however questionable). Avulsion : If the tooth is not replanted at the time of injury, acute approach; otherwise subacute. Primary tooth injury : Subacute approach, unless the primary tooth is displaced into the follicle of the permanent tooth or occlusal problems are present; in the latter instances, an acute approach should be chosen. These treatment guidelines are based on very limited evidence from the literature and should be revised as soon as more evidence about the effect of treatment delay becomes available.     

Autotransplantation of immature third molars: influence of different splinting methods and fixation periods

Abstract  – Different data were published documenting the influence of fixation methods and periods on the outcome of autotransplantations of teeth. Besides studies reporting increased ankylosis and disturbances of pulpal revascularization following rigid or extended fixation, there are studies revealing no connection in this matter. The clinical and radiological results of 76 transplanted germs of third molars were to be assessed after a rigid fixation for 4 weeks or after a suture splinting for 7 days and compared with each other. The choice of fixation method depended on the initial stability of the transplant. After a mean observation period of 3.4 years (range 1.0–6.1 years), 92.9% of the teeth stabilized with a suture, but only 73.5% fixed with an acid-etch composite and wire splint could be classified as successful ( P  = 0.029). The significant increases in ankylosis ( P  = 0.036) and pulp necrosis ( P  = 0.041) were the factors for the less favorable results of the rigidly fixed teeth. Our data support the results of other experimental and clinical studies with regard to the negative influences of an extended and rigid fixation on the success of tooth transplantation. However, apart from a correlation with the method and period of fixation, we also suspect the influence of an incongruity between the transplant and recipient site.     

微生物纤维-甲硝唑促进拔牙创愈合的临床研究

目的探讨微生物纤维(Microberfiber,MB)、与甲硝唑(FLA)的止血、封闭创口、消炎及促进肉芽组织生长的作用。方法选临床正畸拔牙患者80人,将患牙拔除后右侧牙窝内放入MB-FLA做为实验组,牙窝左侧常规咬纱布止血20～30分钟做为对照组。结果实验组拔牙窝愈合程度明显优于对照组。结论MB-FLA具有明显的止血、消炎及促进成纤维细胞及成骨细胞生长的作用,有利于伤口的早期愈合,减少术后并发症的发生。MB-FLA是一种理想的创内充填物。     

bFGF对拔牙创内源性BMP含量及分布的影响

利用骨形成蛋白单克隆抗体（ＢＭＰ－ＭｃＡｂ），采用免疫组化的方法，观察碱怀成纤维细胞生长因子（ｂＦＧＦ）对百拔牙创愈合过程中骨形成蛋白含量与分布的影响，结果表示：局部应用ｂＦＧＦ能刺激内源性ＢＭＰ的合成和分泌，ＢＭＰ促使 发化的间充质细胞向骨系细胞分化，从而诱导新骨生成，促进了拔牙创的早期愈合。     

Basic fibroblast growth factor and epidermal growth factor reverse impaired ulcer healing of the rabbit oral mucosa

BACKGROUND: The therapies for refractory ulcers on the oral mucosa are symptomatic and very unsatisfactory. We hypothesized that application of growth factors might be able to achieve successful remission of the lesion. We evaluated the effects of systemic administration and topical application of epidermal growth factor (EGF) and basic fibroblast growth factor (bFGF) on impaired wound healing of ulcers in the rabbit gingiva. METHODS: Almost uniform round ulcers could be created on the gingiva of the rabbits by chemical injury with acetic acid. When the submandibular glands were removed or i.v. injection of cisplatin (CDDP) and peplomycin sulfate was performed before ulcer formation, healing of the ulcers took longer than in untreated rabbits. To ascertain whether or not human EGF and bFGF affect rabbit cells, we first examined the effects of EGF and bFGF on the proliferation of the cells derived from rabbit gingiva. We then applied EGF or bFGF in these impaired healing models. RESULTS: EGF and bFGF promoted proliferation of the fibroblasts, and EGF also promoted proliferation of the keratinocytes isolated from gingival tissue of rabbits in vitro. Systemic injections of EGF and bFGF in rabbits, which had their submandibular glands removed, and topical application of bFGF accelerated healing of ulcers created in rabbits injected with CDDP and peplomycin sulfate. The ability of bFGF to promote the healing of ulcers was much greater than that of EGF. CONCLUSION: Basic FGF may be effective for refractory oral mucosal lesions.     

Histomorphometrical and clinical comparison of submerged and nonsubmerged implants subjected to experimental peri-implantitis in dogs

OBJECTIVES: Soft and hard tissue healing around submerged and nonsubmerged versions of one dental implant design was evaluated in an experimental canine peri-implantitis model. MATERIAL AND METHODS: Forty-eight c.p. Ti-implants with integrated (one-piece=OPI) or screw-on (two-piece=TPI) abutments were inserted in edentulous mandibles of eight beagle dogs, one OPI and one TPI with connected abutments for nonsubmerged and one TPI without abutment (SMI) for submerged healing. After 3 months, all implants were functionally loaded, and at 4 months peri-implantitis was ligature-induced in one jaw side. Intravital polyfluorochrome labeling, monthly conventional radiography and gingival probing of all 48 implants were performed until sacrifice 8 months postimplantation. Undecalcified ground sections in the bucco-lingual and mesio-distal planes of four dogs (23 implants, one implant lost) were evaluated by light and fluorescence microscopy. The immunohistochemical and SEM-vascular corrosion cast results of the four other dogs (24 implants) will be reported elsewhere. Levels of alveolar bone-to-implant contact (ABICL), alveolar crest (ACL) and junctional epithelium-to-implant contact were determined by computer-assisted histometry. Peri-implant alveolar bone loss (=saucerization) was assessed on the radiographs and calculated as ACL minus ABICL from histometric data. RESULTS: Around SMIs and OPIs without ligature less plaque adhesion and lower gingival indices were found when compared to TPIs. Radiologically, all ligatured, but also some nonligatured implants showed alveolar bone loss. Histometry demonstrated reduced ABICL around all these implants. Saucerization was more pronounced on the lingual and mesio-distal sides. Particularly around TPIs, bone resorption was still active or bone formation was impaired on fluorochrome labeling. Only around SMIs and one OPI without ligature continuing alveolar bone formation reflected by gains in ABICL were found. CONCLUSION: The clinical and histometric results of this study demonstrate that healing of submerged SMIs was not impaired by the two-stage procedure, resulting in equally good healing as around nonsubmerged OPIs. However, peri-implantitis plaque-induced by ligature and/or dilated abutment connection microgaps in TPIs affected alveolar bone-to-implant contacts more than transmucosal or submerged healing mechanisms.     

Dynamics of bone tissue formation in tooth extraction sites. An experimental study in dogs

OBJECTIVES: The aim of the present experiment was to study events involved in the healing of marginal, central and apical compartments of an extraction socket, from the formation of a blood clot, to bone tissue formation and remodeling of the newly formed hard tissue. MATERIAL AND METHODS: Nine mongrel dogs were used for the experiment. The fourth mandibular premolars were selected for study and were divided into one mesial and one distal portion. The distal root was removed and the socket with surrounding soft and mineralized tissue was denoted "experimental unit". The dogs were killed 1, 3, 7, 14, 30, 60, 90, 120 and 180 days after the root extractions. Biopsies including the experimental units were demineralized in EDTA, dehydrated in ethanol and embedded in paraffin. Serial sections 7 microm thick were cut in a mesio-distal plane. From each biopsy, three sections representing the central part of the socket were selected for histological examination. Morphometric measurements were performed to determine the volume occupied by different types of tissues in the marginal, central and apical compartments of the extraction socket at different intervals. RESULTS: During the first 3 days of healing, a blood clot was found to occupy most of the extraction site. After seven days this clot was in part replaced with a provisional matrix (PCT). On day 14, the tissue of the socket was comprised of PM and woven bone. On day 30, mineralized bone occupied 88% of the socket volume. This tissue had decreased to 15% on day 180. The portion occupied by bone marrow (BM) in the day 60 specimens was about 75%, but had increased to 85% on day 180. CONCLUSION: The healing of an extraction socket involved a series of events including the formation of a coagulum that was replaced by (i) a provisional connective tissue matrix, (ii) woven bone, and (iii) lamellar bone and BM. During the healing process a hard tissue bridge--cortical bone--formed, which "closed" the socket.     

Healing after treatment of periodontal intraosseous defects

Abstract Citric acid conditioning of the root surface as a supplement to replaced flap surgery of intraosseous periodontal defects was evaluated, Thirteen patients and a total of 45 proximal defects with residual probing pocket depth ≥ 6 mm after initial preparation were used. The effect of treatment was studied in matched subsamples of the total material including one acid-treated and one nonacid-treated defect from each subject, The results demonstrated that an average gain of probing attachment level amounting to 2.0 mm was obtained following acid treatment as compared to 1.l–1.2 mm for the nonacid-treated controls. Corresponding figures for gain of probing bone level were 1.2–1.3 mm for acid treatment and 0.8–0.9 mm for controls. The clinical significance of these findings was discussed.     

Healing after treatment of periodontal intraosseous defects I. Comparative study of clinical methods

Abstract Four clinical methods to evaluate healing after reconstructive therapy of intraosseous periodontal defects were compared: 1. probing attachment level, 2. probing bone level, 3. entry/re-entry bone height measurements, 4, radiographic bone height determinations. Thirteen patients with a total of 33 defects volunteered for the study. It was found that the depth of the lesions recorded by the various methods showed differences which seem to relate to the varying nature of the methods, On the average, the periodontal probe penetrated 0.8 mm deeper during probing for bone level than during probing for attachment level and another O.3mm deeper after denudation of the lesions during entry/re-entry. The average- gain of periodontal support following treatment was approximately 1.4mm as recorded by probing attachment level, probing bone level and entry/re-entry bone height determinations, respectively. A high degree of correlation was found between all three probing methods when the changes following therapy for the individual sites were compared (r = 0.8 5, 0.75 and 0.81, respectively), Radiographic bone height showed lower degrees of correlation with all three probing parameters (r = 0.45, 0.46 and 0,47, respectively).     

Spontaneously healed horizontal root fracture in maxillary first premolar: report of a case

Abstract –  Root fractures of the posterior teeth are rare and occur as a result of severe trauma. This study describes the horizontal root fracture of a maxillary first premolar. The fractured roots were discovered during a routine radiographic examination. The tooth was asymptomatic and responded positively to electric pulp testing. The patient reported accidental trauma, which occurred 14 years before. Our case is an example of spontaneously healed fractured roots. The interesting findings were that the healing was observed even in the presence of two roots, including preservation of the vitality of the pulp.     

Use of collagen in extraoral wounds

The basic fundamental elements that collagen bring into the wound activity are its hemostatic effect, its interaction with platelets and interaction with fibronection, increase in fluid exudates, increase in cellular components (macrophages) and support for fibroblastic proliferation into wound activity. In this way collagen plays a significant parts in almost every function of the body. Previously broad use of collagen was stifled because of cost, recent advances made it possible to develop cost effective collagen. In this study twenty patients of maxillofacial wounds were treated with the use of collagen. The results were satisfactory without any significant complication.