What is the Best Root Surface Treatment for Avulsed Teeth?

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.

Successful outcome of permanent maxillary incisor reimplanted after 30 hours of extra-oral time-a case report with 5-year follow-up

Key Clinical Message

Tooth reimplantation should be attempted in every possible case with thorough disinfection and impervious obturation. Integration of progressive innovations with recommended protocols can enhance complication free survival in intense situations.

Abstract

The present case describes the unique successful outcome of a tooth reimplanted after the delay of 30 hours. A 21-year old male patient presented with an avulsed #21 after a fall due to electric shock. It was reimplanted according IADT guidelines with the addition of specific irrigation sequence proposed for regenerative endodontic procedures during the endodontic treatment. The final obturation was accomplished by combination of Biodentine and BioRCS root-canal sealer. Subluxated #11 developed symptoms at 6 months and was further managed using recommended endodontic procedure. Both teeth had complication free survival during 5 year follow-up.

An In Vitro Evaluation of Morinda citrifolia and Ocimum sanctum as Potential Storage Media to Maintain Cell Viability for Avulsed Teeth Using Collagenase Dispase Assay

Aim This study aimed to evaluate the protective effects of Ocimum sanctum extract and Morinda citrifolia juice on human periodontal ligament (PDL) cells after the reimplantation of avulsed teeth using a collagenase-dispase test. Materials and methods Sixty-five human premolars, all of which would eventually need to be extracted, were split into three experimental groups: one treated with Hanks Balanced Salt Solution, another with Morinda citrifolia juice and Ocimum sanctum extract, and two control groups (positive and negative). There were 10 teeth in each control group and 15 teeth each were used in the experimental groups, with the first 30 minutes spent dry before being submerged in one of three experimental media for 45 minutes, followed by 30 minutes of treatment with collagenase and dispase II. The cells' vitality was measured by the trypsin dye exclusion technique. To determine how many PDL cells were still alive, An optical microscope and a hemocytometer were used. The data were analyzed using Kruskal-Wallis one-way ANOVA and Mann-Whitney U tests. Results The percentage of viable PDL cells was greatest in Morinda citrifolia juice (85.18%), followed by HBSS (84.3%), and finally by Ocimum sanctum extract (68.04%). There was no significant difference in the number of viable PDL cells in Morinda citrifolia juice and HBSS. Conclusion The results of this research suggest that Morinda citrifolia juice has potential as a storage medium and as an alternative to HBSS, within the study's constraints, considering its availability as well as economic feasibility.

Avulsion of Permanent Mandibular Incisors: A Report of Two Cases with Pertinent Literature

Introduction. This study reports two rare cases of avulsion of permanent mandibular incisors with their sequelae after being reimplanted by two contrary methods. The relevant literature regarding the avulsion of permanent mandibular incisors is also being discussed. Case Presentation. In Case I, a 9-year-old girl reported an avulsion of the permanent mandibular left lateral incisor that was immediately reimplanted within 20 minutes after injury, whereas in Case II, all four permanent mandibular incisors were avulsed and reimplanted after a prolonged extraoral dry time of 36 hours in an 18-year-old female. Both cases missed their scheduled follow-up visits and were reported after 3.5 years and 7 months, respectively, with severe root and alveolar bone resorption that was confirmed by clinical examination and Intra oral periapical radiograph (IOPA) radiographs. Discussion. Avulsion of permanent mandibular incisors is rare. The similar unfavorable outcome of contrary cases at a variable duration of time after missed follow-up illustrates the role of the appropriate treatment protocol and regular follow-up visits for the long-term success of reimplanted teeth.

Comparative gene expression analysis of stemness between periodontal ligament and umbilical cord tissues in humans

Background/purpose

Due to their regenerative potential, periodontal ligament (PDL) and umbilical cord (UBC) tissues are an attractive potential mesenchymal stem cells (MSCs) source. This study compared the expression patterns of genes related to stemness between fresh PDL and UBC tissues.

Materials and methods

PDL tissues were collected from 38 permanent premolars extracted for orthodontic purposes, and UBC tissues were obtained from three newborns. Each sample was immediately frozen to prevent RNA degradation. cDNA microarray analysis, quantitative real-time polymerase chain reaction (PCR), and immunohistochemical staining were performed. Gene expression patterns associated with dental stemness (DS) and induced pluripotent stemness (iPS) were compared between PDL and UBC tissues.

Results

In the cDNA microarray analyses, the expressions of most iPS genes were greater in the PDL than in the UBC. Meanwhile, the expressions of most DS genes were greater in the UBC than in the PDL. Quantitative real-time PCR analyses showed that the expression levels of matrix metallopeptidase 13 (MMP13), ADAM metallopeptidase domain 22 (ADAM22), vascular cell adhesion protein 1 (VCAM1), and kruppel-like factor 4 (KLF4) genes were greater in the PDL than in the UBC, while the expressions of melanoma cell adhesion molecule (MCAM) and activated leukocyte cell adhesion molecule (ALCAM) were greater in the UBC than in the PDL.

Conclusion

These results suggest that UBC and PDL tissues showed slightly different expression patterns of genes related to stemness, which warrants further investigation to use these tissues for future regeneration and implantation therapies.

Periodontal ligament repair after active splinting of replanted dogs' teeth

BACKGROUND/AIM

The high rate of root resorption resulting from tooth replantation represents a serious clinical problem. In order to prevent ankylosis and replacement resorption, the contemporary literature highlights the importance of using a flexible stabilization for traumatized teeth. For this purpose, orthodontic devices may be promising for obtaining a better prognosis and periodontal repair. The aim of this study was to evaluate the effect of an active splinting protocol with controlled force in dog's teeth following replantation.

MATERIAL AND METHODS

Sixty premolar roots from three dogs were used. They were submitted to endodontic treatment, hemisected, atraumatically extracted and subsequently replanted. They were divided into four groups: Passive Stabilization (n = 20)-after 20 min in a dry medium; Active Stabilization (n = 20)-after 20 min in a dry medium; Negative control (n = 10)-immediate replantation and passive Stabilization; and Positive control (n = 10)-90 min of extra-alveolar time and passive Stabilization. The samples were collected and submitted to histologic processing. They were then evaluated for the count of inflammatory cells, expression of neurotrophin 4, osteoclasts, apoptotic cells and collagen fibres. The results were submitted to ANOVA or Kruskal-Wallis statistical tests followed by Tukey or Dunn post-tests (α = 5%).

RESULTS

Passive Stabilization with orthodontic brackets without traction used after replantation had the highest number of inflammatory cells (p = .0122), osteoclasts (p = .0013) and percentage of collagen fibres in the periodontal ligament (p < .0001) when compared to Active Stabilization with orthodontic brackets applying amild tensile force. Neurotrophin 4 had no statistically significant difference (p = .05), regardless of the treatment. The apoptotic cells count revealed statistical differences (p < .0001) between Active Stabilization (189.70 ± 47.99) and Positive Control (198.90 ± 88.92) when compared to Passive Stabilization (21.19 ± 32.94).

CONCLUSION

The active splinting protocol using orthodontic appliances generating a light and controlled force favoured periodontal ligament repair of replanted teeth.

Tissue reaction to novel customized calcium silicate cement based dental implants. A pilot study in the dog

OBJECTIVES

The purpose of this study was to determine the level of periodontal tissue regeneration in a canine model following post-extraction placement of an implant molded from a composite material made from extracted tooth dentin and a calcium silicate cement (CSC) material. The investigation used autologous dentin in conjunction with a CSC material to form a composite implant designed for immediate tooth replacement.

METHODS

Two (2) beagles had a periodontal and radiographic examination performed to rule out any pre-treatment inflammation, significant periodontal disease, or mobility. Then, ination eleven (11) teeth were extracted and polyvinyl siloxane molds were made to fabricate three different types of implants: Particulate Implant (Test Group 1, n = 4), Shell Implant Alone (Test Group 2, n = 2), Shell Implant with Emdogain® (Test Group 3, n = 3). Teeth in the control group were extracted, scaled (n = 2), and then re-implanted into their respective fresh extraction sockets. At 4 weeks, a clinical, radiographic, and histologic assessment was performed.

RESULTS

Clinical evaluation revealed no mobility in any of the test or control implants and no radiographic evidence of significant bone loss or active disease. Based on the MicroCT analysis, direct bone to implant contact was observed in some areas with an apparent periodontal ligament space. Implant-related inflammation, on average, was similar among all groups, with low numbers of infiltrates. Implant-related inflammatory reaction was generally minimal and not interpreted to be adverse.

CONCLUSION

The proposed novel composite materials revealed that not only do these materials demonstrate high biocompatibility, but also their successful integration in the alveolus is likely secondary to a partial ligamentous attachment. The current investigation may lead to the use of calcium silicate-based materials as custom dental implants. Further research on this novel composite's biomechanical properties is necessary to develop the optimal material composition for use as a load-bearing dental implant.

Geomorphologic study of human tooth root surfaces following simulated avulsion by scanning electron microscopy

BACKGROUND/AIMS

Tooth avulsion is the most severe traumatic tooth injury. Immediate replantation after avulsion provides the highest success rate, whereas delayed replantation with dehydration for >1 h always results in ankylosis, replacement resorption, and eventual tooth loss. The aim of this study was to investigate the geomorphologic change of ultrastructure on tooth root surfaces due to dehydration.

MATERIAL AND METHODS

Twenty-four sound human premolars and fully developed third molars without periodontitis were selected for the experiment. Roots were separated into 6-7 pieces with an intact root surface area (3 × 3 mm² ) and then divided into the following groups: fresh group, prolonged dehydration groups (air drying for 1, 2, 4, 12, or 24 h), and dehydrated teeth (air drying for 2 h) treated with acid (Tris-HCl buffer or citric acid buffer). More than six pieces of root from each group were subjected to scanning electron microscopy (SEM) observation. Captured images were exported to ImageJ software to quantitatively analyze the areas covered with fibers. Statistical significance was determined by comparing the means of the different groups using t-testing or one-way analysis of variance followed by post hoc testing.

RESULTS

Fibrous "vegetation" covering the cementum was observed on the fresh root surface by SEM. This was destroyed by dehydration (>1 h), resulting in a root surface resembling the "Gobi Desert." The difference was statistically significant (p < .001). Root surface deteriorated by dehydration could be recovered by the re-use of the fibers embedded in the cementum as acid demineralization of the outer layer of cementum exposed the embedded fibers to simulate the geomorphology of fresh root surface.

CONCLUSIONS

Dehydrated teeth had deteriorated geomorphology of the root surface, which could be reversed by the re-use of the fibers embedded in the cementum using citric acid. Direct evidence from SEM gives new insights into the replantation of dehydrated avulsed teeth.

Effect of lectin (ScLL) on fibroblasts stimulated with LPS - an in vitro study

The lectin (ScLL) extracted from the Synadenium carinatum plant has been evaluated as an immunomodulator in diseases such as asthma, neosporosis and leishmaniasis. However, it has not yet been evaluated in the oral cavity. This study evaluated the effect of ScLL on viability, proliferation and release of IL-10 in human gingival fibroblasts (HGF) stimulated with lipopolysaccharide (LPS). HGF were stimulated with LPS 1 µg/ml and treated with ScLL in concentrations of 10, 5 and 2 µg/ml for 1 and 5 h, and evaluated by flow cytometry for viability, apoptosis (initial/advanced) and necrosis. The supernatant was collected to detect release of IL-10 by ELISA. The proliferation was assessed with the BrdU assay. Positive control consisted of cells maintained in Dulbecco's Modified Eagles Medium (DMEM), and the negative control, of those kept in tap water. Data were analyzed by ANOVA and Dunnett's test (α = 0.05). No significant difference was found for ScLL concentrations regarding viability or initial and advanced apoptosis (p=0.455). All the groups, including the positive control, had a significantly lower necrosis parameter than negative control at 5 h (p < 0.001). No difference was found for proliferation among the experimental groups (p = 0.832). ScLL at 5 and 2 µg/ml resulted in a lower release of IL-10 than positive and negative controls at 5 h (p = 0.047). The results indicated that ScLL concentrations tested were not cytotoxic, and had no effect on proliferation and release of IL-10 parameters. A thorough understanding of ScLL, regarding its immunomodulatory potential, may open the door to new perspectives for dentistry.

Apical Revascularization after Delayed Tooth Replantation: An Unusual Case

The aim of this paper is to present the clinical and radiological outcome of the treatment involving a delayed tooth replantation after an avulsed immature permanent incisor, with a follow-up of 1 year and 6 months. An 8-year-old boy was referred after dental trauma that occurred on the previous day. The permanent maxillary right central incisor (tooth 11) had been avulsed. The tooth was hand-held during endodontic therapy and an intracanal medication application with calcium hydroxide-based paste was performed. An apical plug with mineral trioxide aggregate (MTA) was introduced into the apical portion of the canal. When the avulsed tooth was replanted with digital pressure, a blood clot had formed within the socket, which moved the MTA apical plug about 2 mm inside of the root canal. These procedures developed apical revascularization, which promoted a successful endodontic outcome, evidenced by apical closure, slight increase in root length, and absence of signs of external root resorption, during a follow-up of 1 year and 6 months.