Effect of intra-alveolar delivery of Frondoside A on inflammatory response of delayed tooth replantation

BACKGROUND/AIM

Frondoside A is a sea cucumber extract which is well known for its anti-inflammatory and immunomodulatory properties. The purpose of this study was to evaluate the effect of Frondoside A application in the alveolar socket on inflammatory responses after delayed replantation in rat teeth.

MATERIALS AND METHODS

Human periodontal ligament cells were cultured and exposed to Frondoside A. Cell-counting kit-8 assay was performed to evaluate the cell viability and nitric oxide assay was performed to assess the anti-inflammatory effect of Frondoside A. Molars were extracted from 32 Sprague-Dawley rats and randomly divided into control and Frondoside A groups. After 30 min of extra-oral dry time, molars were replanted. In the Frondoside A group, Frondoside A solution was applied in the alveolar socket before replantation. The animals were sacrificed after 28 days and histologically and immunohistochemically evaluated.

RESULTS

0.5 μM Frondoside A showed higher cellular viability at 6 h and lower production of nitric oxide compared with other Frondoside A solutions (p < .05). The Frondoside A group demonstrated lower inflammatory resorption scores in both middle 1/3 and apical 1/3 of root compared to the control group (p < .05). The Frondoside A group showed lower levels of expression in both cathepsin K and CD45 compared with the control group (p < .05).

CONCLUSIONS

Within the limits of this study, intra-alveolar delivery of Frondoside A alleviates inflammatory root resorption in delayed replantation of rat teeth.

Controversies in Dental Traumatology

The management of traumatic dental injuries is more a shade of gray than it is black and white because not all treatment procedures used for dental trauma management are fully evidence based. This chapter has highlighted some of the gray areas related to the treatment and outcome of traumatic dental injuries. Significant controversies in the management of luxation and avulsive injuries have been brought out. Adjunctive treatment such as antibiotic usage, tetanus vaccination, and pain management is also addressed.

The effect of fibroblast growth factor-2 on the outcomes of tooth replantation: A systematic review of animal studies

Background/Aim: The ideal treatment of tooth avulsion is replantation. However, replanting teeth may lead to root resorption. Fibroblast growth factor-2 (FGF-2) is a cytokine that plays an important role in wound repair and tissue regeneration. Recently, FGF-2 has been studied a potential regenerative agent to prevent root resorption and ankylosis. The aim of this review is to analyze and summarize the currently available literature focusing on using FGF-2 based regenerative modalities to improve the outcomes of tooth replantation. Materials and Methods: An electronic search was conducted via PubMed/Medline, Google Scholar and ISI Web of Knowledge, using the Medical Subject Headings (MeSH) terms "Basic fibroblast growth factor," "Fibroblast growth factor-2," "tooth replantation," and "replantation" for studies published between January 2001 and June 2021. Data was extracted and quality assessment was carried using the ARRIVE guidelines. Results: Nine animal studies were included in this review. In six studies, FGF-2 had a favorable effect on the tissue regeneration around roots of replanted teeth when compared to other treatment groups. However, quality assessment of the studies revealed many sources of bias and deficiencies in the studies. Conclusions: Within the limitations of this study, it may be concluded that FGF-2 may improve the outcomes of delayed replantation of avulsed teeth. However, more long-term animal studies, with improved experimental designs, and clinical trials are required to determine the clinical potential of the growth factor in improving the outcomes of delayed tooth replantation.

Effectiveness of intentional replantation in managing teeth with apical periodontitis: A systematic review

BACKGROUND

Intentional replantation (IR) to treat disease of endodontic origin remains controversial. While IR has been advocated by some clinicians as another valid treatment option, others consider it as a treatment procedure of last resort.

OBJECTIVE

To systematically review and critically evaluate the effectiveness of IR compared with nonsurgical root canal treatment/retreatment or apical surgery in terms of clinical and patient-related outcomes in managing permanent teeth with apical periodontitis (AP).

METHODS

A literature search of five databases (PubMed, Embase, Scopus, Web of Science and Cochrane Central register of Controlled Trials), and the grey literature (Networked Digital Library of Theses and Dissertations, Open Access Theses and Dissertations, DART-Europe E-theses Portal, British Library E-Theses Online Service), from inception to November 2021, was conducted. Randomised clinical trials, comparative clinical trials (CCTs), nonrandomised, retrospective, and prospective comparative cohort and case-control two arm studies which evaluated clinical and/or patient-related outcomes of permanent teeth with AP treated with IR compared with nonsurgical root canal treatment/retreatment or apical surgery were identified. The quality of the studies was appraised using the Cochrane risk of bias tool for randomized trials (RoB 2.0), the Robins-I for nonrandomized controlled clinical trials and the Newcastle-Ottawa scale for observational studies. Two independent reviewers were involved in the literature selection, performed the data extraction and the appraisal of the studies identified; disagreements were resolved in conjunction with a third reviewer.

RESULTS

No comparative study was identified from the literature search. Four longitudinal studies (one prospective and three retrospective) were identified during the screening of titles and abstracts but were excluded after reading the full text, because only IR was evaluated (single arm studies).

DISCUSSION

The available evidence on IR is mainly based on observational studies, which reported high overall mid- to long-term survival, and low complication rates. The results suggest that IR may represent an alternative treatment procedure to solve problems of endodontic origin. However, in the absence of high-quality evidence from CCTs, clinical decision-making should be on a case-by-case basis and in accordance with the clinician's experience and the patient's preference.

CONCLUSION

Clinical studies showed that IR may be a treatment modality to manage problems of endodontic origin. However, clinical trials comparing the effectiveness of IR with nonsurgical root canal treatment/retreatment or apical surgery are still required given the paucity of evidence.

Professional assessment compared to patients' attitudes toward tooth replacement: a cross-sectional study

BACKGROUND

There is a difference between patient self-assessment and professional assessment of oral health needs; therefore, the aim of the study was to investigate patients' individual needs and awareness of replacing missing teeth with prostheses and then to compare this information with professionally assessed clinical prosthetic needs in the Eastern Province of Saudi Arabia.

METHODS

This was a cross-sectional study conducted in the Eastern Province of Saudi Arabia. The study subjects were recruited from Imam Abdulrahman bin Faisal University in Dammam City, Primary Health Care Centers in Alhasa City and from health education campaigns in the same area. All the patients were provided with a questionnaire related to the effect of missing teeth and replacement options, then underwent a clinical examination performed by a well-trained investigator. Statistical analyses were performed using JMP data analysis software (JMP®, Version 16. SAS Institute Inc., Cary, NC, 1989-2021.) RESULTS: A total of 102 participants were included. Most of the participants (94.2%) reported their need to replace missing teeth. Most of the participants stated that losing teeth (teeth) affected their ability to chew food and their appearance (82.6% and 61.6%, respectively). Dental caries was the main reason behind teeth extraction in 77.9% of the study sample. Fixed partial prosthesis was the first treatment option preferred by 33.7%, followed by implant-supported prosthesis with 25.6% to replace the missing teeth. Only 3.5% of participants preferred not to restore the missing teeth. Professional screening showed that 48.8% of the participants had one missing anterior tooth or more, which dictates the need for esthetic restoration, and 58.1% of the participants had three missing posterior teeth or more, which dictates the need for functional restoration.

CONCLUSIONS

Patient knowledge and attitudes toward replacing missing teeth in terms of their functional and esthetic needs were variable among the population in comparison to the professional assessment of patient needs. Dentists plays a major role in raising the level of awareness about missing teeth replacement. The results of this study serve as baseline data for any related future studies.

Health economic evaluation of forced orthodontic extrusion of extensively damaged teeth: up to 6-year results from a clinical study

OBJECTIVES

Clinical data on retaining extensively damaged teeth using forced orthodontic extrusion followed by restorative rehabilitation are scarce, and economic evaluations are basically absent. A health economic evaluation of this method was performed based on a clinical study.

MATERIALS AND METHODS

In a convenience sample of individuals recruited from routine care, extensively damaged teeth were orthodontically extruded prior to restoration. Patients were followed up for up to 6 years. The health outcome was tooth retention time. Direct medical, non-medical, and indirect initial and follow-up costs were estimated using the private payer's perspective in German healthcare. Association of initial direct medical treatment costs and cofounding variables was analyzed using generalized linear models. Success and survival were secondary outcomes.

RESULTS

A total of 35 teeth in 30 patients were followed over a mean ± SD of 49 ± 19 months. Five patients (14%) dropped out during that period. Median initial costs were 1941€ (range: 1284-4392€), median costs for follow-up appointments were 215€ (range: 0-5812€), and median total costs were 2284€ (range: 1453 to 7109€). Endodontic re-treatment and placement of a post had a significant impact on total costs. Three teeth had to be extracted and in three patients orthodontic relapse was observed. The survival and success rates were 91% and 83%, respectively.

CONCLUSIONS

Within the limitations of this clinical study, total treatment costs for orthodontic extrusion and subsequent restoration of extensively damaged teeth were considerable. Costs were by large generated initially; endodontic and post-endodontic therapies were main drivers. Costs for retreatments due to complications were limited, as only few complications arose.

CLINICAL RELEVANCE

The restoration of extensively damaged teeth after forced orthodontic extrusion comes with considerable initial treatment costs, but low follow-up costs. Overall and over the observational period and within German healthcare, costs are below those for tooth replacement using implant-supported crowns.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: DRK S00026697).

Advances in Esthetic, Immediate Tooth Replacement Therapy Aimed at Improving Clinical Outcomes

The criteria for successful tooth replacement in the esthetic zone is comprehensive and often complex. Merely achieving osseointegration is no longer the bar for which clinicians strive to reach in this endeavor. Achieving and maintaining hard- and soft-tissue stability as well as physiologic, scalloped soft-tissue architecture to frame cosmetic restorations is the ultimate goal of esthetic, immediate tooth replacement therapy (EITRT).

Intentional Replantation Of Mandibular First Molar With Two Years Follow Up- Case Report

Intentional replantation (IR) is a reliable and predictable treatment option for cases with failed non-surgical root canal treatment. The success of IR is found to be 52-95%. The current case is of 35years old female who presented with severe pain and swelling in lower right first mandibular molar with previously initiated non-surgical root canal treatment that resulted in instrument separation in mesio-buccal canal. Periapical radiograph showed rarefactions at furcation area, mesial and distal root apices. It was decided to complete the non-surgical root canal treatment followed by intentional replantation and retrograde filling with MTA. The tooth was found to be asymptomatic after two years follow up and periapical radiographs depicted complete healing. Intentional replantation with careful case selection is a successful, easy and reliable treatment option for hopeless cases. Atraumatic extraction, minimum extra-alveolar time and aseptic techniques during the procedure are the key factors for success of the procedure.

[Effects of human periodontal ligament fibroblast-derived exosomes on reducing rat root resorption after delayed tooth replantation]

PURPOSE

To explore the effect of healthy human periodontal ligament fibroblasts (hPDLFs) -derived exosomes on tooth resorption after delayed tooth replantation in rats and its possible mechanism.

METHODS

The exosomes derived from hPDLFs were isolated and identified in thirty six-week-old SD rats and randomly divided into control group and exosome group. The right maxillary first molar was extracted to establish a delayed tooth replantation model. The dislocated teeth were implanted back into the alveolar fossa after 30 minutes. 40 μL Hanks' balanced salt solution (HBSS) were injected into the periodontal tissue, and the experimental group was injected with 40 μL HBSS containing exosomes. The rats were sacrificed at 1, 2, and 4 weeks. Hematoxylin-eosin (H-E) staining was used to observe tooth resorption. Tartrate-resistant acid phosphatase(TRAP) staining was used to observe the number of osteoclasts. The expression of osteoprotegerin(OPG) in periodontal ligament was detected by immunohistochemical staining. The differences in distribution of each genotype were analyzed with SPSS 17.0 software package.

RESULTS

The identification experiment showed that extracellular vesicles were exosomes. hPDLFs-derived exosomes inhibited root resorption after delayed tooth replantation, reduced the expression of TRAP-positive osteoclasts (P＜0.05), and promoted expression of OPG in periodontal ligament (P＜0.05).

CONCLUSIONS

After delayed tooth replantation, PDLFs-derived exosomes reduce the number of osteoclasts, promote OPG expression in the periodontal ligament, and reduce tooth root resorption after replantation.

Platelet-derived growth factor-BB regenerates functional periodontal ligament in the tooth replantation

Tooth ankylosis is a pathological condition of periodontal ligament (PDL) restoration after tooth replantation. Platelet-derived growth factor-BB (PDGF-BB) has been proposed as a promising factor for preventing tooth ankylosis. Using rat tooth replantation model, we investigated whether PDGF-BB accelerates the repair of PDL after tooth replantation without ankylosis, and its molecular mechanisms. In PDGF-BB pretreated replanted teeth (PDGF-BB group), ankylosis was markedly reduced and functionally organized PDL collagen fibers were restored; the mechanical strength of the healing PDL was restored to an average of 76% of that in non-replanted normal teeth at 21 days. The numbers of PDGF-Rβ- and BrdU-positive cells in the periodontal tissues of the PDGF-BB group were greater than those of atelocollagen pretreated replanted teeth (AC group). Moreover, in the PDGF-BB group, the periodontal tissues had fewer osteocalcin-positive cells and decreased number of nuclear β-catenin-positive cells compared to those in the AC group. In vitro analyses showed that PDGF-BB increased the proliferation and migration of human periodontal fibroblasts. PDGF-BB downregulated mRNA expressions of RUNX2 and ALP, and inhibited upregulatory effects of Wnt3a on β-catenin, AXIN2, RUNX2, COL1A1, and ALP mRNA expressions. These findings indicate that in tooth replantation, topical PDGF-BB treatment enhances cell proliferation and migration, and inhibits canonical Wnt signaling activation in bone-tooth ankylosis, leading to occlusal loading of the PDL tissues and subsequent functional restoration of the healing PDL. This suggests a possible clinical application of PDGF-BB to reduce ankylosis after tooth replantation and promote proper regeneration of PDL.

Intentional Replantation for a Right Mandibular Premolar

The present study reports a case of intentional replantation (IR) for a right mandibular second premolar (#45). For the present case, root canal retreatment was first considered after removal of the metal post and core. When the metal post and core could not be removed from #45, micro-apical surgery or intentional tooth replantation was performed. Six-month postoperative evaluation revealed that the right mandibular second premolar had no obvious symptoms of discomfort, and the clinical follow-up revealed uneventful healing and good bone regeneration. The short-term clinical efficacy was acceptable. For cases with root canal treatment failure, when the apical surgical access could not be established due to the adjacent important anatomical structures, IR may be employed as an accepted endodontic treatment procedure. Key Words: Root canal treatment failure, Post-core crown, Root canal retreatment, Intentional replantation.

Proliferation of Fibroblast Cells in Periradicular Tissue Following Intentional Replantation of Vertical Root Fractures Using Two Materials

AIM

This study aimed to investigate the fibroblast cells proliferation in periradicular tissue using mineral trioxide aggregate (MTA) and self-adhesive resin cement as the adhesive material for vertical root fracture fragments following intentional replantation.

MATERIALS AND METHODS

This study used 27 male New Zealand rabbits aged 8-12 weeks. The mandibular incisor of each rabbit was extracted, and to simulate vertical fracture, the incisor tooth was sectioned vertically from the cervical to the 2/3 apical. The samples were randomly divided into three groups of nine each. Group 1 (control group), no application of any material. Group 2, the fracture line was sealed using MTA. Group 3, with self-adhesive resin cement. All teeth in all groups were then inserted back (replanted) into the socket of the rabbits. Each group was further divided into three subgroups according to the duration of replantation, namely, group A: week 1, group B: week 2, and group C: week 3. Rabbits were sacrificed according to each duration of replantation for histological preparations. The number of fibroblast cells was evaluated by counting at the three viewpoints under the light-microscope (400× magnification) and Optilab camera; finally, the calculation results were averaged. Data were analyzed using a two-way ANOVA and post hoc LSD test, with a significance level of 95%.

RESULTS

Following MTA application in the third week produced the highest number of fibroblast cells (104 + 29.5) compared to other groups. Conversely, the lowest number of fibroblast cells occurred in the control group in the first week of observation (4.33 + 3.5).

CONCLUSION

MTA produced the greatest fibroblast cell proliferation than self-adhesive resin cement, particularly in week 3 of vertical root fractures replantation.

CLINICAL SIGNIFICANCE

As the adhesive material for vertical root fracture fragments, MTA generated greater fibroblast proliferation than self-adhesive resin cement. Therefore, it is recommended to use MTA to attach vertical root fracture fragments.

Leveraging digital workflows for immediate single-tooth replacement therapy: A case report

PURPOSE

Simplified and predictable immediate single-tooth replacement therapy can be optimised by leveraging recent advances in digital workflows that combine static surgical guidance and customised prosthesis design and fabrication. The present case report illustrates a novel approach to successfully executing immediate single-tooth replacement therapy via static computer-aided immediate implant placement and digital provisionalisation utilising angulated screw access, with a 1-year follow-up after delivery of the definitive restoration.

MATERIALS AND METHODS

A healthy 27-year-old woman with congenital agenesis of the mandibular second premolars and who required replacement of the mandibular left second premolar underwent immediate single-tooth replacement therapy via computer-aided, restrictive implant placement and provisionalisation using custom prosthetic components designed prior to the surgical intervention being performed.

RESULTS

After a 6-month healing period, the provisional crown was replaced with the definitive restoration. After 1 year, the peri-implant keratinised mucosa demonstrated vertical gain in the mid-buccal portion and stability in the interproximal aspects, and no changes in marginal bone level were observed.

CONCLUSIONS

The present case report demonstrates the successful application of novel digital tools to facilitate both surgical and prosthetic aspects of immediate single-tooth replacement therapy. Digital workflows can optimise the clinical efficiency and predictability of tooth replacement therapy with dental implants by reducing surgical and restorative chair time and increasing patient satisfaction.

Intentional Replantation of a Second Premolar with Internal Resorption and Root Fracture: A Case Report

AIM

This case aims to detail intentional replantation as a last resort to save an otherwise hopeless premolar with perforated internal resorption and root fracture.

BACKGROUND

Internal root resorption, progressive destruction of intraradicular dentin, is a condition that sometimes renders a tooth non-restorable. In the rare cases reported where severe internal resorption leads to root fracture, extraction of the tooth seemed to be a common treatment of choice, and a few literatures had reported endodontic surgery as an alternative treatment option. To date, there had been no report of treating internal root resorption using intentional replantation.

CASE DESCRIPTION

A 20-year-old male presented swelling at the buccal region of his left maxillary second premolar (#13). Clinical examination revealed a sinus tract and fractured dens evaginatus at the occlusal surface of the tooth. Radiographically, a large area of radiolucency was detected within the middle third of the root, where root fracture was present, leaving a triangular-shaped mature root apex. The condition was diagnosed as internal root resorption and root fracture. Endodontic surgery was excluded from treatment choices due to potential damage of periodontal bone. Instead, intentional replantation was performed, with the application of biomaterials including mineral trioxide aggregate (MTA) and platelet-rich fibrin (L-PRF). The tooth achieved satisfactory healing and remained asymptomatic after 2 years of follow-up.

CONCLUSION

The successful outcome of the case suggests that intentional replantation could preserve a fractured tooth caused by internal root resorption. Incorporated application of biomaterials, such as MTA and L-PRF, might as well improve the chances of saving this otherwise hopeless tooth.

CLINICAL SIGNIFICANCE

Through careful planning and execution, intentional replantation is a viable alternative treatment option to preserve a fractured tooth caused by internal root resorption, while leaving periodontal bone architecture almost intact. How to cite this article: Yang Y, Zhang B, Huang C, et al. Intentional Replantation of a Second Premolar with Internal Resorption and Root Fracture: A Case Report. J Contemp Dent Pract 2021;22(5):562-567.

Intranuclear Delivery of Nuclear Factor-Kappa B p65 in a Rat Model of Tooth Replantation

After avulsion and replantation, teeth are at risk of bone and root resorption. The present study aimed to demonstrate that the intra-nuclear transducible form of transcription modulation domain of p65 (nt-p65-TMD) can suppress osteoclast differentiation in vitro, and reduce bone resorption in a rat model of tooth replantation. Cell viability and nitric oxide release were evaluated in RAW264.7 cells using CCK-8 assay and Griess reaction kit. Osteoclast differentiation was evaluated using quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) and tartrate-resistant acid phosphatase (TRAP) staining. Thirty-two maxillary rat molars were extracted and stored in saline (n = 10) or 10 µM nt-p65-TMD solution (n = 22) before replantation. After 4 weeks, specimens were scored according to the inflammatory pattern using micro-computed tomography (CT) imaging and histological analyses. nt-p65-TMD treatment resulted in significant reduction of nitric oxide release and osteoclast differentiation as studied using PCR and TRAP staining. Further, micro-CT analysis revealed a significant decrease in bone resorption in the nt-p65-TMD treatment group (p < 0.05). Histological analysis of nt-p65-TMD treatment group showed that not only bone and root resorption, but also inflammation of the periodontal ligament and epithelial insertion was significantly reduced. These findings suggest that nt-p65-TMD has the unique capabilities of regulating bone remodeling after tooth replantation.

Is Intentional Replantation Appropriate for Treatment of Extensive Endodontic-periodontal Lesions Related to Palatogingival Groove?

This report describes the cases of two patients with a maxillary lateral incisor with palatogingival groove and extensive endodontic-periodontal lesions. Although it is reported that acceptable periodontal status is of great importance in case selection in intentional replantation, it is suggested in this report that intentional replantation could be chosen instead of immediate extraction if extensive endodontic-periodontal lesions exist in a tooth with palatogingival groove. The gingival margin position and gingival papilla were well preserved and the bone defect was almost completely repaired. This was beneficial to the aesthetic prosthodontic treatment and implantation, although external root resorption was observed.

Severe Case of Delayed Replantation of Avulsed Permanent Central Incisor: A Case Report with Four-Year Follow-Up

Avulsion is one of the most serious dental traumatic injuries with a reserved prognosis. This case report describes multiple trauma lesions in permanent central incisors of an eight-year-old girl and a four-year follow-up. The right upper incisor suffered avulsion, remained 16 h extraorally, and was replanted after extraoral endodontic therapy. The left maxillary central incisor suffered a noncomplicated crown fracture with concomitant subluxation. The present case adds to the literature a rare occurrence of success in a severe case with poor prognosis. For this reason, the International Association for Dental Traumatology (IADT) guidelines should be followed and, even in extreme situations, replantation should always be considered.

Fracture necrosis: A risk indicator for tooth loss

BACKGROUND AND OVERVIEW

The term "fracture necrosis" has been used to describe the condition found in a minimally restored tooth without a history of trauma when the suspected etiology for the loss of pulpal vitality is a crown-originating fracture. Teeth with fracture necrosis have a poor prognosis, and, when accompanied by characteristic radiographic findings, extraction may be considered the primary treatment option.

CASE DESCRIPTIONS

Two adult men with crown-originating fractures and suspected fracture necrosis had localized periodontal bone and attachment loss associated with severe pain on mastication from mandibular second molars. In case 1, the patient desired to retain the tooth despite an unfavorable prognosis. Nonsurgical root canal therapy and a crown prolonged tooth survival for only 30 months. The patient in case 2 requested extraction after a thorough review of his dental condition and tooth prognosis.

CONCLUSIONS

A tooth with fracture necrosis may continue to harbor virulent microorganisms after root canal therapy. When these microorganisms have access to the periodontal attachment, progressive loss of supporting tissues can be expected.

PRACTICAL IMPLICATIONS

When weighing treatment options for teeth with fracture necrosis associated with characteristic radiographic findings, preference toward extraction and tooth replacement, rather than treatment aimed at tooth retention, may represent a sound clinical approach.

Clinical and histopathological characterization of root resorption in replanted teeth: Two case reports

RATIONALE

The frequency of tooth avulsion is on the rise due to increasing rates of maxillofacial trauma. Avulsed teeth present with varying degrees of root resorption, and are generally asymptomatic; therefore, they often go undiagnosed. The etiopathogenesis of root resorption in replanted teeth following avulsion remains unclear.

PATIENT CONCERNS

In case 1, the left upper lateral incisor became loose after 10 years of replantation. In case 2, the patient underwent tooth replantation after external root canal treatment due to tooth dislocation caused by trauma 8 years ago.

DIAGNOSIS

According to the medical history, clinical manifestations and imaging studies of the 2 patients, root resorption after replantation was diagnosed.

INTERVENTIONS

The teeth extraction was given to one patient. Besides the histological examination of extracted teeth was performed.

OUTCOMES

Teeth that underwent pulp treatment presented with external resorption. On the other hand, the tooth that had received no pulp treatment showed both external and internal resorption; residual vital pulp tissue was detected within the pulp cavity.

LESSONS

The dental pulp tissues may be involved in the initiation or development of internal resorption. Trauma to the periodontal ligament might play a major role in external resorption, whereas internal tooth resorption may be caused as a result of injury to the residual pulp tissue. Thus, the effective management of these tissues during the treatment of replanted teeth is essential.

[Effects of topical application of doxycycline on avulsed permanent teeth]

PURPOSE

To evaluate the treatment effect of topical doxycycline on avulsed permanent teeth compared with normal saline.

METHODS

A total of 44 avulsed teeth from 38 patients (22 boys and 16 girls, aged 7-14 years) were recruited. Twenty-one teeth in group A were treated with doxycycline for 5 min before replantation while 23 teeth in group B were treated with saline solution. All participants were followed up for at least 12 months. The clinical outcome differences between 2 groups was evaluated by Mann-Whitney U test.

RESULTS

In group A, 18 teeth were found pulp necrosis, 3 with infection-related resorption, 13 with ankylosis-related resorption and 6 were extracted. In group B, 16 were diagnosed with pulp necrosis, 4 with infection-related resorption, 12 with ankylosis-related resorption and 7 were extracted. No significant differences were found between the two groups on pulp survival and periodontal healing.

CONCLUSIONS

Compared with treatment with normal saline, avulsed permanent teeth treated with doxycycline did not show a better clinical outcome.

[Treatment of combined periodontal-pulpal lesions with periodontal therapy]

PURPOSE

To evaluate the clinical effects of periodontal therapy for combined periodontal-pulpal lesions.

METHODS

One hundred and nine patients with periodontal-pulpal lesions were included in this study, with total 120 teeth. All the teeth were treated by perfect root canal therapy, and than divided into group A and B. Group A was treated with periodontal therapy (60 teeth). After 2 weeks of root canal therapy, basic periodontal therapy was performed. After 6 weeks, patients with more than 5 mm periodontal pockets and bleeding after probe were treated with valvuloplasty. Group B underwent non-periodontal treatment (60 teeth), root canal therapy and supragingival scaling alone. The patients were followed up for 3, 6, 12 and 24 months after operation. SPSS 22.0 software package was used to analyze the indexes at initial diagnosis and 24 months after operation.

RESULTS

In group A, the depth of periodontal pockets was significantly reduced before and after PD, from(5.966±1.877) mm to(5.133±1.935) mm. The periodontal pocket depth of group B was significantly increased before and after operation, from(5.533±1.856) mm to (6.167±1.927) mm. The degree of tooth mobility (TM) before operation was similar between the two groups (P>0.05). Two years after operation, the degree of TM in group A was significantly lower than that in group B (P<0.05). There was no significant change in alveolar bone resorption before and after operation in group A (P>0.05). The alveolar bone resorption in group B changed significantly before and after operation (P<0.05).

CONCLUSIONS

Root canal therapy combined with periodontal therapy for combined periodontal-pulpal lesions can achieve good results. It can be widely used in clinic.

Intentional Replantation of Teeth is a Viable and Cost-effective Alternative Treatment to Single-Tooth Implants

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

A Systematic Review of the Survival of Teeth Intentionally Replanted with a Modern Technique and Cost-effectiveness Compared with Single-tooth Implants. Mainkar A. J Endod 2017:43(12):1963-8.

SOURCE OF FUNDING

Information not available.

TYPE OF STUDY/DESIGN

Systematic review/meta-analysis.

Tooth avulsion with extra oral time in less than 60 minutes: two different therapeutic protocols with 13-year follow-up

The aim of this study is to assess what needs to be the priority in tooth avulsion: replantation as quickly as possible and deferred endodontic treatment, or replantation and elimination of every irritating stimulus for the periodontal ligament.

Delayed tooth replantation and inflammatory root resorption in childhood and adolescence

Avulsion of one or more permanent teeth represents an emergency in dentistry. The main treatment is the replantation of the tooth/teeth as soon as possible to decrease possible complications. However, this is not always possible, and, in many cases, the patient undergoes a delayed replantation and subsequently prosthetic and implant treatments.

Computerized three-dimensional design for accurate orienting and dimensioning artificial dental socket for tooth autotransplantation

OBJECTIVE

To present an improved, accurate, and efficient method for planning and preparing an artificial socket for autotransplantation, by using a three-dimensional (3D) surgical guide and a replica of the transplanted donor tooth. The guide and the tooth replica were fabricated using a computerized 3D simulation. A case treated with this approach is presented.

METHOD AND MATERIALS

Cone beam computed tomography (CBCT) and computerized 3D simulations (Simplant plus registration as stereolithography) were used for planning the optimal artificial socket position and dimensions, within the limitations of the alveolar bone borders and the adjacent teeth roots, and for producing a metal replica of the transplanted tooth. The replica was used to assure the correct socket preparation and orientation before extraction and replantation of the donor premolar.

RESULTS

The entire procedure time for autotransplantation of a permanent second premolar to the incisor site without the buccal plate was about 45 minutes. At 15 months' follow up, clinical examination of the transplanted tooth demonstrated both normal mobility and no sensitivity to cold stimulation. A radiographic examination revealed continuous root development and pulp obliteration. The adjacent teeth maintained their vitality with no pathologic signs.

CONCLUSION

We present an improved technique for autotransplantation based on computerized 3D simulations and guidance for accurate dimensioning and optimal locating of the artificial socket relative to the alveolar bone borders and the adjacent teeth roots. This technique may significantly simplify the autotransplantation procedure and will probably also increase its success rate and use in young patients, even in cases with absence of a buccal plate.

Effect of preameloblast-conditioned medium and CPNE7 on root surfaces in dogs: a histologic and histomorphometric evaluation

Preameloblast-conditioned medium (PACM) has been reported as a potent dentin regenerative material, but its effects as a mixture on periodontal regeneration and the role of CPNE7 in PACM are not known. The purpose of this study is to evaluate the histologic and histomorphometric effects of preameloblast-conditioned medium (PACM) and CPNE7 on periodontal tissue healing in dogs. Seventy-two mandibular premolar roots from ten dogs were extracted and randomly divided into six groups (n = 12 each): (1) positive control group; (2) negative control group; (3) cementum-removed and PACM-treated group; (4) cementum-preserved and PACM-treated group; (5) CPNE7-inactivated PACM-treated group; and (6) recombinant CPNE7-treated group. The extracted roots were replanted into extraction sockets for 4 and 8 weeks and analyzed histologically. Most of the root surfaces in the negative control group showed ankylosis; and those in the experimental groups showed newly formed PDL-like and cementum-like tissues. Histomorphometric analysis of horizontal sections showed that the mean length of the PDL on the roots of the positive controls was similar to those in cementum-removed or -preserved and PACM-treated group at 8 weeks (p = 1.08). Sagittal sections showed that the mean length of the new cementum on the roots in cementum-removed and PACM-treated group was significantly greater than that in CPNE7-inactivated PACM-treated group (p = 0.037). The mean length of the newly formed PDL on the roots in CPNE7- inactivated PACM-treated and rCPNE7-treated groups was significantly greater than that in the negative controls at 8 weeks (p = 0.037, p = 0.036). The use of PACM and CPNE7 in tooth replantation resulted in increased PDL and cementum formation, suggesting the beneficial role of PACM and CPNE7 in periodontal tissue healing.

Minimally Invasive Single-Implant Treatment in the Esthetic Zone

Clinicians face significant challenges when placing single-tooth, implant-supported restorations in the esthetic zone. Understanding myriad factors, such as smile design, patient expectations, and hard- and soft-tissue responses, plays a vital role in achieving a predicable outcome. This article presents a case report demonstrating a minimally invasive approach, which combined immediate implant placement, hard- and softtissue augmentation, and immediate provisionalization in 1 visit.

Guidelines for the Management of Traumatic Dental Injuries: 2. Avulsion of Permanent Teeth

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 orurgent care of avulsed permanent teeth.

Dental pulp in mature replanted human teeth: morphological alterations and metalloproteineses-2 and -9, Annexin-5, BCL-2 and iNOS modulation

Tooth replantation, as a treatment concept, has been subject to controversies regarding the mechanism as well as the various parameters underlying this process. This work aimed to study time-related changes in the pulp of replanted mature human premolars through the changes in the levels of certain factors involved in the underlying mechanisms of pulpal tissue healing after replantation. Eleven experimental mature teeth were extracted, immediately replanted in the original socket and left without any other intervention for 1, 2, 3 and 12 weeks before re-extraction. Three premolars served as control. All specimens were subject to histological analysis and the levels of MMP-2, MMP-9, Annexin V, iNOS and BCL-2 (anti-apoptotic family) were analyzed employing immunohistochemistry. The results showed degradation of the extracellular matrix (ECM), inflammatory cell infiltrate, loss in pulpo-dentine interface and loss of odontoblasts in the dental pulp tissue. This was accompanied by increase over time of MMP-9, Annexin V, iNOS and a decrease of BCL-2 and MMP-2, suggesting that apoptosis increased throughout the experimental period.

[Retrospective study about periodontal ligament healing of replanted permanent teeth in children]

OBJECTIVE

To analyze the prognosis about periodontal ligament healing of replanted permanent teeth in children and to examine the associated factors.

METHODS

The sample consisted of 49 children with 61 avulsed permanent teeth, whose injuries had been managed in the period from 2000 to 2012. The clinical data of replanted teeth were collected, and the follow-up period was no less than 12 months. The factors were analyzed in relation to postoperative outcomes, classified as functional periodontal healing (FH), infection-related (inflammatory) resorption (IRR) and replacement resorption (RR).

RESULTS

The functional healing rate was 23.0%, while replacement resorption rate was 72.1%. The replacement resorption (ankylosis) was usually observed earlier by clinical examination than by radiographic examination. 86.0% (40/47) resorptive processes were diagnosed within the first year. Physiological storages, such as milk, saline and saliva were significantly better to periodontal ligament healing than nonphysiological storages, such as tap water and sterilizing solutions (chloramine and alcohol). Functional healing was found significantly more frequent in canines and premolars.

CONCLUSION

The factor significantly affecting periodontal ligament healing is storage medium. Replacement resorption is the most common type of root resorption. The replacement resorption diagnosis must combine the radiographic examination with the clinical examination. It is better to follow up more than 1 year after tooth replantation.

[A retrospective study on pulpal tissue prognosis of avulsed permanent teeth in children]

OBJECTIVE

To analyze the pulpal prognosis of replanted permanent teeth in children and to examine the associated factors.

METHODS

The samples consisted of 67 children with 81 avulsed permanent teeth treated in Peking University Hospital of Stomatology from 2000 to 2012. Their clinical data of the replanted teeth were collected, and the follow-up period was no less than 12 months. The pulpal prognosis was classified as pulp necrosis and pulp non-necrosis.

RESULTS

The replantation within 30 minutes after avulsion led to the most significant increase in pulpal healing (P<0.05). The dental pulp of 80% (4/5) young permanent teeth replanted within 30 minutes remained vital, while all the teeth replanted after 30 minutes developed pulp necrosis within 60 days after replantation.

CONCLUSION

The extra-alveolar period significantly affects the prognosis of pulp in immature permanent teeth after replantation. When the extra-alveolar period is more than 30 minutes, the chance of pulp revascularization after replantation is very low, therefore pulp extirpation should be performed.

Pulp and periodontal healing after replantation of a maxillary immature incisor: a 13-year follow-up

BACKGROUND

Traumatic tooth avulsions occur most often in 7 to 9 year-old children. Replantation is considered the treatment of choice and follow-up is required in order to prevent possible complications.

CASE REPORT

A case of replantation of a maxillary immature incisor in a 9.2-year-old male is reported. Tooth 21 was stored in saliva, in the child's mouth, and it was replanted within 45 min following a bicycle accident. A flexible splint was applied from tooth 11 to tooth 63, and it was removed after 4 weeks. Pulp canal obliteration was diagnosed at the 6 months check-up visit. Pulp sensibility was positive after 3 months and absent after 5 years. During the follow-up the tooth completed its development and always presented a physiological mobility and a probing depth <3 mm. Only a minimal discoloration of the crown was observed.

CONCLUSION

The knowledge of emergency care at the scene of dental trauma is resolutory for treatment outcome.

Knowledge of emergency management of avulsed tooth among Japanese dental students

BACKGROUND

The management of the avulsion of deciduous and permanent teeth in children is well outlined in the guidelines of the International Association of Dental Traumatology and the American Academy of Pediatric Dentistry. However, little information is available about the level of knowledge in the management of dental trauma among undergraduate dental students in Japan. The objective of this study is to explore dental students' level of educational knowledge in the management of avulsed teeth.

METHODS

A three-part questionnaire was used to gather demographic data and evaluate the knowledge of students at Kyushu Dental University.

RESULTS

Questionnaire data were collected from 121 (53 first-year, 68 sixth-year) students. Regarding the immediate emergency management of a case in which a 9-year-old girl had fallen down the stairs and lost a maxillary incisor but remained conscious, 55.9% of sixth year students and 28.3% of first-year students suggested the immediate transportation of the tooth to a dentist. The answer selected by the largest number (50.9%) of first-year respondents was "sideline the injured girl and get her to bite on a tissue paper for several hours". In a case in which a boy had an avulsed tooth after falling down on a road, only 13.2% of first-year students suggested the transportation of the tooth in his mouth to the clinic. Most the largest number of respondents believed that the best way to transport an avulsed tooth to the dental clinic was to "wrap it in dry tissue paper".

CONCLUSIONS

These results suggest that education in first aid for accidents that occur outside dental clinics or hospitals is insufficient. Japanese dentists and dental educations must immediately improve the utilization of the guidelines for dental trauma and the education of undergraduate students and patients in the management of dental trauma using an integrated approach.

New treatment option for an incomplete vertical root fracture--a preliminary case report

Instead of extraction this case report presents an alternative treatment option for a maxillary incisor with a vertical root fracture (VRF) causing pain in a 78-year-old patient. After retreatment of the existing root canal filling the tooth was stabilized with a dentine adhesive and a composite restoration. Then the tooth was extracted, the VRF gap enlarged with a small diamond bur and the existing retrograde root canal filling removed. The enlarged fracture line and the retrograde preparation were filled with a calcium-silicate-cement (Biodentine). Afterwards the tooth was replanted and a titanium trauma splint was applied for 12d. A 24 months clinical and radiological follow-up showed an asymptomatic tooth, reduction of the periodontal probing depths from 7 mm prior to treatment to 3 mm and gingival reattachment in the area of the fracture with no sign of ankylosis. Hence, the treatment of VRF with Biodentine seems to be a possible and promising option.

Alendronate promotes bone formation by inhibiting protein prenylation in osteoblasts in rat tooth replantation model

Bisphosphonates (BPs) are a major class of antiresorptive drug, and their molecular mechanisms of antiresorptive action have been extensively studied. Recent studies have suggested that BPs target bone-forming cells as well as bone-resorbing cells. We previously demonstrated that local application of a nitrogen-containing BP (N-BP), alendronate (ALN), for a short period of time increased bone tissue in a rat tooth replantation model. Here, we investigated cellular mechanisms of bone formation by ALN. Bone histomorphometry confirmed that bone formation was increased by local application of ALN. ALN increased proliferation of bone-forming cells residing on the bone surface, whereas it suppressed the number of tartrate-resistant acid phosphatase (TRAP)-positive osteoclasts in vivo. Moreover, ALN treatment induced more alkaline phosphatase-positive and osteocalcin-positive cells on the bone surface than PBS treatment. In vitro studies revealed that pulse treatment with ALN promoted osteocalcin expression. To track the target cells of N-BPs, we applied fluorescence-labeled ALN (F-ALN) in vivo and in vitro. F-ALN was taken into bone-forming cells both in vivo and in vitro. This intracellular uptake was inhibited by endocytosis inhibitors. Furthermore, the endocytosis inhibitor dansylcadaverine (DC) suppressed ALN-stimulated osteoblastic differentiation in vitro and it suppressed the increase in alkaline phosphatase-positive bone-forming cells and subsequent bone formation in vivo. DC also blocked the inhibition of Rap1A prenylation by ALN in the osteoblastic cells. These data suggest that local application of ALN promotes bone formation by stimulating proliferation and differentiation of bone-forming cells as well as inhibiting osteoclast function. These effects may occur through endocytic incorporation of ALN and subsequent inhibition of protein prenylation.

Education of Sport University students regarding first-aid procedures after dental trauma

AIM

The aim of this survey was to establish the current state of knowledge with regard to first-aid procedures and to compare the effectiveness of an educational lecture and a subsequent educational session.

METHODS

A questionnaire to assess the attitudes and anticipated behaviours of Sport University students related to first-aid procedures following dental injury was administered to the students 3 times (after 3 and 12 months). A lecture on the subject of dental trauma was given just after the first questionnaire survey. A randomly selected students group received an extra educational task.

RESULTS

The present study revealed a low level of initial knowledge of physical education students concerning first-aid measures in the case of dental trauma. A 30 minute lecture and an extra educational task significantly improved the knowledge evel. Even after one year the knowledge level was still high and sufficient to properly react when faced with dental trauma.

CONCLUSION

Our research proves that the inclusion of dental trauma as a topic in the Sport University students' curricular training and paedagogical education should be introduced in the form of a clear and concise lecture.

Effect of a leaflet given to parents on knowledge of tooth avulsion

AIM

Parents can play an important role in improving the prognosis of avulsed permanent teeth if they are properly informed about the necessary dental first-aid steps at the time of an accident. The purpose of this study was to assess the knowledge of Shirazi parents in traumatic a simple leaflet on improving their knowledge about this topic.

MATERIALS AND METHODS

One hundred and fifty parents of children receiving dental care at the Shiraz Dental School participated in this study. Half of the participants received an informative leaflet with the possibility of asking questions about it to an operator, while the other half did not receive any leaflets and served as a control group. Using a questionnaire and a scoring system, the level of knowledge of parents was measured in the following categories: general knowledge of tooth avulsion, knowledge of replantation and primary/permanent teeth, knowledge of how to clean an avulsed tooth, knowledge of extra- oral time, and knowledge of storage, methods and transporting media.

RESULTS

The results showed that knowledge level was low among Shirazi parents. Improvements were observed in all the categories of knowledge as a result of reading the leaflet and answering the questions.

CONCLUSION

A simple leaflet is a suitable tool to impart knowledge to parents and improve awareness about tooth avulsion.

Assessment of awareness amongst school teachers regarding prevention and emergency management of dentoalveolar traumatic injuries in school children in Pune City, before and 3 months after dental educational program

Children have boundless energy, so, they are continuously engaged in some or the other physical activity. It is seen that when child reaches school age, accidents in the school environment in the form of falls, injuries due to contact sports, fights, abuse, etc. are very common and the main cause of traumatic dental injuries. Trauma may vary from minor enamel chipping or avulsion to extensive maxillofacial damage, more serious neck and brain injury, which may cause pain, disfigurement and mental agony, having immediate and long lasting effects. In such cases, a school teacher is in the right position to handle such an emergency and refer the child to the concerned dental surgeon or a pedodontist for further needful care. The main reason for delayed treatment of dental trauma is that people present at the site of injury are unaware of protocol of rapid and appropriate management leading to improper first aid treatment. The purpose of this study was to investigate the awareness of a group of school teachers from different schools about the prevention and emergency management of dental trauma in school children, by means of a questionnaire. Then educating them and reassessing their knowledge after a period of 3 months. Unfortunately, the public is unaware of the risks and does not have enough information about first aid emergency treatment or to avoid traumatic injuries.

Emerging therapies for the management of traumatized immature permanent incisors

Early loss of immature permanent teeth due to pulpal necrosis secondary to trauma can have dire consequences for a child's growth and development. The treatment alternatives include surgical endodontics, traditional calcium hydroxide apexification, and mineral trioxide aggregate (MTA) apexification. These options pose potential complications, including: arrest of root development; weakened dentinal walls; and increased potential for fracture. Revascularization of the dentin-pulp complex is a new approach that involves disinfecting the root canal system followed by tissue repair and regeneration while allowing for continued root development and thickening of the lateral dentinal walls through deposition of new hard tissue. The purpose of this report was to present the revascularization of an immature permanent maxillary central incisor that had evidence of external root resorption. Six months later, internal bleaching was performed to remove cervical discoloration from the triple antibiotic paste. At 18 months, the tooth remained vital and had evidence of continued root development.

Intentional replantation of periodontally hopeless teeth using a combination of enamel matrix derivative and demineralized freeze-dried bone allograft

This study evaluated the clinical and radiographic results of the intentional replantation of periodontally hopeless teeth with combined enamel matrix derivative and demineralized freeze-dried bone allograft therapy. Eleven patients (five female, six male; age range, 13 to 53 years) with 12 periodontally hopeless teeth resulting from extensive alveolar bone loss and vertical defects extending to the apexes were studied. At the 12-month clinical and radiologic follow-up, significant improvement was observed for all clinical and radiographic parameters except gingival recession (P < .05). These preliminary findings show that intentional replantation combined with regenerative techniques is a successful alternative to tooth extraction.

Teachers' knowledge of emergency management of traumatised teeth in preschools

Dental trauma remains one of the major oral health problems in childhood and is the cause of much pain and distress. It may occur as a result of a sports mishap, an altercation or a fall while playing inside the school premises. Prompt and appropriate management of traumatised teeth is essential for a good prognosis of an injured tooth.

AIM AND OBJECTIVE

The aim of the study was to assess teachers' knowledge of emergency management of traumatized teeth in early childhood developmental centres (ECDCs).

METHOD

A cross sectional self-administered questionnaire was used to collect data among teachers in ECDCs in Hillbrow and Berea suburbs, Johannesburg, South Africa.

RESULTS AND CONCLUSION

Almost all respondents (98.1%) were female; 59.6% were between 20 and 29 years of age. Almost a quarter of the centres were not registered and 39.1% of the school teachers were not formally qualified as ECDCs teachers. A small percentage (11.5%) received dental emergency training as a part of their school health education programs. Knowledge of ECDCs teachers on the emergency management of traumatized teeth appeared inadequate; in the event of emergency dental trauma, substantial number of teachers would not be able to respond appropriately. All teachers should have training on basic management of dental trauma.

Combined orthodontic-restorative management of maxillary central incisors lost following traumatic injury: a case report

A history of traumatic dental injury to the maxillary central incisors during preadolescence or adolescence is common and may result in premature loss. Treatment options include prosthetic implant replacement, autotransplantation, and orthodontic space closure with direct composite recontouring. This case report describes the treatment of an adolescent girl who presented with a crowded Class I malocclusion complicated by a history of trauma to the maxillary central incisors. The treatment plan consisted of orthodontic space closure following loss of both maxillary central incisors and mandibular premolars. This case highlights that orthodontic space closure can be a valuable treatment option in selected Class I crowded and Class II uncrowded malocclusions, producing predictable and efficient results.

Experience and attitudes of paramedics with regard to first aid in dental avulsion

INTRODUCTION

The objective of this study was to assess the experience and attitudes of paramedics with regard to first aid in dental avulsion.

MATERIAL AND METHODS

An anonymous, voluntary, 11-item survey was conducted in three randomly selected emergency medical service (EMS) stations in the Province of Podlasie. We analyzed what the respondents know about procedures in dental avulsion. We were also interested in the impact of professional and personal experience on the ability to take proper action in the case of avulsed/injured teeth. The use of teeth protectors during intubation was another aspect of our study. Data were statistically analyzed with the chi2 test.

RESULTS

The study revealed that paramedics in EMS stations are not trained to provide first aid in dental avulsion. Avulsed teeth were usually not taken from the scene of the accident. We also found that previous experience with dental avulsion did not necessarily help to undertake proper action. However, we found that more than 95% of the respondents would act properly when not on duty. Paramedics do not use any teeth protectors to avoid accidental tooth injuries during intubation.

CONCLUSION

We found that paramedics in the Province of Podlasie, Poland, need specialist training courses introducing them to principles of first aid in dental avulsion. Ambulances should carry equipment for the transport of avulsed teeth.

Tooth replantation as an alternative to dental implantology in adolescent patients

A 16-years old female patient was referred to our observation in July 2006, 14 days after an accident, with traumatic intrusive luxation of the right upper central incisor that caused the nasal floor and buccal cortical bone fracture. While the extraoral examination showed the traumatic lesions of the upper lip, the intraoral examination revealed intrusive luxation, pain and high mobility of the tooth, and bleeding of the adjacent oral tissue. The treatment protocol consisted in surgical buccal bone removal, tooth extraction, retrograde root-canal filling, and tooth repositioning in occlusion with a resilient splinting. After 8 weeks the splinting was removed, and clinical and radiological examinations were taken 3, 6, 9, 12, and 24 months after surgery. At the 24 months follow-up the root showed no radiographic signs of inflammation, resorption or ankylosis, and the function of the replanted tooth was fully maintained. Tooth replantation can be considered an effective alternative to dental implant, when the latter is contraindicated in young patient with incomplete skeletal development. The long-term success of the procedure will likely require a multidisciplinary approach.