Replantation after traumatic avulsion

Delayed replantation of avulsed permanent maxillary central incisor: Case report with 6-year follow-up

Replantation should be attempted in any case of avulsion, be it immediate or delayed. Retention of the replanted tooth helps in preservation of adjacent alveolar bone. Despite the occurrence of replacement resorption, the tooth can stay healthy and functional in the arch for a longer duration.

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.

Effect of platelet-rich plasma concentrations on the proliferation of periodontal cells: An in vitro study

Objective:

The purpose of this study was to evaluate the effect of different concentrations of platelet-rich plasma (PRP) on the proliferation of undifferentiated periodontal ligament (PDL) fibroblasts.

Materials and Methods:

The undifferentiated PDL fibroblasts were obtained from two healthy human premolar teeth and cultured in Dulbecco's modified Eagle's medium. Cell wells were divided into five groups. Experimental groups received 0.1%, 5%, or 50% PRP; the positive and negative control groups were cultured in fetal bovine serum (FBS) 12% and in a medium without FBS 12%, respectively. The plates were incubated at 37°C for 1, 2, 3, 4, and 7 days. PDL cell viability was assessed by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide proliferation assay. Statistical analysis of the data was accomplished using repeated measure ANOVA and Tukey's test. P < 0.05 was considered statistically significant.

Results:

The 5% PRP had the greatest effect on undifferentiated fibroblast proliferation, which was significant on the 3^rd day. There was no significant difference between 0.1% PRP and positive control during the first 3 days. The group with 50% PRP presented significantly lower proliferation, compared to other experimental and control groups.

Conclusions:

It may be concluded that the growth-stimulating effect of PRP is dose dependent with the best results in low concentrations.

Reasonable Outcome of Avulsed Permanent Upper Incisor after Seven Years Follow-Up Period: a Case Report

Background

Avulsion of the permanent teeth is one of the most serious oral health problems among active children and adolescents. Traumatized patients require immediate and correct treatment in order to restore damaged structures and function that have major impact on daily patient's life. As a result, proper guidelines and fast treatment methods are necessary. This case report discusses treatment of maxillary right central incisor with an open apex that had been avulsed and replanted. We review applied treatment procedures to manage dental avulsion and restore function and aesthetics.

Methods

A 10-year-old male presented with avulsion of his maxillary right central incisor as a result of unintentional playground injury. The tooth had been stored dry before the patient received immediate care. The avulsed tooth was reimplanted and splinted. The applied treatment procedures include endodontic and restorative treatment as well as careful follow-up visits.

Results

The patient underwent endodontic therapy of his maxillary right central incisor with calcium hydroxide as an intracanal medicament in apexification technique and the closure of apex was achieved. Canal was obturated and the tooth was restored with composite resin. Clinical and radiographic imaging follow-up showed endodontic success with closed apex. However, severe infra-position of maxillary right central incisor developed due to ankylosis.

Conclusions

Ankylosis due to tooth avulsion is a common complication of reimplanted permanent incisors and must be taken into consideration. While addressing ankylosis and its results is supported by little evidence, every case must be diagnosed correctly and treated according to its negative outcomes.

Swinging Replantation: A Possible Protocol for the Management of Inverted Impacted Upper Central Incisor Tooth

INTRODUCTION

Inverted tooth impaction is a rare occurrence. Third molar impaction is the most extensively studied, and only eight cases of inverted third molars have been reported in a literature search of 40 years from 1973 to 2013. In a study, 43.4% of the premaxillary supernumeraries were inverted and 21.1% were transversely oriented, while occasional inverted central incisors have been mentioned in the literature. Severe dilaceration makes the management of this case a big challenge. The case of an 8-year-old boy with an inverted, rotated, and impacted upper left central incisor obstructed by an odontome is presented here. Under local anesthesia, the odontome was excised; the inverted tooth was swung and repositioned. The patient experienced uneventful healing, and with 30 months follow-up, progressive tooth eruption has been observed. Vitality test is positive, while radiologically there was no sign of resorption. Swinging replantation is a protocol that has been used for the management of an inverted, rotated, and impacted central incisor. Open root apex is an important factor in the selection of the method. The minimal periodontal damage prevents inflammatory and replacement resorption. With some clear advantages over options like orthodontic and prosthetic replacement, it could be a method to be considered in the management of severely dilacerated central incisors. The clinical significance is that even though management of a severely malpositioned tooth has always been a big challenge in dental practice, requiring extraction and prosthodontic replacement, swinging replantation provides a possible protocol of tooth retention, i.e., less expensive and associated with fewer hospital visits.

Comparative in vitro study of the effectiveness of Green tea extract and common storage media on periodontal ligament fibroblast viability

Objective:

Green tea extract (GTE) was shown to be effective in preserving periodontal ligament fibroblasts (PDLFs) of avulsed teeth. This study aimed at determining the potential of GTE in preserving the viability of PDLFs comparing with different storage media.

Materials and Methods:

Periodontal ligament cells were obtained from freshly extracted healthy impacted third molars and cultured in Dulbecco's Modified Eagle Medium (DMEM). Cell viability was determined by storing the cells in seven media; DMEM, tap water, Hank's balanced salt solution (HBSS), whole milk, hypotonic sucrose solution, GTE, and GTE + sucrose for 1, 2, 4, and 24 h at 37°C using tetrazolium salt-based colorimetric (3-[4, 5-dimethylthiazol-2-yl]-2, 5-diphenyl tetrazolium bromide) assay. Statistical analysis was performed by one-way analysis of variance and post hoc tests.

Results:

GTE showed significantly higher protective effect than HBSS at 2, 4, and 24 h (P = 0.009, P = 0.02, P = 0.016), DMED at 2 h (P = 0.003), and milk at 4 h (P = 0.039).

Conclusion:

Although with undesirable osmolality and pH, GTE had a good ability in preserving the PDLFs comparing with other studied media.