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Eggmann F, Filippi A, Mukaddam K. Endodontic and restorative management of an adult with avulsion of multiple teeth: A case report with 5 years and 9 months of follow-up. Dent Traumatol 2024; 40:345-352. [PMID: 38031999 DOI: 10.1111/edt.12915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 12/01/2023]
Abstract
Simultaneous avulsion of four or more teeth is a rare event. This case report examines the dental care given to an adult who, during a bicycle accident, experienced the avulsion of a mandibular incisor as well as all of his maxillary incisors. In the immediate aftermath of the accident, four out of the five incisors were located, promptly collected, and stored in a tooth rescue box, all within a 20-min window. Replantation and splinting were performed on the day of the accident. Endodontic treatment involved sequential intracanal dressing with an antibiotic-corticosteroid paste followed by calcium hydroxide prior to root canal obturation. 3 months post-accident, signs of external replacement resorption (ERR) began to appear in all the replanted teeth. The gap created by the missing maxillary central incisor was managed with a three-unit fixed dental prosthesis, despite the onset of ERR in the incisors used as abutment teeth. Regular follow-ups showed a relatively slow ERR progression rate over a span of nearly 6 years. The patient expressed satisfaction with both the esthetic and functional outcomes. This case, marked by multiple avulsions, underscores the importance of immediate and appropriate intervention alongside the imperative for carefully considered long-term management strategies. Given the decelerated bone remodeling rate in adults, ERR generally progresses at a slower pace than in children. Accordingly, this case demonstrates the viability of retaining replanted teeth over the long term, even when these teeth have been subjected to nonphysiological storage for extended durations, a factor known to impede periodontal healing.
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Affiliation(s)
- Florin Eggmann
- Department of Periodontology, Endodontology, and Cariology, University Center for Dental Medicine Basel UZB, University of Basel, Basel, Switzerland
- Center of Dental Traumatology, University Center for Dental Medicine Basel UZB, University of Basel, Basel, Switzerland
| | - Andreas Filippi
- Center of Dental Traumatology, University Center for Dental Medicine Basel UZB, University of Basel, Basel, Switzerland
- Department of Oral Surgery, University Center for Dental Medicine Basel UZB, University of Basel, Basel, Switzerland
| | - Khaled Mukaddam
- Department of Oral Surgery, University Center for Dental Medicine Basel UZB, University of Basel, Basel, Switzerland
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2
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Aksel H, Zhu X, Gauthier P, Zhang W, Azim AA, Huang GTJ. A new direction in managing avulsed teeth: stem cell-based de novo PDL regeneration. Stem Cell Res Ther 2022; 13:34. [PMID: 35090556 PMCID: PMC8796335 DOI: 10.1186/s13287-022-02700-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 11/16/2021] [Indexed: 02/06/2023] Open
Abstract
Management of avulsed teeth after replantation often leads to an unfavorable outcome. Damage to the thin and vulnerable periodontal ligament is the key reason for failure. Cell- or stem cell-based regenerative medicine has emerged in the past two decades as a promising clinical treatment modality to improve treatment outcomes. This concept has also been tested for the management of avulsed teeth in animal models. This review focuses on the discussion of limitation of current management protocols for avulsed teeth, cell-based therapy for periodontal ligament (PDL) regeneration in small and large animals, the challenges of de novo regeneration of PDL on denuded root in the edentulous region using a mini-swine model, and establishing a prospective new clinical protocol to manage avulsed teeth based on the current progress of cell-based PDL regeneration studies.
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Affiliation(s)
- Hacer Aksel
- Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Periodontics and Endodontics, School of Dental Medicine, University at Buffalo, Buffalo, USA
| | - Xiaofei Zhu
- Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Endodontics, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA, USA.,VIP Dental Service and Geriatric Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - Philippe Gauthier
- Department of Endodontics, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA, USA.,Département d'endodontie, Faculté de Médecine Dentaire, Université Laval, Québec, QC, G1V 0A6, Canada
| | - Wenjing Zhang
- Department of Genetics, Genomics and Informatics, College of Medicine, University of Tennessee Health Science Center, Memphis, USA
| | - Adham A Azim
- Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Periodontics and Endodontics, School of Dental Medicine, University at Buffalo, Buffalo, USA.,Department of Endodontics, Arthur A Dugoni School of Dental Medicine, University of Pacific, San Francisco, California, USA
| | - George T-J Huang
- Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center, Memphis, TN, USA. .,Department of Endodontics, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA, USA. .,Cancer Research Building, University of Tennessee Health Science Center, 19 S. Manassas St. Lab Rm 256, office 255, Memphis, TN, 38163, USA.
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Long-Term Retention of Avulsed Maxillary Incisors with Replacement Root Resorption: A 9-Year Follow-Up. Case Rep Dent 2021; 2021:8872859. [PMID: 33505733 PMCID: PMC7814949 DOI: 10.1155/2021/8872859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/19/2020] [Accepted: 12/30/2020] [Indexed: 11/26/2022] Open
Abstract
The purpose of this case report is to present a case of long-term retention of avulsed upper maxillary incisors with external replacement root resorption in a 15-year-old boy. The avulsed teeth, #11, 21, and 22, were stored under dry conditions for 40 min and replanted. Endodontic treatment was initiated after two weeks, and the nonrigid splint was removed after 3.5 months. A year after replantation of the teeth, replacement root resorption was detected radiographically. For the following 9 years, the resorption progressed slowly, but the teeth were maintained without any adverse effects on esthetic appearance. Under dry storage conditions, replacement root resorption was expected. In this case, the patient was a growing 15-year-old boy; thus, replantation was performed despite a possible poor prognosis. Consequently, root resorption progressed. Nevertheless, maintenance of the tooth crowns led to satisfying results for the patient both esthetically and psychologically. Ankylosis or replacement root resorption is a complication occurring after replantation of avulsed teeth, which could require additional treatment. However, in young patients, replantation could be considered to maintain the teeth until growth is complete.
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Amaro RG, Dos Santos LCM, Lima TCDS, Coste SC, Barbato Ferreira DA, Côrtes MIDS, Colosimo EA, Bastos JV. Pulp healing in immature replanted permanent teeth: A competing risk analysis. Dent Traumatol 2021; 37:447-456. [PMID: 33421350 DOI: 10.1111/edt.12652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND/AIM Tooth displacement during avulsion causes total rupture of the pulp's neurovascular supply. Revascularization and pulp healing may occur in immature teeth, which gives rise to the recommendation that root canal treatment may not be required. The aim of this study was to evaluate the prognostic factors for the pulp's response after replantation of young permanent teeth. METHODS Records from 117 patients with 133 replanted permanent immature teeth were reviewed, and pulp outcomes were classified as healing (hard tissue deposition on the dentinal walls followed by narrowing of the pulp lumen or ingrowth of bone-like tissue inside the pulp canal) or non-healing (pulp necrosis with infection). The effect of clinical and demographic co-variates on the hazards of both outcomes was assessed performing a competing risk model. RESULTS Pulp necrosis with infection was diagnosed in 78.2% of the teeth, and healing was observed in 12.8% of the teeth. A total of 12 teeth (9.0%) were censored due to prophylactic removal of the pulp or severe external root resorption caused by eruption of adjacent canines. The cs-Cox model demonstrated that the hazards of pulp healing increased in teeth with extra-alveolar periods <15 min (csHR: 7.83, 95% CI 1.76-34.80, p = .01), while the hazards of pulp necrosis with infection decreased (csHR: 0.31, 95% CI: 0.10-0.92, p = .04). Teeth replanted with Moorrees' stages 4 and 5 of root development had higher hazards of pulp necrosis with infection than teeth with stage 2 of root development (csHR: 2.23, 95% CI 1.11-4.50, p = .03; csHR: 2.89, 95% CI: 1.40-5.95; p = .01). CONCLUSIONS Pulp healing rarely occurred after replantation of young permanent teeth being associated with short extra-alveolar periods <15 min. Early stages of root development decreased the hazards of pulp necrosis with infection.
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Affiliation(s)
- Roberta Gabriela Amaro
- Dental Trauma Program, Department of Restorative Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Thiago César da Silva Lima
- Dental Trauma Program, Department of Restorative Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Sylvia Cury Coste
- Dental Trauma Program, Department of Restorative Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Daniela Augusta Barbato Ferreira
- Dental Trauma Program, Department of Restorative Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Maria Ilma de Souza Côrtes
- Dental Trauma Program, Department of Restorative Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Department of Dentistry, Pontifical University of Minas Gerais, Belo Horizonte, Brazil
| | - Enrico Antonio Colosimo
- Departament of Statistics, Institute of Exact Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Juliana Vilela Bastos
- Dental Trauma Program, Department of Restorative Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Tričković-Janjić O, Janjić-Ranković M, Stojković B, Igić M, Stojanović S. Dry extraoral storage and delayed replantation of avulsed tooth: Therapy and outcome. ACTA STOMATOLOGICA NAISSI 2021. [DOI: 10.5937/asn2183175t] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction: The aim of this study was to present the therapeutic procedure and the outcome of replantation of the avulsed permanent central maxillary incisor, found at the site of high contamination, after an extraoral period of 15 hours and dry transport. Case report: By clinical examination it was determined that the root reached the full length, with parallel edges, which corresponded to the age of the girl-8.5 years. After carefully removing the necrotic periodontal ligament from the root of the tooth, extraoral endodontic treatment was performed. The pulp was removed, the multi-sessional intracanal medicament fillings were avoided and the definitive obturation of the root canal was performed. The tooth was returned to the alveolar socket and immobilized with a wire-composite splint. After replantation, the condition of the tooth was monitored. Replacement resorption and dentoalveolar ankylosis occurred after nine months, and then cervical inflammatory resorption led to tooth loss after three and a half years. Conclusion: The achieved result can be considered as a success because during this time the replanted tooth met the developmental, functional and aesthetic requirements, which is especially important in the period of intensive growth and development of the child.
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Grageda E, Grageda E. Periodontal plastic surgery for the management of an ankylosed permanent maxillary lateral incisor: A clinical report with 5-year follow-up. J Prosthet Dent 2020; 127:27-31. [PMID: 33190866 DOI: 10.1016/j.prosdent.2020.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/15/2020] [Accepted: 06/15/2020] [Indexed: 10/23/2022]
Abstract
Anterior maxillary tooth ankylosis disturbs the development of the alveolar bone process, leading to discrepancies between the cervical gingival margin and incisal edge position of the affected tooth, and therefore, the esthetics is compromised. Proposed treatments in adults and growing patients have been used successfully, but they have disadvantages and are contraindicated in some circumstances. This article proposes an alternative treatment for an ankylosed permanent maxillary anterior tooth with a slow replacement resorption rate in an adult patient, for whom a combination of a periodontal plastic surgery procedure and a fixed dental prosthesis was used to correct the esthetics. This treatment has less risk of complications, preserves the ankylosed tooth as long as possible, creates an optimal gingival contour, and maintains the alveolar bone for further treatment should the tooth be lost.
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Affiliation(s)
- Edgar Grageda
- Associate Professor, Department of Restorative Dentistry, Technological University of Mexico UNITEC, Medica Sur Hospital, Mexico City, Mexico; Professor, Department of Prosthodontics, National Autonomous University of Mexico UNAM, Mexico City, Mexico; Private practice, Medica Sur Hospital, Mexico City, Mexico.
| | - Enrique Grageda
- Professor, Department of Orthodontics, National Autonomous University of Mexico UNAM, Mexico City, Mexico; Private practice, Medica Sur Hospital, Mexico City, Mexico
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Fouad AF, Abbott PV, Tsilingaridis G, Cohenca N, Lauridsen E, Bourguignon C, O'Connell A, Flores MT, Day PF, Hicks L, Andreasen JO, Cehreli ZC, Harlamb S, Kahler B, Oginni A, Semper M, Levin L. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth. Dent Traumatol 2020; 36:331-342. [DOI: 10.1111/edt.12573] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 05/19/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Ashraf F. Fouad
- Adams School of Dentistry University of North Carolina Chapel Hill NC USA
| | - Paul V. Abbott
- UWA Dental School University of Western Australia Crawley WA Australia
| | - Georgios Tsilingaridis
- Division of Orthodontics and Pediatric Dentistry Department of Dental Medicine Karolinska Institutet Huddinge Sweden
- Center for Pediatric Oral Health Research Stockholm Sweden
| | - Nestor Cohenca
- Department of Pediatric Dentistry University of Washington and Seattle Children’s Hospital Seattle WA Australia
| | - Eva Lauridsen
- Resource Center for Rare Oral Diseases Copenhagen University Hospital Copenhagen Denmark
| | | | - Anne O'Connell
- Paediatric Dentistry Dublin Dental University Hospital Trinity College Dublin The University of Dublin Dublin Ireland
| | - Marie Therese Flores
- Department of Pediatric Dentistry Faculty of Dentistry Universidad de Valparaíso Valparaíso Chile
| | - Peter F. Day
- School of Dentistry Community Dental Service Bradford District Care NHS Trust University of Leeds Leeds UK
| | - Lamar Hicks
- Division of Endodontics University of Maryland School of DentistryUMB Baltimore MD USA
| | - Jens Ove Andreasen
- Department of Oral and Maxillofacial Surgery Resource Centre for Rare Oral Diseases University Hospital in Copenhagen (Rigshospitalet) Copenhagen Denmark
| | - Zafer C. Cehreli
- Department of Pediatric Dentistry Faculty of Dentistry Hacettepe University Ankara Turkey
| | - Stephen Harlamb
- Faculty of Medicine and Health The University of Sydney Sydney NSW Australia
| | - Bill Kahler
- School of Dentistry The University of Queensland St Lucia QLD Australia
| | - Adeleke Oginni
- Faculty of Dentistry College of Health Sciences Obafemi Awolowo University Ile‐Ife Nigeria
| | | | - Liran Levin
- Faculty of Medicine and Dentistry University of Alberta Edmonton AB Canada
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8
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de Souza BDM, Dutra KL, Reyes-Carmona J, Bortoluzzi EA, Kuntze MM, Teixeira CS, Porporatti AL, De Luca Canto G. Incidence of root resorption after concussion, subluxation, lateral luxation, intrusion, and extrusion: a systematic review. Clin Oral Investig 2020; 24:1101-1111. [PMID: 31953685 DOI: 10.1007/s00784-020-03199-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 01/07/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Traumatic dental injuries often affect the dental hard tissues, periodontal tissues, and dental pulp. Root resorption (RR) is a significantly concerning phenomenon that could lead to loss of the traumatized tooth. The purpose of this systematic review was to analyze the incidences of different types of RR after concussion, subluxation, lateral luxation, intrusive luxation, and extrusive luxation. MATERIAL AND METHODS Seven databases were electronically and manually searched for the identification of observational studies that evaluated the incidence of RR after luxation injuries. Following study selection, data extraction, and risk of bias assessment through MAStARI checklist, the GRADE quality of available evidence was assessed. RESULTS In total, 14 studies were included in the present systematic review. Ten and four studies presented a moderate and low RoB, respectively, and the overall GRADE quality of evidence was "very low" for all outcomes. The highest incidence rates of RR were observed for teeth with intrusive luxation, followed by those with extrusive luxation, lateral luxation, subluxation, and concussion. In general, the most common type of RR documented for all injuries was inflammatory RR, followed by replacement RR, surface RR, and internal RR. CONCLUSIONS Our findings suggest that RR most commonly occurs in association with intrusive luxation and by inflammatory RR. Awareness regarding the incidence of RR after injuries is useful for clinicians to minimize the risk and severity of its occurrence, because a late diagnosis of RR may limit treatment alternatives and result in tooth loss. CLINICAL RELEVANCE Knowledge about the incidence of RR in teeth with concussion and different types of luxation injuries can ensure appropriate follow-up protocols and favorable outcomes.
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Affiliation(s)
| | - Kamile Leonardi Dutra
- Department of Dentistry, Federal University of Santa Catarina, Florianópolis, Brazil
| | | | | | - Morgane Marion Kuntze
- Department of Dentistry, Federal University of Santa Catarina, Florianópolis, Brazil
| | | | - André Luís Porporatti
- Department of Dentistry, Federal University of Santa Catarina, Florianópolis, Brazil
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Krug R, Kremeier K, Krastl G. Long-term retention of avulsed maxillary permanent incisors replanted after prolonged non-physiological storage. Dent Traumatol 2018; 35:147-152. [PMID: 30296000 DOI: 10.1111/edt.12445] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/28/2018] [Accepted: 09/30/2018] [Indexed: 12/18/2022]
Abstract
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.
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Affiliation(s)
- Ralf Krug
- Department of Conservative Dentistry and Periodontology and Center of Dental Traumatology, University Hospital of Würzburg, Würzburg, Germany
| | | | - Gabriel Krastl
- Department of Conservative Dentistry and Periodontology and Center of Dental Traumatology, University Hospital of Würzburg, Würzburg, Germany
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10
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Souza BDM, Dutra KL, Kuntze MM, Bortoluzzi EA, Flores-Mir C, Reyes-Carmona J, Felippe WT, Porporatti AL, De Luca Canto G. Incidence of Root Resorption after the Replantation of Avulsed Teeth: A Meta-analysis. J Endod 2018; 44:1216-1227. [PMID: 29866405 DOI: 10.1016/j.joen.2018.03.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 03/05/2018] [Accepted: 03/09/2018] [Indexed: 10/14/2022]
Abstract
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.
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Affiliation(s)
| | - Kamile Leonardi Dutra
- Department of Dentistry, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Morgane Marion Kuntze
- Department of Dentistry, Federal University of Santa Catarina, Florianópolis, Brazil
| | | | - Carlos Flores-Mir
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta Edmonton, Alberta, Canada
| | | | - Wilson Tadeu Felippe
- Department of Dentistry, Federal University of Santa Catarina, Florianópolis, Brazil
| | - André Luís Porporatti
- Brazilian Centre for Evidence-Based Research, Department of Dentistry, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Graziela De Luca Canto
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta Edmonton, Alberta, Canada; Brazilian Centre for Evidence-Based Research, Department of Dentistry, Federal University of Santa Catarina, Florianópolis, Brazil
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11
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Fiore PMD, Hartwell GR. Dental Pulp Revascularization in a Replanted Avulsed Immature Maxillary Permanent Central Incisor. Eur Endod J 2017; 2:1-6. [PMID: 33403346 PMCID: PMC7757963 DOI: 10.5152/eej.2017.17031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 06/16/2017] [Accepted: 06/21/2017] [Indexed: 12/25/2022] Open
Abstract
An 8-year-old girl sustained an accidental traumatic avulsion of her right maxillary permanent central incisor. She arrived with her mother at a hospital dental clinic with the right maxillary central incisor tooth wrappe in a wet paper towel over 1 hour after the injury. Replantation was accomplished without root surface alteration or root canal intervention. Clinical and radiographic follow-up examinations for over 1 year revealed continued root growth and apical development of the replanted avulsed immature maxillary central incisor with no signs or symptoms of pulpal or periapical pathosis. Excellent outcomes were achieved for periodontal ligament reattachment without removal of the periodontal membrane and pulp revascularization without endodontic intervention.
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Affiliation(s)
- Peter M Di Fiore
- Department of Endodontics, University of Texas School of Dentistry, Houston, TX, USA
| | - Gary R Hartwell
- Department of Endodontics, Rutgers University School of Dental Medicine, Newark, NJ, USA
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12
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Zhu W, Zhang Q, Zhang Y, Cen L, Wang J. PDL regeneration via cell homing in delayed replantation of avulsed teeth. J Transl Med 2015; 13:357. [PMID: 26572489 PMCID: PMC4647325 DOI: 10.1186/s12967-015-0719-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 10/31/2015] [Indexed: 01/10/2023] Open
Abstract
Background This study was aimed to investigate whether regeneration of periodontal ligament (PDL) like tissue could be promoted by stromal cell-derived factor-1 (SDF1) and bone morphogenetic protein-7 (BMP7) induced cell homing in delayed replantation of avulsed teeth. Methods Canine mandibular premolar teeth were first extracted and air-dried for 2 h followed by complete detachment of their PDL tissues. The crown and pulp of the teeth were also removed. Twenty-four roots divided into two groups (n = 12/group) were used for the following in vivo transplantation. The roots of Group A were treated with 17 % EDTA for 24 h to achieve demineralization, and then coated with SDF1 and BMP7 supplemented collagen solution. The roots of Group B were similarly treated except being coated with a pristine collagen solution. The above roots were transplanted in the sockets that formed previously during tooth extraction. At 6 months’ post-operation, PDL-like tissue composed of spindle-shaped cells, capillaries and highly organized collagen fibers was observed in the interstitial space between the avulsed root surface and surrounding alveolar bone in Group A. The neo-fibers inserted deeply and perpendicularly into the cementum and adjacent bone. The periodontium-like characteristics of the neo-tissue was confirmed by immunohistochemical staining for collagen I, fibronectin and osteocalcin. Results A high incidence of PDL re-establishment as 42 % was achieved for samples of Group A. However, no PDL-like tissue was found but root ankylosis and replacement resorption as well as inflammatory resorption was observed in the replanted roots of Group B. Conclusions It can be confirmed that avulsed teeth could be successfully rescued even in delayed transplantation to avoid dentoalveolar ankylosis or replacement resorption via the current developed cell homing method. Electronic supplementary material The online version of this article (doi:10.1186/s12967-015-0719-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wenting Zhu
- Department of Pediatric Dentistry, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, No. 639, Zhi Zao Ju Road, Shanghai, 200011, China.
| | - Qian Zhang
- Department of Pediatric Dentistry, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, No. 639, Zhi Zao Ju Road, Shanghai, 200011, China.
| | - Yang Zhang
- Department of Pediatric Dentistry, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, No. 639, Zhi Zao Ju Road, Shanghai, 200011, China.
| | - Lian Cen
- School of Chemical Engineering, East China University of Science and Technology, No. 130, Mei Long Road, Shanghai, 200237, China. .,National Tissue Engineering Center of China, No. 68, East Jiang Chuan Road, Shanghai, 200241, China.
| | - Jun Wang
- Department of Pediatric Dentistry, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, No. 639, Zhi Zao Ju Road, Shanghai, 200011, China.
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13
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Abd-Elmeguid A, ElSalhy M, Yu DC. Pulp canal obliteration after replantation of avulsed immature teeth: a systematic review. Dent Traumatol 2015; 31:437-41. [DOI: 10.1111/edt.12199] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Ashraf Abd-Elmeguid
- School of Dentistry; Faculty of Medicine and Dentistry; University of Alberta; Edmonton AB Canada
| | - Mohamed ElSalhy
- School of Dentistry; Faculty of Medicine and Dentistry; University of Alberta; Edmonton AB Canada
| | - Donald C. Yu
- School of Dentistry; Faculty of Medicine and Dentistry; University of Alberta; Edmonton AB Canada
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Kostka E, Meissner S, Finke CH, Mandirola M, Preissner S. Multidisciplinary treatment options of tooth avulsion considering different therapy concepts. Open Dent J 2014; 8:180-3. [PMID: 25352922 PMCID: PMC4209498 DOI: 10.2174/1874210601408010180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 07/24/2014] [Accepted: 08/27/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Avulsion of permanent front teeth is a rare accident, mostly affecting children between seven and nine years of age. Replanted and splinted, these teeth often develop inflammation, severe resorption or ankylosis affecting alveolar bone development and have to be extracted sooner or later. OBJECTIVES The purpose of this study was to evaluate different therapy concepts to create a structured concept for the treatment of avulsions. RESULTS Based on existing therapy concepts, a concept for different initial conditions (dry time, age, growth, tooth, hard and soft tissues) was developed and is presented here. CONCLUSION A great deal of research has been performed during recent years and guidelines for the management of avulsions have been published. With the help of this literature it is possible to identify the best treatment procedure for each tooth. CLINICAL RELEVANCE The prognosis of avulsed teeth can be improved by considering evidence-based therapy concepts. Resorption, ankylosis and tooth loss could be minimized.
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Affiliation(s)
- Eckehard Kostka
- Department of Operative and Preventive Dentistry, Assmannshauser Straße 4-6, 14197 Berlin, Germany
| | - Simon Meissner
- Department of Oral Medicine, Dental Radiology and Oral Surgery, Assmannshauser Straße 4-6, 14197 Berlin,
Germany
| | - Christian H Finke
- Department of Orthodontics, Dentofacial Orthopedics and Pedodontics, Assmannshauser Straße 4-6, 14197 Berlin, Germany
| | - Manlio Mandirola
- Department of Orthodontics, Dentofacial Orthopedics and Pedodontics, Assmannshauser Straße 4-6, 14197 Berlin, Germany
| | - Saskia Preissner
- Department of Operative and Preventive Dentistry, Assmannshauser Straße 4-6, 14197 Berlin, Germany
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15
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Mertens B, Boukari A, Tenenbaum H. Long-term follow up of post-surgical tooth autotransplantation: a retrospective study. ACTA ACUST UNITED AC 2014; 7:207-14. [DOI: 10.1111/jicd.12126] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 07/19/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Brenda Mertens
- Department of Periodontology; University of Strasbourg; Strasbourg France
| | | | - Henri Tenenbaum
- Department of Periodontology; University of Strasbourg; Strasbourg France
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16
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Abstract
The aim of this report is to present the case of an accidentally avulsed maxillary central incisor kept in saline solution from the moment of trauma until its replantation 3 h later in a 13-year-old girl. The avulsed tooth was replanted back into the alveolar socket and splinted with composite resin. Calcium hydroxide intracanal dressing was used to prevent inflammatory root resorption. Radiographic and clinical examinations were performed during 27 months follow-up. During the 15 months follow-up period, the tooth remained in a stable functional position and did not reveal replacement resorption. But mild infraocclusion and root resorption were developed 21 months after replantation. The amount of damage to tooth and supporting structures, emergency treatment and follow-up period play a role in the prognosis of the avulsed tooth. It can be recommended to keep the avulsed tooth in saline solution at least when more appropriate storage media are not on handle immediately.
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Affiliation(s)
- Huseyin Tezel
- Department of Restorative Dentistry, Ege University, School of Dentistry, Bornova, Izmir, Turkiye
| | - Cigdem Atalayin
- Department of Restorative Dentistry, Ege University, School of Dentistry, Bornova, Izmir, Turkiye
| | - Gul Kayrak
- Department of English Language Teaching (Preparatory School), Dokuz Eylul University, School of Foreign Languages, Izmir, Turkiye
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17
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Calasans-Maia J, Neto A, Batista M, Alves A, Granjeiro J, Calasans-Maia M. Management of ankylosed young permanent incisors after trauma and prior to implant rehabilitation. ACTA ACUST UNITED AC 2013. [DOI: 10.1111/ors.12047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- J.A. Calasans-Maia
- Orthodontic Department; Fluminense Federal University; Nova Friburgo Brazil
| | - A.S. Neto
- Prived Prosthodontic Practice; Niteroi Brazil
| | - M.M.D. Batista
- Endodontics Department; Gama Filho University; Rio de Janeiro Brazil
| | - A.T.N.N. Alves
- Oral Pathology Department; Gama Filho University; Rio de Janeiro Brazil
| | - J.M. Granjeiro
- Cell Therapy Center and Biology Institute; Fluminense Federal University; Niteroi Brazil
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18
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Single-visit revascularization treatment of an immature permanent tooth with apical periodontitis: A case report. PEDIATRIC DENTAL JOURNAL 2013. [DOI: 10.1016/j.pdj.2013.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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19
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Andersson L, Andreasen JO, Day P, Heithersay G, Trope M, Diangelis AJ, Kenny DJ, Sigurdsson A, Bourguignon C, Flores MT, Hicks ML, Lenzi AR, Malmgren B, Moule AJ, Tsukiboshi M. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth. Dent Traumatol 2012; 39:412-419. [PMID: 22409417 DOI: 10.1111/j.1600-9657.2012.01125.x] [Citation(s) in RCA: 337] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Avulsion of permanent teeth is one of the most serious dental injuries, and a prompt and correct emergency management is very important for the prognosis. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the task group. The guidelines represent the current best evidence and practice based on literature research and professionals' opinion. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion or majority decision of the task group. Finally, the IADT board members were giving their opinion and approval. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care of avulsed permanent teeth.
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Affiliation(s)
- Lars Andersson
- Department of Surgical Sciences, Faculty of Dentistry, Health Sciences Center, Kuwait University, Kuwait City, Kuwait.
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20
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Lee W, Shon WJ, Baek SH, Kum KY, Kim HC. Outcomes of intentionally replanted molars according to preoperative locations of periapical lesions and the teeth. J Dent Sci 2012. [DOI: 10.1016/j.jds.2012.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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21
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Jain S, Agarwal V, Gupta AK, Prabhakar P. Replantation of Immature Avulsed Teeth with Prolonged Extraoral Dry Storage: A Case Report. Int J Clin Pediatr Dent 2012; 5:68-71. [PMID: 25206138 PMCID: PMC4093644 DOI: 10.5005/jp-journals-10005-1137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 01/22/2012] [Indexed: 11/23/2022] Open
Abstract
This case report presents delayed replantation of avulsed teeth after extended extraoral period and nonphysiological storage. Yet, long-term prognosis is not good, it presents alternate treatment modality to immediately restore esthetic and function as well as to promote the growth of alveolar crest for proper eruption of adjacent unaffected teeth until a definite prosthetic treatment seems appropriate. How to cite this article: Jain S, Agarwal V, Gupta AK, Prabhakar P. Replantation of Immature Avulsed Teeth with Prolonged Extraoral Dry Storage: A Case Report. Int J Clin Pediatr Dent 2012;5(1):68-71.
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Affiliation(s)
- Shweta Jain
- Senior Lecturer, Department of Conservative Dentistry and Endodontics NIMS Dental College, NIMS University, Jaipur, Rajasthan, India
| | - Vijay Agarwal
- Senior Lecturer, Department of Orthodontics, NIMS Dental College NIMS University, Jaipur, Rajasthan, India
| | - Arun Kumar Gupta
- Professor and Head, Department of Prosthodontics, NIMS Dental College, NIMS University, Jaipur, Rajasthan, India
| | - Pramod Prabhakar
- Associate Professor, Department of Prosthodontics, NIMS Dental College, NIMS University, Jaipur, Rajasthan, India
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22
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Nuvvula S, Mohapatra A, Kiranmayi M, Rekhalakshmi K. Anterior fixed interim prosthesis with natural tooth crown as pontic subsequent to replantation failure. J Conserv Dent 2011; 14:432-5. [PMID: 22144819 PMCID: PMC3227297 DOI: 10.4103/0972-0707.87220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Revised: 06/09/2011] [Accepted: 06/12/2011] [Indexed: 12/02/2022] Open
Abstract
Facial trauma resulting in tooth avulsion results in problems of physical and emotional nature for the patient and a challenge for the dentist. Avulsion accounts for 0.5–16% of traumatic injuries in the permanent dentition that can occur at any age and is most common in the young permanent dentition. As an emergency procedure, it is advisable to replant a traumatically avulsed tooth, but unfortunately long-term success is rather low. After unsuccessful replantation and subsequent extraction, it is prudent to replace the lost tooth to avoid aesthetic, masticatory, and psychological difficulties and also to prevent arch length discrepancy with various alternatives are available for the same. We presented a method for management of one of the two replanted teeth that showed failure, using the natural crown as pontic in a fixed semi-permanent bridge until a more definitive prosthesis can be fabricated at a later age for better patient compliance.
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Affiliation(s)
- Sivakumar Nuvvula
- Department of Paedodontics and Preventive Dentistry, Narayana Dental College and Hospital, Nellore, Andra Pradesh, India
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23
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Day PF, Duggal MS, High AS, Robertson A, Gregg TA, Ashley PF, Welbury RR, Cole BO, Westland S. Discoloration of Teeth after Avulsion and Replantation: Results from a Multicenter Randomized Controlled Trial. J Endod 2011; 37:1052-7. [DOI: 10.1016/j.joen.2011.04.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2011] [Revised: 04/16/2011] [Accepted: 04/18/2011] [Indexed: 10/18/2022]
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24
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Rocha SRT, Moro A, Moresca RC, Sydney G, Fraiz F, Baratto Filho F. Tratamento ortodôntico em pacientes com dentes reimplantados após avulsão traumática: relato de caso. Dental Press J Orthod 2010. [DOI: 10.1590/s2176-94512010000400007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUÇÃO: a alta prevalência de indivíduos com traumatismo dentário prévio ao tratamento ortodôntico justifica os cuidados a serem observados antes e durante o tratamento, considerando todas as implicações do movimento ortodôntico sobre os dentes traumatizados. Entre as lesões traumáticas dentárias, a avulsão com posterior reimplantação do dente é a que apresenta maior risco de complicações - como necrose pulpar, reabsorção radicular e anquilose -, sendo também a que inspira maiores cuidados pelo ortodontista. OBJETIVO: este trabalho busca, através do relato de um caso clínico, analisar as implicações do reimplante dentário após avulsão traumática, em pacientes que requerem tratamento ortodôntico. CONCLUSÕES: a movimentação ortodôntica de um dente reimplantado, após sua avulsão traumática, é possível desde que não ocorra qualquer sinal de anormalidade. Porém, dentes que sofrem anquilose não são passíveis de movimentação ortodôntica, mas devem ser preservados como mantenedores de espaço, até a reabsorção total da raiz, desde que não apresentem infraposição severa. Ocorrendo infraposição severa do dente anquilosado, é indicada a amputação da coroa e o sepultamento da raiz, como meio de favorecer a manutenção do osso alveolar na região, pois ocorrerá reabsorção por substituição da raiz sepultada, como ocorreu no caso clínico apresentado.
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25
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Petrovic B, MarkoviÄ D, Peric T, Blagojevic D. Factors related to treatment and outcomes of avulsed teeth. Dent Traumatol 2010; 26:52-9. [DOI: 10.1111/j.1600-9657.2009.00836.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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26
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Day P, Duggal M. Interventions for treating traumatised permanent front teeth: avulsed (knocked out) and replanted. Cochrane Database Syst Rev 2010:CD006542. [PMID: 20091594 DOI: 10.1002/14651858.cd006542.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Dental trauma is common. One of the most severe injuries is when a permanent tooth is knocked completely out (avulsed) of the mouth. In most circumstances the tooth should be replanted as quickly as possible. There is uncertainty on how best to prepare teeth for replantation. OBJECTIVES To compare the effects of a range of interventions for managing traumatised permanent teeth with avulsion injuries. SEARCH STRATEGY The Cochrane Oral Health Group's Trials Register (to 28th October 2009); CENTRAL (The Cochrane Library 2009, Issue 4); MEDLINE (1950 to October 2009); EMBASE (1980 to October 2009); www.clinicaltrials.gov/; www.controlled-trials.com/ and reference lists of articles were searched. There were no language restrictions. SELECTION CRITERIA Only randomised controlled trials (RCTs), that included a minimum follow-up period of 12 months, for interventions for avulsed and replanted permanent teeth were considered. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed trial quality and the risk of bias in studies to be included. MAIN RESULTS Three studies, involving a total of 162 patients and 231 teeth were identified. Study one (with a high risk of bias) investigated the effect of extra-oral endodontics. This showed no significant difference in radiographic resorption compared with intra-oral endodontics provided at week 1 for teeth avulsed for longer than 60 minutes dry time. Study two (which had a moderate risk of bias) investigated a 10-minute soaking in thymosin alpha 1 prior to replantation and then its further use as a daily gingival injection for the first 7 days. They reported a strong benefit at 48 months (14% with periodontal healing in the control group versus 77% for the experimental group). Study three (with a high risk of bias) investigated a 20-minute soaking with gentamycin sulphate (4x10(7) U/L) for both groups prior to replantation and then the use of hyperbaric oxygen daily in the experimental group for 80 minutes for the first 10 days. They reported a strong benefit at 12 months (43% periodontal healing versus 88% for the experimental group). There was no formal reporting of adverse events. AUTHORS' CONCLUSIONS The available evidence suggests that extra-oral endodontics is not detrimental for teeth replanted after more than 60 minutes dry time. Studies with moderate/high risk of bias indicate that soaking in thymosin alpha 1 and gentamycin sulphate followed by hyperbaric oxygen may be advantageous however, they have not previously been reported as interventions for avulsed teeth and need further validation. More evidence with low risk of bias is required and, with the low incidence of avulsed teeth, collaborative multicentre trials are indicated.
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Affiliation(s)
- Peter Day
- Department of Paediatric Dentistry, Leeds Dental Institute, Clarendon Way, Leeds, UK, LS2 9LU
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27
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Sapir S, Kalter A, Sapir MR. Decoronation of an ankylosed permanent incisor: alveolar ridge preservation and rehabilitation by an implant supported porcelain crown. Dent Traumatol 2009; 25:346-9. [DOI: 10.1111/j.1600-9657.2009.00788.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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28
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Mullane EM, Dong Z, Sedgley CM, Hu JCC, Botero TM, Holland GR, Nör JE. Effects of VEGF and FGF2 on the revascularization of severed human dental pulps. J Dent Res 2009; 87:1144-8. [PMID: 19029083 DOI: 10.1177/154405910808701204] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The long-term outcome of replanted avulsed permanent teeth is frequently compromised by lack of revascularization, resulting in pulp necrosis. The purpose of this study was to evaluate the effects of vascular endothelial growth factor (VEGF) and fibroblast growth factor (FGF-2) on the revascularization of severed human dental pulps. Tooth slices were prepared from non-carious human molars and treated with 0-50 ng/mL rhVEGF(165) or rhFGF-2 for 7 days in vitro. Both angiogenic factors enhanced pulp microvessel density compared with untreated controls (p < 0.05). Tooth slices were also treated with 0 or 50 ng/mL rhVEGF(165) for one hour prior to implantation into the subcutaneous space of immunodeficient mice. Treatment with rhVEGF(165) increased pulp microvessel density in vivo (p < 0.05). These results demonstrate that rhVEGF(165) enhanced neovascularization of severed human dental pulps and suggest that topical application of an angiogenic factor prior to replantation might be beneficial for the treatment of avulsed teeth.
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Affiliation(s)
- E M Mullane
- Department of Cariology, Restorative Sciences and Endodontics, University of Michigan School of Dentistry, 1011 N. University, Ann Arbor, MI 48109-1078, USA
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29
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Filippi C, Kirschner H, Filippi A, Pohl Y. Practicability of a tooth rescue concept the use of a tooth rescue box. Dent Traumatol 2008; 24:422-9. [DOI: 10.1111/j.1600-9657.2008.00598.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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30
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Polat ZS, Tacir IH. Esthetic rehabilitation of avulsed-replanted anterior teeth: a case report. Dent Traumatol 2008; 24:e385-9. [PMID: 18489473 DOI: 10.1111/j.1600-9657.2007.00551.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Avulsion is a complex injury affecting the pulp, periodontal ligament and the alveolar bone. Avulsed permanent teeth can survive following replantation. However, post-traumatic external root resorption eventually resulting in loss of the traumatized tooth is a frequent finding. After replantation of the avulsed teeth, esthetic requirements can be needed. Treatment options include porcelain laminate veneers, metal-ceramic restorations and all-ceramic crowns as well as minimally invasive procedures such as direct resin composite bonding. This article describes the restoration of avulsed and replanted teeth with direct resin composite laminate veneers. Because of the fact that lost fragments were recovered with the loss of anterior esthetic, and bearing in mind the patient's psychologically affected, we considered direct resin composite laminate veneer restoration of the avulsed and replanted teeth as the best therapeutic option. The patient was satisfied with the final result.
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Affiliation(s)
- Zelal Seyfioğlu Polat
- Prosthetics Department, Faculty of Dentistry, University of Dicle, Diyarbakir, Turkey.
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31
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Management of a multiple dentoalveolar trauma in permanent dentition with avulsion of a canine: a 4-year follow-up. J Endod 2008; 34:336-9. [PMID: 18291289 DOI: 10.1016/j.joen.2007.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2007] [Revised: 11/16/2007] [Accepted: 11/23/2007] [Indexed: 11/20/2022]
Abstract
Traumatic dental injuries are relatively frequent accidents that typically involve teeth in the maxillary anterior segment. The emergency treatment and the clinical decisions must be efficiently made at the time of injury, and there is a need for long-term follow-up because of the high incidence of complications. The aim of this article was to present the emergency and rehabilitation treatments of a multiple dentoalveolar trauma in the permanent dentition involving different extensions of enamel-dentin crown fracture, pulp exposure, and the avulsion of a canine. The treatment outcomes are reported up to the 4-year follow-up, and the clinical approaches and their rationale are discussed.
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32
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Sapir S, Shapira J. Decoronation for the management of an ankylosed young permanent tooth. Dent Traumatol 2008; 24:131-5. [DOI: 10.1111/j.1600-9657.2006.00506.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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33
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Díaz JA, Sandoval HP, Pineda PI, Junod PA. Conservative treatment of an ankylosed tooth after delayed replantation: a case report. Dent Traumatol 2007; 23:313-7. [PMID: 17803490 DOI: 10.1111/j.1600-9657.2006.00463.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
An 8-year-old boy sustained avulsion of his upper right maxillary central incisor and lateral luxation of his upper left maxillary incisors. Subsequently, the upper right maxillary central incisor developed replacement resorption, and both upper left maxillary incisors developed pulpal canal obliteration. In the ankylosed tooth, decoronation procedure was performed, and in the 44-month follow-up period the involved alveolar site showed vertical apposition of bone and continuing replacement resorption. Decoronation is a surgical procedure that allows preservation of the bone volume for the future, avoiding aesthetic disturbances and more aggressive treatments in cases where other therapeutic alternatives are not feasible.
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Affiliation(s)
- Jaime Andrés Díaz
- Dental Department, Faculty of Medicine, University of La Frontera, Temuco, Chile.
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34
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Cobankara FK, Ungor M. Replantation after extended dry storage of avulsed permanent incisors: report of a case. Dent Traumatol 2007; 23:251-6. [PMID: 17635361 DOI: 10.1111/j.1600-9657.2005.00425.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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.
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Affiliation(s)
- Funda Kont Cobankara
- Department of Endodontics, Faculty of Dentistry, Selçuk University, Konya, Turkey.
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35
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Campbell KM, Casas MJ, Kenny DJ. Development of ankylosis in permanent incisors following delayed replantation and severe intrusion. Dent Traumatol 2007; 23:162-6. [PMID: 17355290 DOI: 10.1111/j.1600-9657.2005.00420.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Ankylosis is a predictable outcome for replanted incisors and for most severely intruded incisors. There is no treatment to arrest or reverse this periodontal ligament complication. Ankylosis of the incisors of preadolescents alters local alveolar growth and eventually produces tooth loss subsequent to resorption. Currently, clinical methods used to diagnose ankylosis in the early postinjury period include subjective assessments of percussion sound and mobility and quantitative devices such as the Periotest. This paper describes the progression of ankylosis in two preadolescent patients that sustained severe trauma to their maxillary central incisors. A number of clinical assessments for diagnosis of ankylosis were compared for their usefulness, reliability and suitability.
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Affiliation(s)
- Karen M Campbell
- Department of Dentistry, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada
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36
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Cobankara FK, Ungor M. Replantation after extended dry storage of avulsed permanent incisors: report of a case. Dent Traumatol 2007. [DOI: 10.1111/j.1600-9657.2007.00425.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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37
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Cohenca N, Stabholz A. Decoronation ? a conservative method to treat ankylosed teeth for preservation of alveolar ridge prior to permanent prosthetic reconstruction: literature review and case presentation. Dent Traumatol 2007; 23:87-94. [PMID: 17367456 DOI: 10.1111/j.1600-9657.2006.00454.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Avulsed teeth that are stored extraorally in a dry environment for >60 min generally develop replacement root resorption or ankylosis following their replantation due to the absence of a vital periodontal ligament on their root surface. One negative sequelae of such ankylosis is tooth infra-positioning and the local arrest of alveolar bone growth. Removal of an ankylosed tooth may be difficult and traumatic leading to esthetic bony ridge deformities and optimal prosthetic treatment interferences. Recently a treatment option for ankylosed teeth named 'de-coronation' gained interest, particularly in pediatric dentistry that concentrated in dental traumatology. This article reviews the up-to-date literature that has been published on decoronation with respect to its importance for future prosthetic rehabilitation followed by a case presentation that demonstrates its clinical benefits.
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Affiliation(s)
- Nestor Cohenca
- Department of Endodontics, School of Dentistry, University of Washington, Seattle, WA 98195-7448, USA.
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Pohl Y, Krema M, Kirschner H. Interrelation between endodontic status, pathologic cemental granules and periodontal ligament adhering to the root of extracted teeth. ACTA ACUST UNITED AC 2006; 103:127-33. [PMID: 17178506 DOI: 10.1016/j.tripleo.2005.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2005] [Revised: 11/30/2005] [Accepted: 11/30/2005] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To evaluate if the endodontic status has influence on the adherence of periodontal ligament (PDL) to extracted teeth and if the presence of "pathologic granules" is correlated to the endodontic status and/or the amount of adhering PDL. STUDY DESIGN Extracted teeth with different endodontic status and exhibiting no marginal periodontitis were histologically examined. RESULTS Observation of pathologic granules was related to a nonvital endodontium and to acute peroperative inflammation. Pathologic granules and denudation of the extracted roots were significantly related. Acute peroperative inflammation and low extraction forces were related to denudation of the roots. Such relation was not found for endodontic status, tooth type, root-form, and age of patients. CONCLUSION The existence of pathologic granules in unexposed cementum is strictly related to teeth with a nonvital endodontium. There is no effect of the endodontic status on the adherence of PDL when an acute inflammation is absent.
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Affiliation(s)
- Yango Pohl
- Department of Oral Surgery, University of Bonn, Bonn, Germany.
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Filippi A, Pohl Y, von Arx T. Treatment of replacement resorption by intentional replantation, resection of the ankylosed sites, and Emdogain�? results of a 6-year survey. Dent Traumatol 2006; 22:307-11. [PMID: 17073922 DOI: 10.1111/j.1600-9657.2005.00363.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The present clinical study investigated the outcome of intentional replantation using resection of the ankylosed sites of the root, extraoral endodontic treatment using titanium posts and Emdogain for periodontal healing following trauma-related ankylosis. During an evaluation period of 6 years, 16 ankylosed teeth affected by replacement resorption were treated as described. Evaluation parameters before treatment and during the follow-up period included Periotest scores, percussion sound and periapical radiographs. All findings were compared to those of the adjacent teeth. In a second accident, one tooth was lost after 7 months and was excluded as a dropout. Ankylosis did not recur in seven replanted teeth, which were observed for an average of 52.3 months (range: 24-68 months). Ankylosis recurred in eight teeth after an average period of 12 months (range: 4-26 months). An infraocclusion, normal or only slightly reduced Periotest scores and normal percussion sound were preoperatively found in six of seven successfully replanted teeth, which corresponded to a relatively small area of ankylosis. The majority of the teeth showing recurrent ankylosis preoperatively presented with normal position, negative Periotest scores and a high percussion sound which corresponded to an extended area of ankylosis. Statistically significant relationship between preoperative findings and the treatment outcome (P = 0.031) have become apparent. The results indicate that the treatment of minor areas of ankylosis by intentional replantation, resection of the ankylosed sites and Emdogain appeared to prevent or delay the recurrence of ankylosis in 7 of 15 teeth.
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Affiliation(s)
- Andreas Filippi
- Department of Oral Surgery, University of Basel, Basel, Switzerland.
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40
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41
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Springer ING, Açil Y, Spies C, Jepsen S, Warnke PH, Bolte H, Kuchenbecker S, Russo PAJ, Wiltfang J, Terheyden H. RhBMP-7 improves survival and eruption in a growing tooth avulsion trauma model. Bone 2005; 37:570-7. [PMID: 16043428 DOI: 10.1016/j.bone.2005.04.037] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2005] [Revised: 04/25/2005] [Accepted: 04/29/2005] [Indexed: 11/17/2022]
Abstract
Long-term loss of avulsed and replanted teeth is a frequent clinical problem. Bone morphogenetic protein-7 (BMP 7) induces cementogenesis in periodontitis-associated periodontal ligament (PDL) defects. This study's aim was to assess the utility of rhBMP 7 in a tooth avulsion trauma model in growing individuals. Immature primary incisors of 12 minipigs were extracted. PDL and cementum were removed either partially (group 1: 4 mm2 [n=28 teeth]; group 2: 16 mm2 [n=26 teeth]) or totally (group 3 [n=26 teeth]). 500 microg rhBMP 7/g collagen matrix was applied to the teeth from one side while the corresponding teeth on the contralateral side served as controls (split mouth model). After an experimental period of 4 months, microradiography, fluorescence and light microscopy of nondecalcified sections were performed. All teeth of group 1 survived and all teeth of group 3 were lost, whether rhBMP-7 was applied or not. In group 2, nine out of ten teeth survived when rhBMP-7 was applied and four out of ten teeth were lost when rhBMP-7 was not applied. In the presence of rhBMP-7, eruption of teeth in group 2 was significantly improved (difference [median]: 5 mm, P<0.05, n=6). Even though there was a tendency towards increased deposition rates of cementum under rhBMP-7, this difference was not significant (Wilcoxon: P>0.05, ANOVA: P=0.002; n=6/group). In conclusion, rhBMP-7 improved survival rates and eruption of replanted teeth in growing individuals. No adverse effects were seen. Based on the present results, future clinical trials appear to be warranted.
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Affiliation(s)
- Ingo N G Springer
- Department of Oral and Maxillofacial Surgery, University of Kiel, Arnold-Hellerstr. 16, D-24105 Kiel, Germany.
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42
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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.
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Affiliation(s)
- Vivianne Chappuis
- Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Berne, Switzerland.
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43
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Campbell KM, Casas MJ, Kenny DJ, Chau T. Diagnosis of ankylosis in permanent incisors by expert ratings, PeriotestR and digital sound wave analysis. Dent Traumatol 2005; 21:206-12. [PMID: 16026526 DOI: 10.1111/j.1600-9657.2005.00305.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The objectives of this investigation were to: (i) assess the reliability of expert raters to detect ankylosis from recordings of percussion sounds, (ii) measure differences in Periotest values (PTV) between ankylosed and non-ankylosed incisors and (iii) identify characteristic differences in recorded percussion sounds from ankylosed and non-ankylosed incisors using digital sound wave analysis. A convenience sample of healthy children (age range 7-18 years) was invited to participate. Ankylosis group children had one or more documented ankylosed maxillary incisors. Control group children had intact, non-ankylosed incisors. Digital recordings of percussion sounds and PTV were acquired for each incisor of interest. Four experienced pediatric dentists rated the randomized percussion sound pairs for the presence of ankylosis. Percussion sounds were also subjected to digital sound wave analysis. Overall agreement for the expert raters was substantial (kappa = 0.7). Intra-rater agreement was substantial to almost perfect (kappa = 0.6-0.9). Diagnosis of ankylosis demonstrated sensitivity of 76-92% and specificity of 74-100%. PTV from ankylosed incisors were statistically lower than PTV from non-ankylosed incisors. Ankylosed incisor digital sound wave signals exhibited significantly more energy in high-frequency bands than non-ankylosed incisors. This investigation demonstrated that: (i) experienced pediatric dentists reliably detected ankylosis by percussion sound alone; (ii) PTV for ankylosed incisors were statistically lower than PTV from non-ankylosed incisors; and (iii) ankylosed incisors exhibited a higher proportion of their signal energy in high-frequency bands.
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Affiliation(s)
- Karen M Campbell
- Department of Dentistry, Bloorview MacMillan Children's Centre, University of Toronto, Toronto, Canada
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Pohl Y, Filippi A, Kirschner H. Results after replantation of avulsed permanent teeth. I. Endodontic considerations. Dent Traumatol 2005; 21:80-92. [PMID: 15773887 DOI: 10.1111/j.1600-9657.2004.00297.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- Yango Pohl
- Department of Oral Surgery, University of Bonn, Germany.
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Pohl Y, Wahl G, Filippi A, Kirschner H. Results after replantation of avulsed permanent teeth. III. Tooth loss and survival analysis. Dent Traumatol 2005; 21:102-10. [PMID: 15773889 DOI: 10.1111/j.1600-9657.2004.00299.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Avulsed permanent teeth were replanted following immediate extraoral endodontic treatment by insertion of posts from a retrograde direction. Some teeth were rescued in a physiologic environment (tissue culture medium contained in a tooth rescue box), and in some cases antiresorptive-regenerative therapy (ART) was used. The aim of the study was to identify variables that influence the incidence of tooth loss and the survival of avulsed and replanted permanent incisors. Twenty-eight permanent teeth in 24 patients aged 7-17 years were investigated. In all teeth extraoral endodontic treatment by retrograde insertion of posts was performed. All nine teeth with functional healing (FH) were in situ. Of the 19 teeth with non-FH, seven were removed to allow transplantations. Two teeth were removed due to severe infrapositions. One tooth was lost following a new trauma. No tooth was lost due to acute infections. In descriptive statistics the incidence of tooth loss was significantly related to healing (P = 0.0098, Fisher's exact test), to treatment planning, i.e. consecutive replantation of premolars and primary canines (P = 0.0001, Fisher's exact test) and to immediate physiologic rescue (P = 0.0394). ART was related to tooth loss when tested in teeth with a compromised periodontal ligament (P = 0.0389). No influence could be found for the parameters maturity, age and all other factors. In a regression analysis treatment planning was the only factor left which had a significant influence (P = 0.0002). The estimated mean survival time (Kaplan-Meier analysis) for all teeth was 57.3 months. The survival was significantly reduced (P = 0.0002, log rank test) when consecutive transplantations were intended and performed. No influence could be found for maturity, age and all other factors. The different findings to previous studies can be explained by the prevention of complications related to conventional endodontic treatment approaches. Statistics have to be carefully interpreted due to case preselection which is determined by the treatment guidelines and actual treatment options of the individual treating dentist.
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Affiliation(s)
- Yango Pohl
- Department of Oral Surgery, University of Bonn, Bonn, Germany.
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Nguyen PMT, Kenny DJ, Barrett EJ. Socio-economic burden of permanent incisor replantation on children and parents. Dent Traumatol 2004; 20:123-33. [PMID: 15144442 DOI: 10.1111/j.1600-4469.2004.00235.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study describes the socio-economic burden and attitudes of children and their parents following replantation of avulsed incisors. Records of 80 patients with 99 avulsion injuries treated in a teaching hospital clinic from 1988 to 1999 were reviewed. Mean age at time of injury was 10.6 years (range = 6.6-17.7 years). Complete records for a minimum of 1 year were obtained for 43 patients with 60 replanted incisors. Mean treatment procedures provided during the first year included 5.5 diagnostic periapical radiographs, 1.9 occlusal radiographs, 1.3 pulpectomies, and 2.7 pulp medicament applications. The mean estimated treatment cost and direct time (dentist) for first-year post-trauma management was 1465 dollars CAD and 7.2 h, respectively. Treatment costs were significantly higher during the first year post-trauma for patients who had their incisors extracted (P = 0.04), but there was no significant difference in direct treatment time between the two groups (P = 0.19). Twenty-one patient-parent pairs were surveyed for a number of qualitative factors. Ninety per cent of patients and 86% of parents reported that school and work time was lost. Even after having gone through the painful experience of replantation, the demands of recall, and in some cases, extraction, the majority of patients (67%) and parents (81%) stated that they would have still made the same (replantation) decision. Patient and parent responses were not statistically different (P = 0.453). Almost half the parents stated they would be willing to pay over 2000 dollars CAD to save an incisor. Patients rated retention of an incisor as significantly more important than infraocclusion. This is the first study to quantify the treatment burden of replantation of avulsion injuries exclusively in the pediatric population. This study describes the socio-economic burden and responsibilities of patient/parent and dentist and their role in informed consent.
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Affiliation(s)
- Phu-My T Nguyen
- The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
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Majorana A, Bardellini E, Conti G, Keller E, Pasini S. Root resorption in dental trauma: 45 cases followed for 5 years. Dent Traumatol 2003; 19:262-5. [PMID: 14708650 DOI: 10.1034/j.1600-9657.2003.00205.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
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.
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Affiliation(s)
- A Majorana
- Dental School, University of Brescia, Italy.
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Pohl Y, Filippi A, Kirschner H. Extraoral endodontic treatment by retrograde insertion of posts: a long-term study on replanted and transplanted teeth. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2003; 95:355-63. [PMID: 12627110 DOI: 10.1067/moe.2003.19] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
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.
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Affiliation(s)
- Yango Pohl
- Department of Oral Surgery, University of Bonn, Germany.
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Moffat MA, Smart CM, Fung DE, Welbury RR. Intentional surgical repositioning of an ankylosed permanent maxillary incisor. Dent Traumatol 2002; 18:222-6. [PMID: 12442833 DOI: 10.1034/j.1600-9657.2002.00113.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Replacement resorption (ankylosis) may be a significant complication after replantation of avulsed permanent incisor teeth. This report explains the aetiology, diagnosis, management and current treatment options in ankylosis and then describes an alternative surgical technique, intentional luxation and repositioning. This technique, in the presence of an acceptable root length, may be a realistic treatment option in adolescence until osseointegrated implants can be considered at the age of 18-20 years.
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Affiliation(s)
- Michelle A Moffat
- Glasgow Dental Hospital and School, The Royal Hospital for Sick Children, UK
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50
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Filippi A, Pohl Y, von Arx T. Treatment of replacement resorption with Emdogain--a prospective clinical study. Dent Traumatol 2002; 18:138-43. [PMID: 12154769 DOI: 10.1034/j.1600-9657.2002.00078.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The present clinical study investigated the outcome of intentional replantation using Emdogain for periodontal healing following trauma-related ankylosis. Sixteen ankylosed teeth affected by replacement resorption were treated as follows: After tooth extraction, the root canal was obturated with a retrograde titanium post. Emdogain was applied to the root surface and into the extraction socket with subsequent replantation of the tooth. Evaluation parameters included horizontal and vertical Periotest scores, percussion sound and periapical radiographs. All findings were compared to those of the adjacent teeth. The mean follow-up period was 15 months (range 4-24 months). Eleven teeth showed no signs of recurrence of ankylosis: they were in full function and exhibited no pathological clinical findings. Four severely traumatized teeth demonstrated a recurrence of ankylosis after a mean period of 6 months, one tooth was lost in a second accident after 7 months. The estimated probability of 1 year without recurrence of ankylosis was P=0.66 (95% confidence interval [0.40; 0.94]). The mean survival time was 10.2 months (SD 1.1). The results indicate that treatment of replacement resorption following light to moderate trauma with replantation and Emdogain appears to prevent or delay recurrence of ankylosis in many cases.
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Affiliation(s)
- Andreas Filippi
- Department of Oral Surgery, University of Basel, Switzerland.
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