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PubMed1990

[Complete luxation of the upper incisor. Analysis of the mid-term results. Treatment of sequelae].

The study involved 18 children aged 7 to 13 years, who all benefited from early reimplantation and appropriate immobilisation. Radicular treatment appeared to have little influence and adverse results, especially early rhizalysis, were common (50% versus 30% of good results). In the event of failure, dento-facial orthopedic treatment, where indicated, may provide a cosmetically acceptable solution.

Adolescent↗

PubMed2000

Diagnosis and management of dental injuries in children.

Approximately half of children sustain some type of dental injury. Management of injuries to the anterior teeth of preschool children is directed toward minimizing potential damage to the developing permanent teeth; therefore, heroic measures to save primary teeth are not indicated. Crown fractures in the permanent dentition, even those exposing the dental pulp, can be successfully treated hours after an injury. Prompt referral for dental treatment is advisable. Displacement injuries to permanent teeth constitute genuine dental emergencies in which the prognosis is directly related to the timeliness of treatment. Avulsed permanent teeth should be immediately reimplanted by any capable person. If that is impossible, the teeth should be placed in cold milk and the child referred for immediate treatment by a dentist. Mouthguards prevent dental injuries but are not widely used outside of a few organized sports. Efforts should continue to promote mouthguard use in all contact sports.

Child↗

PubMed1978

Submergence of roots for alveolar bone preservation. II. Reimplanted endodontically treated roots.

Root canal therapy was accomplished on the mandibular premolars of four dogs. These premolars were then extracted, contoured, reimplanted, and submerged. Resorption occurred up to 60 days; healing progressed satisfactorily, with some evidence of coronal osseous regeneration. Root canal sealer was expressed out the coronal orifice after the roots were submerged. This sealer appeared to affect normal healing over the coronal surface of the roots.

Alveolar Process↗

PubMed1977

Effects of amalgam restorations on the periodontal membrane in monkeys.

The response of the periodontal membrane to reimplanted teeth carrying amalgam restorations in the middle third of their roots was studied from seven days to six months after grafting. The study revealed that the amalgam restorations produced an initial localized inflammation in the periodontal tissues that subsided subsequently with the formation of a pseudocapsule.

Animals↗

PubMed2001

Efficacy of laser Doppler flowmetry for the diagnosis of revascularization of reimplanted immature dog teeth.

UNLABELLED: This study was performed to assess if laser Doppler flowmetry (LDF) is an improved method for the detection of revascularization of replanted teeth. Teeth were extracted and reimplanted under different experimental conditions. LDF readings were taken before extraction and weekly for 3 months. In control teeth, LDF baseline readings were taken and then repeated after the apical blood vessels were cut surgically. At the end of 3 months it was determined radiographically and histologically whether revascularization had occurred, i.e. vitality had returned. RESULTS: LDF readings correctly predicted the pulp status (vital vs. non-vital) in 83.7% of the readings. 73.9% (17 of 23) were correct for the vital teeth and 95% (19 of 20) were correct for the non-vital teeth. Fisher's exact test (2-tail) indicated that there was no significant association between the efficacy of LDF and tooth type (P = 0.166), although P2 was the least accurate tooth tested. Wilcoxon's matched-pair signed rank test demonstrated that in the revascularized (vital) teeth, the flux value between the baseline and week 2 dropped significantly (P = 0.0001), increased significantly from week 2 to week 4 (P = 0.0001) and then decreased steadily until week 12. However, at week 12 the flux was still significantly higher than at week 2 (P = 0.010). In the teeth that failed to revascularize, the flux value dropped significantly by weeks 1 and 2 (P = 0.004 and P = 0.0001, respectively). Flux values did not increase from week 2. A Fast Fourier Transform (FFT) analysis confirmed a pulse of dominant frequency of 2 Hz in the teeth that returned to vitality and the lack thereof in those that stayed non-vital. One tooth in which the flux value evaluation indicated a non-vital tooth but the radiographic/histologic findings showed vital (false negative) possessed a pulse of dominant frequency and proved by this method to have successfully revascularized.

Animals↗

PubMed1995

Formation of differentiated tissues in vivo by periodontal cell populations cultured in vitro.

The periodontium contains heterogeneous mesenchymal cell populations with various differentiation potentials. The capacity of these cells for tissue formation as well as the origin of their precursors are still not entirely defined. In this study, cells originating from different periodontal tissues were cultured in vitro, and tissue formation in vivo following orthotopic re-implantation was investigated. Cells were recovered from the alveolar bone and periodontal ligament tissue of six minipigs, and cultured cells were then grown on extracted dental roots from the homologous animals by means of co-culture in vitro. Each minipig received 2 roots covered with alveolar bone cells, 2 roots covered with periodontal ligament cells, and 2 control roots (without cells) implanted into palatal bone defects. Intravital fluorochrome labeling was performed, and two minipigs were histologically examined after 2, 4, and 12 weeks in each case. Controls showed widespread resorption and ankylosis, whereas roots covered with cultured periodontal cells exhibited tissue formation in vivo. Alveolar bone cells synthesized a calcified cellular tissue resembling cellular cementum, suggesting that cells within this population might differentiate into cementoblasts when reimplanted with a dental substrate in vivo. Periodontal ligament cells exhibited no calcified tissue formation in vivo, but cells synthesized a connective tissue with orientated fiber bundles attached to both host bone and root, resembling periodontal ligament.

Alveolar Process↗

PubMed1990

Pulp revascularization in reimplanted immature monkey incisors--predictability and the effect of antibiotic systemic prophylaxis.

In 32 monkeys 105 immature maxillary incisors were extracted and reimplanted either immediately or after 30 or 60 min wet or dry storage. Of the monkeys, 17 (group I) did not receive and 15 (group II) received prophylactic treatment with 4 mg/kg doxycycline before extraction and 2 mg/kg for 5 d after reimplantation. The observation time varied from 6 to 8 weeks. After being histologically processed, the material was evaluated with respect to the amount of vital tissue and presence of micro-organisms in the pulpal lumen. A comparison revealed no difference in the results between the groups. The results were therefore pooled and statistically analysed with respect to the significance of apical foramen width, extra-alveolar time, wet or dry storage and presence of micro-organisms in the pulpal lumen for the occurrence of complete pulp revascularization (CPR). The overall frequency of CPR was 18%. Log-linear analyses (SAS, 1985) of the material as a whole or of separate parameters consistently revealed a relationship between presence of micro-organisms and absence of CPR (P = 0.0001). A higher frequency of CPR and a lower frequency of micro-organisms (P = 0.05) was found only for the group of immediately reimplanted teeth. The presence of micro-organisms could be explained for 61 teeth. In 27 of these, blood clots containing bacteria in the apical portion of pulpal lumen indicated contamination during the extra-alveolar time, while in 34, the micro-organisms originated from plaque covered mechanical damage in the cervical part of the root surface.

Animals↗

PubMed2006

Morphometric and microscopic evaluation of the effect of solution of acetazolamide as an intracanal therapeutic agent in late reimplanted rat teeth.

The use of substances that inhibit root resorption may be an alternative for cases of unsuccessful reimplants. Hence, the purpose of this study was to test a solution of acetazolamide, a resorption inhibitor, as an intracanal therapeutic agent for late reimplanted teeth. Thirty rat maxillary right central incisors were avulsed and kept dry for 30 min. The teeth were instrumented, and the root surfaces treated with 1% hypochlorite solution followed by application of 2% sodium fluoride. Thereafter, the teeth were divided into two groups according to the intracanal dressing: Group I, solution of acetazolamide and Group II, calcium hydroxide paste. Teeth were then reimplanted in their respective sockets. The animals were killed at 15, 30, and 60 days after reimplantation and the samples processed for morphometric and microscopic analysis. The results showed that calcium hydroxide paste limited root resorption, even though not avoiding it. In contrast, no root resorption was observed after 60 days in the acetazolamide group, confirming the efficacy of the substance in inhibiting root resorption.

Acetazolamide↗

PubMed1993

The distribution and morphological characteristics of axons innervating the periodontal ligament of reimplanted teeth in cats.

Twelve weeks after reimplanting lower canines the distribution and characteristics of myelinated and non-myelinated axons within the periodontal ligament were investigated by light and electron microscopy. The ligament was examined at 2-mm intervals along the length of the root of four reimplanted teeth and of the contralateral canines, which served as controls. In each case the periodontal ligament was reinnervated. In two of the teeth, which showed extensive apical resorption, the innervation was much less than in control teeth. In two teeth showing minimal or no apical resorption the degree of innervation at the most apical level did not differ significantly from controls.

Animals↗

PubMed1990

[The prognostic assessment of dental reimplantations and autotransplants. Clinico-statistical studies].

The identification of prognostic factors which influence the long-term results of dental retransplantation and autotransplantation is one of the main aims of clinical research whose principal scope is remove or alter those factors which have a negative influence on outcome, and to identify the causes of failure and areas for improvement. The paper reports the most significant results of a clinical survey which was carried out on 135 patients who had undergone retransplantation and/or autotransplantation and were then followed for 8 years.

Follow-Up Studies↗

PubMed2000

Periodontal healing after intentional auto-alloplastic reimplantation of injured immature upper front teeth.

BACKGROUND/AIMS: Conventional endodontic treatment results in high complication quota when performed in immature teeth. Intentional reimplantation with extraoral insertion of an endodontic implant (auto-alloplastic reimplantation) is an alternative. METHOD: In a retrospective study, the healing of 40 teeth reimplanted intentionally according to this method in patients aged 7 to 15 years was evaluated. Clinical tests (palpation, percussion sound, periotest values) and radiographical examinations were used to determine the type of periodontal healing (inflammatory resorption/periodontitis apicalis; replacement resorption/ankylosis; normal healing). RESULTS: Mean lifetime of the replanted teeth was 59.2+/-42.5 months, estimated survival time on the basis of the Kaplan-Meier analysis was 99.5 months. 17 teeth (42.5%) were classified as failures, mostly due to inflammatory resorption or periodontitis apicalis. Further investigations demonstrated that success rate and retention period of intentionally replanted teeth depend on the preoperative condition of the pulp. Teeth with preoperative infection suffered frequently from inflammatory resorption or periodontitis apicalis after being replanted (14 of 28 teeth). Estimated survival time according to Kaplan-Meier was 75.5 months. In contrast, inflammations or progressive resorptions were not observed in teeth without preoperative infection of the pulp. All these 12 teeth showed normal periodontal healing and regular tooth mobility. In the absence of any pathology in clinical or radiological findings after an average functional period of 72.3 months, the prognosis can be presumed excellent. Estimated survival time of 148.3 months according to Kaplan-Meier differs significantly from survival time of teeth infected preoperatively. CONCLUSIONS: From the results of this investigation, it may be concluded that an infection of the pulp - due to delay of treatment or attempts at endodontic therapy - should be avoided before intentional replantation of immature front teeth with pulp necrosis. Periodontal healing of the autologous root is not impaired by the insertion of posts made of Al2O3-ceramics or titanium. The inserted posts do not ankylose. Orthodontic movement of auto-alloplastically replanted teeth is possible.

Adolescent↗

PubMedDate not supplied

Growth considerations in planning treatment of avulsion in an adolescent.

Reimplantation failure of avulsed anterior teeth in an adolescent patient requires removal of the attempted-reimplanted teeth and consideration of several restorative options. These options may include a removable partial denture, as well as a transitional bridge or permanent fixed prosthesis. In all cases, the potential effects of the adolescent's expected amount and directions of maxillary and mandibular growth must be considered. A case is presented examining how maxillary growth may affect the restorative treatment options for avulsed anterior teeth replacement for an adolescent boy. Unfortunately, the patient and family were unable to complete treatment due to financial considerations. Consequently, the case presented here is submitted as a treatment planning exercise.

Adolescent↗

PubMed1984

Surgical treatment of ankylosed and infrapositioned reimplanted incisors in adolescents.

A method for preserving the alveolar ridge of ankylosed and infrapositioned incisors and improving conditions for a subsequent prosthetic therapy is described and evaluated clinically and radiographically. The method involves removal of the crown and root filling from the root, which is retained and covered with a mucoperiosteal flap. Clinically, there were no postoperative complications and after the follow-up a satisfactory prosthetic restoration was performed in all cases, regardless of the degree of infraposition before treatment. Radiographically, no pathologic changes were observed apart from a continuous resorption and replacement of lost root substance by bone. Alveolar bone level shifted only slightly between postoperative and 12-month follow-up radiographs, in a majority of cases in a coronal direction.

Adolescent↗

PubMed1999

Inflammatory and replacement resorption in reimplanted permanent incisor teeth: a study of the characteristics of 84 teeth.

Avulsion is a serious injury which can cause damage to some or all of the dental and surrounding tissues. This study examined the profiles of teeth showing inflammatory resorption, in terms of time prior to reimplantation, contamination, pulp extirpation time and period of splinting and compared them to teeth without resorption. There were a total of 71 children in the present study (mean age 9.8 years, range 6-16 years) with a total of 84 reimplanted teeth. Inflammatory resorption was present in 22 teeth. There was a significant relationship between the presence of inflammatory resorption and the time the teeth were dry prior to reimplantation, with a lesser effect for total delay time. There were slightly later pulp extirpation times for teeth with inflammatory resorption, with median delays of 16 and 11 days respectively and increased inflammatory resorption in teeth extirpated at 20 days or later. Replacement resorption was present in 40 teeth. There was a significantly longer splinting time in teeth with replacement resorption and more resorption in teeth splinted for longer than 10 days. It was concluded that pulp extirpation time was not critical unless the delay exceeded 20 days and that splinting time should not exceed 10 days.

Adolescent↗

PubMed1982

Effect of root surface alterations on periodontal healing. I. Surgical denudation.

The present study was undertaken to evaluate the effect of root surface denudation on periodontal healing. Twelve teeth, distributed in four squirrel monkeys, were extracted and reimplanted after surgically denuding the coronal root surface of connective tissue fibers and cementum by root planing. The reimplantation schedule provided three teeth for histologic analysis at 1, 3, 7 and 21 days after reimplantation. One day after reimplantation a zone of fibrin enmeshing erythrocytes and inflammatory cells was interposed between th root surface and the remaining periodontal fibers attached to the alveolar bone. Epithelium migrated rapidly along the denuded root, had reached the alveolar crest at 3 days, and was within the ligament space at 7 days. At 21 days, the epithelium was at the apical limit of root instrumentation, which corresponded to the level of attached connective tissue fibers on the root surface. No evidence of new connective tissue attachment was observed on the denuded root surface. It was concluded that the absence of fibers on the root surface resulted in apical migration of the epithelium, and precluded formation of new connective tissue attachment.

Animals↗

PubMed1986

[Reimplantation of 83 teeth].

A total of 83 teeth were reimplanted after extraction and treatment of periapical or pulpoperiodontal lesions in 79 patients, age range 9 to 55 years. Only anterior teeth were immobilized by ligature and self-polymerizable resin. Follow up of from 1 to 5 years showed complete success in 69% clinical success but with root lysis in 11%, as shown by radiologic imaging, and failure of treatment, mainly in patients over 40 years, in 20%. Healing was usually by ankylosis but an alveolodental new ligament formation was noted in only 3 cases. Root lysis occurred in 28% of cases, including 1/3 rd of the compensated type with a very slow course and 2/3 rds of the inflammatory type with resulting failure of treatment.

Adolescent↗

PubMed1982

Effect of root surface alterations on periodontal healing. II. Citric acid treatment of the denuded root.

A companion study reported that new connective tissue attachment did not occur to a surgically denuded root surface when transplanted into a normal periodontium. It was the purpose of this study to evaluate periodontal healing adjacent to a citric acid treated denuded root surface. In four squirrel monkeys, 12 teeth were extracted and reimplanted after surgical denudation and citric acid conditioning of the coronal root surface. The study design provided three teeth for histologic analysis at 1, 3, 7 and 21 days after reimplantation. One and 3 days after reimplantation a zone of fibrin containing inflammatory cells and erythrocytes was interposed between the root surface and remaining periodontal fibers. The fibrin network appeared to be attached to the root surface by arcade-like formations. The apical termination of the epithelium was located at the coronal extent of the fibrin zone. Granulation tissue and new fibers were aggregating along and perpendicular to the root surface at 7 days, and new connective tissue attachment had been established at 21 days. Extensive root resorption was present along the intra-alveolar part of the root surface. Epithelium had not migrated apically along the denuded root surfaces. The results indicated that citric acid treatment of denuded root surfaces resulted in new connective tissue attachment, and the response appeared to be dependent upon early establishment of fibrin linkage with the root surface.

Animals↗

PubMed1983

Fibrin linkage: a precursor for new attachment.

Previous studies indicated that connective tissue attachment to the root surface appeared to be dependent upon a chronologic healing sequence related to fibrin and collagen interactions. It was the purpose of the present study to try and substantiate this hypothesis by using histologic techniques designed to differentiate between fibrin and collagen during healing at the root surface interface. In four squirrel monkeys, 24 normal teeth were extracted and reimplanted after either (i) surgically denuding the coronal root surface of connective tissue fibers and cementum by root planing or, (ii) surgical denudation followed by topical application of citric acid (pH = 1; 3 minutes). Three specimens were available for histological analysis 1, 3, 7 and 21 days after reimplantation. Mallory's phosphotungstic acid hematoxylin staining technique was used to differentiate between fibrin and collagen. Epithelium migrated rapidly along the denuded, non-acid-treated, root surfaces, had reached the alveolar crest at 3 days, and was within the ligament space to the level of root denudation at 21 days. Epithelium did not migrate apically along denuded root surfaces treated with citric acid. At 1 and 3 days, inflammatory cells were enmeshed in a fibrin network which appeared to be attached to the root surface by arcade-like structures. At 7 and 21 days, the region had repopulated with connective tissue cells, and collagen fibers had replaced the fibrin. It was concluded that collagen fiber attachment to the root surface was preceded by fibrin linkage, and that the linkage process occurred as an initial event in the wound healing response.

Animals↗