Results after replantation of avulsed permanent teeth. III. Tooth loss and survival analysis

Effect of icariin surface treatment on the resorption of denuded roots after replantation in rat

AIM

Limiting the incidence of resorption associated with delayed replantation of avulsed teeth is critical for long-term tooth survival. In this study, we assessed whether icariin, a natural product with anti-osteoclastic properties, could reduce root resorption in a rat model of tooth replantation.

METHODOLOGY

Cytocompatibility of icariin (10, 20, 40 and 80 μM) was evaluated by CCK-8 proliferation assay in vitro, and an osteoclastogenesis assay was performed to evaluate the effect of icariin on the differentiation of rat bone marrow macrophages and human peripheral blood monocytes into tartrate-resistant acid phosphatase-stained (TRAP+ ) multinucleated giant cells (MNGCs). Differentiation of human periodontal ligament stem cells (hPDLSCs) treated with icariin (10 μM) was also evaluated at 5, 10 and 21 days of osteogenic induction. The first maxillary molars of five-week-old male Sprague-Dawley rats were extracted, denuded of PDL, then treated either with neutralized collagen solution (Carrier control) or icariin in collagen (3 μg/μL) before replantation into their sockets. The animals were euthanized 2 weeks post-surgery for micro-computed tomography (micro-CT) imaging and histological analyses.

RESULTS

Icariin was cytocompatible and significantly reduced the differentiation of TRAP+ MNGCs in a dose-dependent manner compared to the control. Moreover, icariin enhanced alkaline phosphatase activity, expression of osteogenic marker genes and proteins, and calcium deposition in hPDLSCs. Micro-CT imaging of the replanted samples demonstrated a significantly higher volume of remaining roots in the icariin-treated group than in the control group. Histological analysis revealed a marked number of resorptive lacunae with TRAP activity in the control group, whereas icariin-treated samples showed signs of functional healing and reduced osteoclastic activity.

CONCLUSIONS

Icariin was biocompatible and demonstrated potent anti-osteoclastic and pro-osteogenic properties that reduced resorption and promoted functional healing of denuded roots in a rat maxillary first molar model of replantation. These findings indicate that root surface treatment with icariin may be a clinically relevant and practical method for improving the retention and survival of teeth with compromised PDL after delayed replantation following traumatic avulsion.

Survival and complication analyses of avulsed and replanted permanent teeth

This retrospective clinical study investigated the survival probability of avulsed and replanted permanent teeth in relation to functional healing, replacement and inflammatory resorption. The explorative data analysis included data from 36 patients and 49 replanted permanent teeth with a minimum observation time of 60 days; the patients were generally treated according to the current guidelines of the International Association of Dental Traumatology at the university hospital in Munich, Germany, between 2004 and 2017. The mean observation period was 3.5 years. Functional healing was observed in 26.5% (N = 13/49) of the included avulsion cases. In comparison, replacement resorption affected 51.0% (N = 25/49) of the replanted teeth, of which 24.0% (N = 6/25) were lost over the course of years (mean, 6.1 years). In contrast, inflammatory resorption resulted in the early loss of all replanted teeth (mean, 1.7 years) and affected 22.5% (N = 11/49) of all the monitored teeth. Therefore, it can be concluded that tooth avulsion remains a severe dental injury with an unpredictable prognosis. This topic demands further fundamental research aiming to maintain and/or regenerate the periodontal ligament after tooth avulsion, particularly in association with non-physiological tooth rescue.

Traumatic Dental Injuries Resulting from Sports Activities; Immediate Treatment and Five Years Follow-Up: An Observational Study

Background:

Traumatic dental injuries (TDIs) represent 18-30% of all oral pathologies and a considerable number of these are sports related. It is very important to treat sports-related injuries and prevent complications. However, very few studies investigate the most expedient therapeutic strategies for the treatment of dental trauma correlated to sports.

Objective:

The aim of this work was to focus on the average recovery time for different lesions, to assess adequate times for each athlete, to identify any association with complications and to investigate whether or not the use of mouth-guards interfered with a full recovery to normal health.

Methods:

This study involved a group of 30 athletes (15 male and 15 female) who had dental injuries of varying severity.

For the purposes of data collection, two classifications were taken into account: a classification for hard tissue trauma and another for periodontal lesions. The athletes were subdivided in “type of lesion’ groups”.They were then treated depending on their individual lesions and followed up for 5 years. A statistical analysis was carried out to study the association between recovery time, lesion types and occurrence of complications.

Results:

The time for recovery was different for each type of lesion and ranged from 3-5 days (only uncomplicated fractures) to 14 days (all hard-periodontal tissue traumas). The total number of recorded pulp complications amounted to 6 cases. Among 30 athletes, 20 had begun and maintained, during the five-year follow-up period, the habit of using mouth-guards when practicing their sport activities.

Conclusions:

Recovery time and the severity of lesions are statistically associated: the more serious the injury, the more time an athlete needs to recover and return to competitive sports events. Furthermore, recovery time and precautionary measures (mouth-guards) did not influence the onset of complications. The subjects’ habit of wearing a mouth guard continued even after the end of the therapy and follow-up periods.

Aetiology, treatment patterns and long-term outcomes of tooth avulsion in children and adolescents

OBJECTIVE

Tooth avulsion constituting an emergency for children and adolescents necessitates management approaches ensuring the survival of avulsed teeth. The aim of this study was to determine the causes of tooth avulsion and to examine some factors affecting the clinical & radiographic assessment of their prognosis after replantation.

METHODOLOGY

The study sample was created by using archival records of patients who were referred to the Suleyman Demirel University, Faculty of Dentistry, Department of Pedodontics, with complaint of traumatic injuries, between December 1999 and 2008. The information about age, gender, time and cause of the injury, number of affected teeth, the root maturation level (mature/immature), vitality of the affected teeth, condition of supporting tissues, extra-oral time of avulsed teeth, storage media, time of replantation, type and duration of splinting, and healing process was obtained from the patients' records.

RESULTS

The sample consisted of 66 traumatized children who had a total of 93 avulsed anterior permanent teeth. The age of these patients ranged from 6 to 16 years and the 9- and 10-year-old group had the highest incidence (n=25). The most frequent causes were falls (n=24; 36.4%). Thirty-three out of a total of 93 avulsed teeth (35.5%) were replanted. Of the 33 replanted teeth, 3 (9.1%) were stored in milk and 25 were stored in dry media (n=25; 75.8%). Fifteen teeth (45.5%) were replanted within 30 minutes after the injury. After clinical and radiographic evaluation a total of 12 replanted teeth (36.4%) were considered as failed. Ten of the replanted teeth had to be extracted due to progressive root resorption. Statistical analysis showed no significant relationship between the successes of replanted teeth with extra-oral period, storage media, root formation stage, and additional traumas to the supporting tissues (p>0.05).

CONCLUSION

In this study, during the 9-year period, it was determined that 5.87% of all traumatic dental consisted of avulsion injuries. Thirty-three avulsed teeth in 26 patients were replanted, and 12 replanted teeth were revealed as failures. A high rate of success can be obtained when the avulsed teeth are kept under wet conditions and brought to a dental clinic as soon as possible.

International Association of Dental Traumatology 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 or urgent care of avulsed permanent teeth.

Replantation of Immature Avulsed Teeth with Prolonged Extraoral Dry Storage: A Case Report

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.

Traumatic injury to permanent tooth resulting in complete root resorption: a case report

When a tooth is avulsed and replanted following traumatic dental injury, complications such as replacement and inflammatory resorption may occur. Ultimately, resorption may result in loss of the tooth. This case report describes a traumatic injury to a permanent tooth resulting in complete root resorption within a short period, which required surgery. In the present case, improper treatment measures such as dry condition of the avulsed tooth before replantation and extra-oral retrograde root canal filling may have led to rapid complete root resorption. Even if it is impossible to avoid resorption completely, the overall knowledge of both dentists and patients regarding traumatic dental injuries should be improved to delay the progress of resorption.

Interrelation between endodontic status, pathologic cemental granules and periodontal ligament adhering to the root of extracted teeth

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.

Treatment of replacement resorption by intentional replantation, resection of the ankylosed sites, and Emdogain�? results of a 6-year survey

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.

Epithelial cells in PDL are critical in resuming the integral relation between tooth root and supporting bone after trauma--a transplantation experiment

OBJECTIVE

The aim of this study was to determine the response of the residual epithelial network following traumatic breakdown of the periodontal ligament (PDL).

METHODS

Mandibular incisor sections with PDL (experimental) and sections denuded of PDL (control) from 4- to 6-week-old Wistar-Furth rats were transplanted into the defects created in the frontal bone of the recipient syngeneic rats. At intervals, the defects with implanted teeth roots were collected and processed for histological and biochemical examination. Immunolocalization of epithelial cells was performed to monitor their phenotypic changes during transplantation healing period.

RESULTS

(1) Histological observation of the experimental sample revealed the sequence of cellular response characterized by an initial degeneration of PDL followed by a proliferation of granulation tissue. There was also a marked odontoblastic reaction with extensive deposition of regular dentine within the pulp chambers. In the control group, initial signs of bony fusion with dentine led to an extensive ankylosis and bone replacement between roots and defects. (2) Immunostaining indicated that, in experimental groups, the pattern of regularly spaced epithelial cells lying in close approximation to the root surface was distinct 10 days post-transplantation but became diminished afterwards. The immunoreaction against epithelial cells was negative in the control.

CONCLUSION

Residual PDL is essential to prevent ankylosis after trauma and epithelial cells may facilitate the re-establishment of root-PDL-bone complex by transforming into mesenchymal cells.

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

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