[Replantation of avulsed immature permanent teeth. Results in 39 cases after an average of 2.5 years]

Incidence of Root Resorption after the Replantation of Avulsed Teeth: A Meta-analysis

INTRODUCTION

An avulsion injury is a serious trauma to pulp and periodontal tissues. After avulsion and replantation, teeth are at risk of infection and root resorption, which may affect treatment outcome and survival rate. Thus, the purpose of this systematic review was to evaluate the incidence of root resorption after the replantation of avulsed teeth.

METHODS

Two reviewers searched 7 electronic databases for observational studies involving human subjects that evaluated the incidence of root resorption after tooth avulsion. Risk of bias (RoB) was evaluated using the Meta-Analysis of Statistics Assessment and Review Instrument, and the quality of available evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation tool.

RESULTS

Of the 1507 articles, 23 met the inclusion criteria. A meta-analysis was conducted and showed that the incidence of internal root resorption was 1.2% (95% confidence interval [CI], 0.02-5.50). Regarding external root resorption, the incidence of surface root resorption was 13.3% (95% CI, 6.21-22.62), that of inflammatory root resorption was 23.2% (95% CI, 13.94-34.19), and that of replacement root resorption was 51.0% (95% CI, 40.10-62.00). Two studies presented a high RoB, 16 had a moderate RoB, and 11 had a low RoB. The overall level of evidence identified was very low.

CONCLUSIONS

The incidence of root resorption after avulsion and replantation in descending order was replacement root resorption > inflammatory root resorption > surface root resorption > internal root resorption.

Results after replantation of avulsed permanent teeth. I. Endodontic considerations

Following avulsion and replantation, teeth are at risk for infection and infection related resorption (IRR). Severe discolorations of tooth crowns and cervical root fractures are common. This study presents data on endodontic related complications of avulsed teeth replanted following an extraoral endodontic treatment. Periodontal aspects will be discussed in the second part of the present publication. Twenty-eight permanent teeth in 24 patients aged seven to 17 years were replanted after avulsion. All teeth could be evaluated. In all teeth extraoral endodontic treatment by retrograde insertion of ceramic or titanium posts was performed. Mean observation period was 31.2 months (median: 24.1 months). Nine teeth healed with a functional periodontal ligament (PDL) (functional healing, FH), 19 teeth exhibited replacement resorption (RR), which was succeeded by IRR in three teeth after observation periods of more than 14 months. Diagnosis was set to tunneling resorption (one case) and to cervical resorption preceded by complete RR (two cases). No early IRR was observed. All six teeth rescued in physiologic conditions (cell culture medium of tooth rescue box) exhibited FH. Discolorations of tooth crowns or other complications (cervical root fractures, fractures of posts) were not observed. No differences in the healing results of immature and mature teeth were observed which is in contrast to previous studies. This finding is explained with the different endodontic treatment protocols. Extraoral endodontic treatment by retrograde insertion of posts prevents early IRR and minimizes the overall incidence of IRR. The method does not negatively influence periodontal healing. As there are further advantages (no discoloration, no root fractures, patient not involved, less radiographs, less time consumption, less costs) the method is recommended in isolated teeth before replantation. Especially immature teeth profit from the prevention of complications.

Root resorption in dental trauma: 45 cases followed for 5 years

We aimed to: (i) study the prevalence of root resorption after luxation or avulsion injuries on permanent teeth referred to our dental clinic over a 3-year period; (ii) study the relationship between type of injury and resultant type of resorption complication; and (iii) evaluate success of treatment protocols for various resorption complications. We observed 1943 patients with dental trauma, aged between 2 and 26 years, referred to the Accident and Emergency Department of the Dental Clinic, University of Brescia, from 1st September 1997 to 31st December 2001. Of these, 261 permanent teeth had sustained luxation (n = 188) or avulsion (n = 73) injuries. Permanent teeth luxation and avulsion injuries occurred most often in upper incisors (75%) of patients mostly aged 12-21 years, with males more commonly affected than females (68.3% vs. 31.7%). These cases were followed for 5 years, and complications and response to treatment were recorded. Root resorption was observed in 45 (17.24%) of these cases. Of the 45 cases with resorption, 9 were associated with luxation injury (20%) while 36 (80%) with avulsion. We distinguished 30 cases of inflammatory root resorption (18 transient and 12 progressive) and 15 cases of ankylosis and osseous replacement. When resorption was recognized, quick and effective treatment could still result in an excellent functional and aesthetic outcome for these teeth.

Extraoral endodontic treatment by retrograde insertion of posts: a long-term study on replanted and transplanted teeth

OBJECTIVE

The aim of the study was to investigate the healing results of teeth replanted or transplanted in different indications and treated by extraoral root canal therapy.

STUDY DESIGN

Extraoral root canal treatment was performed from a retrograde direction with posts made of ceramics or titanium. Preoperatively, the pulp status was classified as definitely infected (n = 47) or not infected/symptomless (n = 78), and the condition of the periodontal ligament (PDL) was classified as damaged (n = 50) or not damaged (n = 75) according to trauma type and extraoral storage. The healing after replantation or transplantation was diagnosed as functional, ankylosis, or infection depending on clinical and radiographic findings.

RESULTS

In total, 125 teeth in 99 patients were replanted or transplanted. Mean observation period was 44.4 months. Teeth with a less damaged PDL in no case exhibited ankylosis/replacement resorption after a mean observation period of 53 months. Teeth without preoperative infection of the pulp in no case showed infection-related complications after a mean observation period of 30 months. Teeth classified as definitely infected before treatment had a high frequency of continuous periradicular bone and root resorption.

CONCLUSIONS

The extraoral insertion of posts appeared to inflict no additional damage to the PDL that was clinically relevant. Infection-related complications were prevented. Teeth that were classified as definitely infected at the time of treatment had a low rate of healing and should undergo conventional root canal disinfection before this surgical procedure is applied.