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Chu T, Qin Q, Liu K, Zhao Y, Fu Y, Liu Q. Enucleation of jaw cyst combined with intentional replantation to retain cyst-involved teeth. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101731. [PMID: 38097014 DOI: 10.1016/j.jormas.2023.101731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/09/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Jaw cysts often deeply involve adjacent tooth roots, making it difficult to preserve them. The purpose of this retrospective study was to investigate the effectiveness of an intentional replantation (IR) strategy combined with cyst enucleation in preserving cyst-involved teeth during jaw cyst removal. MATERIALS AND METHODS Fifteen patients with jaw cysts and deeply involved teeth were treated with IR and cyst enucleation. All patients received root canal therapy prior to surgery, except for one patient who received it during surgery. The involved teeth were extracted, and the root surface was carefully cleaned before IR and cyst enucleation. Patients were followed up for 12-14 months, with indicators including clinical complaints, replanted tooth stability, and root resorption. RESULTS No cyst recurrence was observed, and all replanted teeth survived with good local gingival condition and no marked swelling or recession. Radiographic findings showed clear periodontal space surrounding the replanted teeth. One replanted tooth exhibited slight root resorption due to occlusal trauma, but the resorption ceased after occlusal adjustment. CONCLUSIONS IR combined with cyst enucleation is an effective strategy for thoroughly cleaning jaw cysts and preserving teeth involved in the cyst.
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Affiliation(s)
- Tianshu Chu
- The Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Jilin University, Changchun, PR China
| | - Qingyan Qin
- The Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Jilin University, Changchun, PR China
| | - Kang Liu
- The Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Jilin University, Changchun, PR China
| | - Yitong Zhao
- The Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Jilin University, Changchun, PR China
| | - Yongzhen Fu
- The Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Jilin University, Changchun, PR China
| | - Qilin Liu
- The Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Jilin University, Changchun, PR China.
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Huang JW, Gan YN, Xu H, Han S, Zhu H, Jia L, Li N, Li DD, Cai ZG. Tooth intentional replantation from 1964 to 2023: A bibliometric analysis. Dent Traumatol 2024; 40:121-132. [PMID: 37646307 DOI: 10.1111/edt.12884] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/10/2023] [Accepted: 08/13/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND/AIM There is no thorough overview of intentional tooth replantation techniques. We performed a bibliometric analysis of the development of intentional tooth replantation. MATERIALS AND METHODS A comprehensive search of the Web of Science and SCOPUS databases was conducted in February 2023. Original articles and reviews of human studies with "intentional replantation" or synonyms in the titles, abstracts, or keywords were included. A descriptive analysis of bibliographic data, co-occurrence analysis, and coupling of publications was performed. Multivariate analysis was used to explore the bibliometric parameters associated with the citation counts. RESULTS The study included 171 papers, which were co-authored by 500 individuals affiliated with 217 institutions from 28 countries/regions. The USA contributed the greatest number of publications, followed by China, and Japan. The USA had 694 citations, followed by Japan (210), and Turkey (210). The Journal of Endodontics and Dental Traumatology contributed the most citations. Five directions for future research were identified based on the coupling relationships of publications, including "managing vertical root fractures with adhesive resin using the intentional replantation technique," "intentional replantation for periodontally hopeless or endodontically compromised teeth," "intentional replantation for treating abnormalities of morphological development," "outcomes and prognosis factors of intentional replantation," and "treating root replacement resorption by intentional replantation." Multivariate analysis showed that the publication year, Journal Citation Reports ranking of journals, study design, and disease type were predictors of citation counts. CONCLUSIONS This bibliometric analysis provides a comprehensive description of the intentional replantation technique. The USA published the greatest volume of papers and generated the most citations. The Journal of Endodontics and Dental Traumatology are considered the most influential. The Journal Citation Reports journal ranking (Q1, Q2), study design (case reports, cohort studies), and disease type (crown root fractures) were associated with the citation counts.
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Affiliation(s)
- Jin-Wei Huang
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Department of General Dentistry II, Peking University School and Hospital of Stomatology, Beijing, China
| | - Ye-Na Gan
- Department of Tuina and Pain, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - He Xu
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - Sheng Han
- Department of Academic Research, International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - He Zhu
- Department of Academic Research, International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Lu Jia
- Dental Laboratory Center, Peking University School and Hospital of Stomatology, Beijing, China
| | - Nan Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Duo-Duo Li
- Department of Tuina and Pain, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Zhi-Gang Cai
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
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Kumar G, Biswas KP, Mishra N. Bridging the Gap between Endodontic Failure and Success: A Case Report on Intentional Replantation. Contemp Clin Dent 2024; 15:67-70. [PMID: 38707664 PMCID: PMC11068240 DOI: 10.4103/ccd.ccd_134_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 01/27/2024] [Accepted: 02/09/2024] [Indexed: 05/07/2024] Open
Abstract
This case report describes a case of intention replantation in a 15-year-old patient with a mandibular permanent right second molar that had undergone root canal treatment previously. The tooth was tender on percussion. Radiographic evaluation showed the presence of a separated instrument and periapical radiolucency. The surgical procedure was performed under local anesthesia, and the tooth was extracted. After cleaning and disinfecting the root canal system, the tooth was reimplanted, and the socket was filled with a mixture of bone graft material and a growth factor. A stainless steel crown was then placed to protect the tooth. A follow-up examination was performed after 12 months. The clinical and radiographic examinations revealed a well-healing periapical lesion with no signs of infection. The patient was asymptomatic, and the tooth was functional. The results of this case indicate that intentional replantation can lead to a favorable outcome.
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Affiliation(s)
- Gaurav Kumar
- Department of Conservative, Endodontics and Aesthetic Dentistry, Dental Institute, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Krishna Prasad Biswas
- Department of Dentistry, All India Institute of Medical Sciences, Guwahati, Assam, India
| | - Navin Mishra
- Department of Conservative Dentistry and Endodontics, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
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Plotino G, Abella Sans F, Bastos JV, Nagendrababu V. Effectiveness of intentional replantation in managing teeth with apical periodontitis: A systematic review. Int Endod J 2023; 56 Suppl 3:499-509. [PMID: 35294790 DOI: 10.1111/iej.13727] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
| | - Francesc Abella Sans
- Department of Endodontics, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Juliana Vilela Bastos
- Department of Restorative Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Spinas E, Pipi L, Mezzena S, Giannetti L. Use of Orthodontic Methods in the Treatment of Dental Luxations: A Scoping Review. Dent J (Basel) 2021; 9:18. [PMID: 33557060 PMCID: PMC7913869 DOI: 10.3390/dj9020018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 01/08/2023] Open
Abstract
(1) Background: Treating dental luxation injuries is challenging for the clinician. Dental luxations account for 18-33% of injuries to permanent teeth and can be addressed using different therapeutic approaches. The present work was conducted with two aims: (i) to evaluate, through a scoping review, current knowledge of the orthodontic methods (repositioning and stabilization splinting) that can be used at the time of the trauma, and (ii) to investigate the frequency and type of pulp consequences arising after these traumatic injuries. (2) Methods: The literature search was conducted in the period June 2020-December 2020 using the PubMed/MEDLINE, SCOPUS and Web of Science databases. The research questions were formulated according to the PICO (Population, Intervention, Comparison, Outcomes) method and considered the following aspects: type of luxation injury and stage of root development; use of orthodontic repositioning and splinting techniques; frequency and type of pulp consequences; and compliance of treatments with international guidelines. (3) Results: The initial screening of the databases, using the selected search keywords, yielded a total of 587 articles, just 8 fully met the inclusion criteria. Closer analysis of these 8 publications revealed that they would not produce clear meta-analytical data. This made it necessary to limit the data collected to the following six items: number and type of injuries, initial therapeutic intervention, duration of follow-up, number, and type of different pulp consequences. (4) Conclusions: While orthodontic techniques are commonly used to treat dental intrusions, in the case of extrusive and lateral luxation injuries, they are less frequently used and the orthodontic approach is generally confined to the stabilization phase. Among the various possible pulp consequences, many authors consider only pulp canal obliteration (PCO) and pulp necrosis (PN), often tending to overlook physiological healing (pulp survival) and the possible development of PN after PCO. There is therefore a clear need for new, high-quality clinical studies of this topic based on systematic and standardized data collection.
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Affiliation(s)
- Enrico Spinas
- Department of Surgical Sciences, Sports Dental Research Center, University of Cagliari, Via Ospedale, 40-09124 Cagliari, Italy;
| | - Laura Pipi
- Department of Surgical Sciences, Sports Dental Research Center, University of Cagliari, Via Ospedale, 40-09124 Cagliari, Italy;
| | - Silvia Mezzena
- Department of Conservative Dentistry and Endodontics, School of Dentistry, University of Cagliari, Via Ospedale, 40-09124 Cagliari, Italy;
| | - Luca Giannetti
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, Via del Pozzo, 71-41124 Modena, Italy;
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Kaddoura RH, Madarati AA. Management of an over-extruded fragment in a C-shaped root canal configuration: A case report and literature review. J Taibah Univ Med Sci 2020; 15:431-436. [PMID: 33132814 PMCID: PMC7564934 DOI: 10.1016/j.jtumed.2020.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/22/2020] [Accepted: 07/01/2020] [Indexed: 11/24/2022] Open
Abstract
Separation of root canal instruments is a common incident during root canal treatments' procedures. The complex configuration of root canal systems is one of the most influencing factors, not only during the occurrence of instrument separation but also during the management of such unpleasant incidents. There are few reports on the management of fractured instruments located in the apical third of the root canals apical, especially those extruded beyond the apex. A 37-year-old woman was referred to an endodontic specialist to complete a root canal treatment after the separation of an endodontic file in the middle-third of the C-shaped root canal configuration (Vertucci type II) of the mandibular second molar. A failed attempt at managing the fragment by the dentist resulted in the backward placement of the fragment, which was more apically, and partial extrusion beyond the root apex. The fractured instrument was successfully and safely retrieved using different procedures and techniques including bypassing the fragment, loosening the fragment using ultrasonics and then removing it by the crab-claw shaped tweezers (Zumax broken instruments removal kit). This case report demonstrates the importance of high magnification provided by the dental operating microscopes and sound clinical skills and judgment, especially in assessing the difficulty of cases that is necessary for various treatment approaches. In addition, the availability of different armamentaria to manage separated instruments is essential. Finally, this case report proposes and advocates the idea of removing fractured instruments extruding beyond the apex without surgery.
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Affiliation(s)
- Rami H Kaddoura
- Endodontic & Operative Dentistry Department, College of Dentistry, Damascus University, Syria
| | - Ahmad A Madarati
- Restorative Dental Sciences Department, College of Dentistry, Taibah University, Almadinah Almunawwarah, KSA
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Cunliffe J, Ayub K, Darcey J, Foster-Thomas E. Intentional replantation - a clinical review of cases undertaken at a major UK dental school. Br Dent J 2020; 229:230-238. [PMID: 32855480 DOI: 10.1038/s41415-020-1988-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Introduction Intentional replantation (IR) may offer a solution for persistent periapical lesions associated with endodontically treated teeth in select cases. This case series demonstrates the use of IR as an alternative treatment approach to both orthograde and surgical endodontic retreatment. The indications, contraindications, benefits and risks of IR are discussed, and the clinical procedure is outlined.Setting Restorative Department, University Dental Hospital of Manchester, UK.Case reports Of the 13 cases presented, the follow-up period before discharge ranged from 3-28 months. Only one tooth which presented intra-operative challenges required extraction three months after IR due to post-operative mobility.Conclusion In select cases, IR may provide a simple, less invasive and cost-effective alternative to both endodontic retreatment and extraction alone following appropriate training.
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Affiliation(s)
- Joanne Cunliffe
- Senior Lecturer/Honorary Consultant, University of Manchester, UK.
| | - Khawer Ayub
- Speciality Registrar in Restorative Dentistry, King's College Hospital and William Harvey Hospital, UK
| | - James Darcey
- Consultant and Honorary Lecturer in Restorative Dentistry, University Dental Hospital of Manchester, UK
| | - Emma Foster-Thomas
- Academic Clinical Fellow in Restorative Dentistry, University of Manchester, UK
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Lee SH, Cho SY, Kim DH, Jung IY. Clinical Outcomes after Apical Surgery on the Palatal Root of the Maxillary First Molar Using a Palatal Approach. J Endod 2020; 46:464-470. [DOI: 10.1016/j.joen.2020.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 12/28/2019] [Accepted: 01/07/2020] [Indexed: 10/25/2022]
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Zhang J, Luo N, Miao D, Ying X, Chen Y. Intentional replantation of periodontally involved hopeless teeth: a case series study. Clin Oral Investig 2019; 24:1769-1777. [DOI: 10.1007/s00784-019-03039-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 06/28/2019] [Indexed: 10/26/2022]
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10
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Kim Y, Lee D, Kim DV, Kim SY. Analysis of Cause of Endodontic Failure of C-Shaped Root Canals. SCANNING 2018; 2018:2516832. [PMID: 30595786 PMCID: PMC6286757 DOI: 10.1155/2018/2516832] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/27/2018] [Accepted: 10/04/2018] [Indexed: 06/09/2023]
Abstract
The purpose of this study was to analyze various characteristics and classification of C-shaped root canals and evaluate the causes of endodontic failure of C-shaped root canals by examining the resected root surface with an endodontic microscope and a scanning electron microscope (SEM). Forty-two teeth with C-shaped root canals were included in this study and had undergone intentional replantation surgery. Before surgery, periapical radiography and cone-beam computed tomography were taken. The root canal configuration was analyzed and classified according to Melton's classification at coronal and apical level. After injection of 1 : 100,000 epinephrine with 2% lidocaine, the tooth was carefully extracted. After the root-end resection, the resected root surface was examined using an operating microscope and SEM. Mandibular second molars were most frequently involved teeth (90.4%). The most frequently observed root canal configurations were C1 at the coronal level (45.2%) and C3 at the apical 3 mm level (45.2%). The most common cause of failure for a C-shaped root canal treatment was a leaky canal (45.2%), followed by an isthmus (23.8%), missing canal, overfilling, and iatrogenic problems. In conclusion, C-shaped root canals were most frequently found in mandibular second molars. The most common cause of failure was a leaky canal and isthmus.
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Affiliation(s)
- Yemi Kim
- Department of Conservative Dentistry, Dental Research Institute, Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Donghee Lee
- Department of Conservative Dentistry, Seoul St. Mary's Dental Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Da-Vin Kim
- Department of Conservative Dentistry, Seoul St. Mary's Dental Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sin-Young Kim
- Department of Conservative Dentistry, Seoul St. Mary's Dental Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Deotale SP, Shewale AH, Gattani DR, Nathani AI, Banode AM. Reliability of two different protocols used for intentional re-implantation of periodontally hopeless teeth. J Indian Soc Periodontol 2018; 22:353-359. [PMID: 30131630 PMCID: PMC6077966 DOI: 10.4103/jisp.jisp_170_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 05/17/2018] [Indexed: 11/09/2022] Open
Abstract
Intentional re-implantation is the careful removal and re-insertion of an endodontically treated tooth performed with an attempt to preserve the natural dentition and patients' esthetic concerns. Its limited success rate and a possibility to obtain undesirable outcomes such as root resorption and ankylosis of the tooth restrict its clinical use to be attempted only as a last option after routine procedures. A vast array of procedures have been performed till date with inconsistent results due to lack of analogous protocols followed. Regardless of having a controversial background behind its success in periodontally compromised teeth, this procedure raises a hope to avoid unwarranted natural tooth loss. Performing each step with precision governs the success of the treatment. This case report demonstrates two different techniques with an interdisciplinary approach assessed over 1 year each.
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Affiliation(s)
| | | | - Deepti Rakesh Gattani
- Department of Periodontology, SDKS Dental College and Hospital, Nagpur, Maharashtra, India
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Grzanich D, Rizzo G, Silva RM. Saving Natural Teeth: Intentional Replantation—Protocol and Case Series. J Endod 2017; 43:2119-2124. [DOI: 10.1016/j.joen.2017.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 07/26/2017] [Accepted: 08/03/2017] [Indexed: 10/18/2022]
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13
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Song D, Zhang L, Zhou W, Zheng Q, Duan X, Zhou X, Huang D. Comparing cone-beam computed tomography with periapical radiography for assessing root canal obturation in vivo using microsurgical findings as validation. Dentomaxillofac Radiol 2017; 46:20160463. [PMID: 28332866 DOI: 10.1259/dmfr.20160463] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES The aim of this study was to verify whether there is a difference in the in vivo performance characteristics of CBCT and periapical radiography (PR) in assessing the apical extension of root canal obturation (RCO) and to evaluate the ability of CBCT in void detection using microsurgical findings as validation. METHODS This study included 323 tooth roots that required surgical treatment and for which pre-existing periapical radiographs and CBCT images were available. Three calibrated observers individually analyzed the periapical radiographs, CBCT images and photomicrographs of each root. Performance characteristics of CBCT and PR were compared in terms of their evaluation of the apical extension of the RCOs. The ability of CBCT to detect voids in the RCOs was evaluated using microsurgical findings as validation. Kappa values were used for intraobserver/interobserver agreement. RESULTS Perfect intraobserver/interobserver agreement (1.0) was achieved when using photomicrography. The two agreements of PR were superior to those of CBCT when CBCT was used to detect voids (p < 0.05). The sensitivity of CBCT [0.86, 95% confidence interval (CI) 0.76-0.93] was superior to that of PR (0.66, 95% CI 0.54-0.76) in detecting overextension (p < 0.005). CBCT showed a poor sensitivity (0.24, 95% CI 0.19-0.30) and specificity (0.67, 95% CI 0.54-0.78) in void detection. CONCLUSIONS CBCT was better than PR for evaluating the apical extension of RCOs. CBCT, with its poor sensitivity and specificity, might both overestimate and underestimate the proportion of voids in RCOs. CBCT was not suitable for evaluating the quality of RCOs.
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Affiliation(s)
- Dongzhe Song
- 1 State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Lan Zhang
- 1 State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,2 Department of Conservative Dentistry and Endodontics, West China College of Stomatology, Sichuan University, Chengdu, China
| | - Wei Zhou
- 1 State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Qinghua Zheng
- 1 State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xingyu Duan
- 1 State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xuedong Zhou
- 1 State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,2 Department of Conservative Dentistry and Endodontics, West China College of Stomatology, Sichuan University, Chengdu, China
| | - Dingming Huang
- 1 State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,2 Department of Conservative Dentistry and Endodontics, West China College of Stomatology, Sichuan University, Chengdu, China
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Del Fabbro M, Corbella S, Sequeira‐Byron P, Tsesis I, Rosen E, Lolato A, Taschieri S. Endodontic procedures for retreatment of periapical lesions. Cochrane Database Syst Rev 2016; 10:CD005511. [PMID: 27759881 PMCID: PMC6461161 DOI: 10.1002/14651858.cd005511.pub3] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND When primary root canal therapy fails, periapical lesions can be retreated with or without surgery. Root canal retreatment is a non-surgical procedure that involves removal of root canal filling materials from the tooth, followed by cleaning, shaping and obturating of the canals. Root-end resection is a surgical procedure that involves exposure of the periapical lesion through an osteotomy, surgical removal of the lesion, removal of part of the root-end tip, disinfection and, commonly, retrograde sealing or filling of the apical portion of the remaining root canal. This review updates one published in 2008. OBJECTIVES To assess effects of surgical and non-surgical therapy for retreatment of teeth with apical periodontitis.To assess effects of surgical root-end resection under various conditions, for example, when different materials, devices or techniques are used. SEARCH METHODS We searched the following electronic databases: the Cochrane Oral Health Trials Register (to 10 February 2016), the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 1), MEDLINE Ovid (1946 to 10 February 2016) and Embase Ovid (1980 to 10 February 2016). We searched the US National Registry of Clinical Trials (ClinicalTrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform for ongoing trials (to 10 February 2016). We placed no restrictions regarding language and publication date. We handsearched the reference lists of the studies retrieved and key journals in the field of endodontics. SELECTION CRITERIA We included randomised controlled trials (RCTs) involving people with periapical pathosis. Studies could compare surgery versus non-surgical treatment or could compare different types of surgery. Outcome measures were healing of the periapical lesion assessed after one-year follow-up or longer; postoperative pain and discomfort; and adverse effects such as tooth loss, mobility, soft tissue recession, abscess, infection, neurological damage or loss of root sealing material evaluated through radiographs. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data from included studies and assessed their risk of bias. We contacted study authors to obtain missing information. We combined results of trials assessing comparable outcomes using the fixed-effect model, with risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) for continuous outcomes, and 95% confidence intervals (CIs). We used generic inverse variance for split-mouth studies. MAIN RESULTS We included 20 RCTs. Two trials at high risk of bias assessed surgery versus a non-surgical approach: root-end resection with root-end filling versus root canal retreatment. The other 18 trials evaluated different surgical protocols: cone beam computed tomography (CBCT) versus periapical radiography for preoperative assessment (one study at high risk of bias); antibiotic prophylaxis versus placebo (one study at unclear risk); different magnification devices (loupes, surgical microscope, endoscope) (two studies at high risk); types of incision (papilla base incision, sulcular incision) (one study at high risk and one at unclear risk); ultrasonic devices versus handpiece burs (one study at high risk); types of root-end filling material (glass ionomer cement, amalgam, intermediate restorative material (IRM), mineral trioxide aggregate (MTA), gutta-percha (GP), super-ethoxy benzoic acid (EBA)) (five studies at high risk of bias, one at unclear risk and one at low risk); grafting versus no grafting (three studies at high risk and one at unclear risk); and low energy level laser therapy versus placebo (irradiation without laser activation) versus control (no use of the laser device) (one study at high risk).There was no clear evidence of superiority of the surgical or non-surgical approach for healing at one-year follow-up (RR 1.15, 95% CI 0.97 to 1.35; two RCTs, 126 participants) or at four- or 10-year follow-up (one RCT, 82 to 95 participants), although the evidence is very low quality. More participants in the surgically treated group reported pain in the first week after treatment (RR 3.34, 95% CI 2.05 to 5.43; one RCT, 87 participants; low quality evidence).In terms of surgical protocols, there was some inconclusive evidence that ultrasonic devices for root-end preparation may improve healing one year after retreatment, when compared with the traditional bur (RR 1.14, 95% CI 1.00 to 1.30; one RCT, 290 participants; low quality evidence).There was evidence of better healing when root-ends were filled with MTA than when they were treated by smoothing of orthograde GP root filling, after one-year follow-up (RR 1.60, 95% CI 1.14 to 2.24; one RCT, 46 participants; low quality evidence).There was no evidence that using CBCT rather than radiography for preoperative evaluation was advantageous for healing (RR 1.02, 95% CI 0.70 to 1.47; one RCT, 39 participants; very low quality evidence), nor that any magnification device affected healing more than any other (loupes versus endoscope at one year: RR 1.05, 95% CI 0.92 to 1.20; microscope versus endoscope at two years: RR 1.01, 95% CI 0.89 to 1.15; one RCT, 70 participants, low quality evidence).There was no evidence that antibiotic prophylaxis reduced incidence of postoperative infection (RR 0.49, 95% CI 0.09 to 2.64; one RCT, 250 participants; low quality evidence).There was some evidence that using a papilla base incision (PBI) may be beneficial for preservation of the interdental papilla compared with complete papilla mobilisation (one RCT (split-mouth), 12 participants/24 sites; very low quality evidence). There was no evidence of less pain in the PBI group at day 1 post surgery (one RCT, 38 participants; very low quality evidence).There was evidence that adjunctive use of a gel of plasma rich in growth factors reduced postoperative pain compared with no grafting (measured on visual analogue scale: one day postoperative MD -51.60 mm, 95% CI -63.43 to -39.77; one RCT, 36 participants; low quality evidence).There was no evidence that use of low energy level laser therapy (LLLT) prevented postoperative pain (very low quality evidence). AUTHORS' CONCLUSIONS Available evidence does not provide clinicians with reliable guidelines for treating periapical lesions. Further research is necessary to understand the effects of surgical versus non-surgical approaches, and to determine which surgical procedures provide the best results for periapical lesion healing and postoperative quality of life. Future studies should use standardised techniques and success criteria, precisely defined outcomes and the participant as the unit of analysis.
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Affiliation(s)
- Massimo Del Fabbro
- Università degli Studi di MilanoDepartment of Biomedical, Surgical and Dental SciencesIRCCS Galeazzi Orthopaedic InstituteVia Riccardo Galeazzi 4MilanItaly20161
| | - Stefano Corbella
- Università degli Studi di MilanoDepartment of Biomedical, Surgical and Dental SciencesIRCCS Galeazzi Orthopaedic InstituteVia Riccardo Galeazzi 4MilanItaly20161
| | - Patrick Sequeira‐Byron
- University of BernDepartment of Preventive, Restorative and Pediatric DentistryFreiburgstrasse 7BernBernSwitzerlandCH‐3010
| | - Igor Tsesis
- Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv UniversityDepartment of EndodontologyTel AvivIsrael
| | - Eyal Rosen
- Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv UniversityDepartment of EndodontologyTel AvivIsrael
| | - Alessandra Lolato
- Università degli Studi di MilanoDepartment of Biomedical, Surgical and Dental SciencesIRCCS Galeazzi Orthopaedic InstituteVia Riccardo Galeazzi 4MilanItaly20161
| | - Silvio Taschieri
- Università degli Studi di MilanoDepartment of Biomedical, Surgical and Dental SciencesIRCCS Galeazzi Orthopaedic InstituteVia Riccardo Galeazzi 4MilanItaly20161
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Torabinejad M, Dinsbach NA, Turman M, Handysides R, Bahjri K, White SN. Survival of Intentionally Replanted Teeth and Implant-supported Single Crowns: A Systematic Review. J Endod 2015; 41:992-8. [DOI: 10.1016/j.joen.2015.01.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 12/20/2014] [Accepted: 01/04/2015] [Indexed: 01/18/2023]
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16
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Hamanaka EF, Nogueira LM, Pires WR, Panzarini SR, Poi WR, Sonoda CK. Replantation as Treatment for Extrusive Luxation. Braz Dent J 2015. [DOI: 10.1590/0103-6440201300283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In the treatment of extrusive luxation cases, it is important that the repositioning of extruded tooth in the socket is done as soon as possible. If this does not occur, periapical clot becomes organized and makes replantation difficult reposition. In this article the patient referred to the Clinics for dental trauma sustaining extrusive luxation of the maxillary right central incisor. The patient reported having suffered a bicycle accident 12 days before, which caused traumatic tooth injuries. The repositioning was attempted without success and an alternative form of treatment was necessary to solve the case. Intentional tooth replantation, which is the deliberate extraction of the tooth and its replantation, was indicated. This technique allows clot removal and correct repositioning of the extruded tooth. Care should be taken as endodontic treatment is required for the prevention of subsequent infection-related resorption. Intracanal dressing with calcium hydroxide was used for 30 days before final root filling. Splint, systemic antibiotics and avoidance of further damage to the root surface is also important. After 49 months, showed clinical and radiographic characteristics of normality and demonstrates the availability of this technique to adversity in trauma.
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17
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Treatment of necrotic calcified tooth using intentional replantation procedure. Case Rep Dent 2014; 2014:793892. [PMID: 24716000 PMCID: PMC3970054 DOI: 10.1155/2014/793892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 01/22/2014] [Indexed: 01/04/2023] Open
Abstract
Introduction. If the teeth are impacted by a chronic irritant, the pulp space possibly will undergo calcific changes that may impede access opening during root canal treatment. In such cases that conventional endodontic treatment is impossible or impractical, intentional replantation may be considered as a last solution to preserve the tooth. Methods. After failing to perform conventional root canal therapy for a necrotic calcified right mandibular second premolar, the tooth was gently extracted. The root apex was resected and the root end cavity was prepared and filled with calcium enriched mixture (CEM) cement. Then, the extracted tooth was replanted in its original position. Results. After a year the tooth was asymptomatic, and the size of periapical radiolucency was remarkably reduced and no clinical sign of ankylosis was observed. Conclusion. Intentional replantation of the necrotic calcified teeth could be considered as an alternative to teeth extraction, especially for the single-rooted teeth and when nonsurgical and surgical endodontic procedures seem impossible.
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18
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Choi YH, Bae JH, Kim YK, Kim HY, Kim SK, Cho BH. Clinical outcome of intentional replantation with preoperative orthodontic extrusion: a retrospective study. Int Endod J 2014; 47:1168-76. [DOI: 10.1111/iej.12268] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 02/08/2014] [Indexed: 12/21/2022]
Affiliation(s)
- Y. H. Choi
- Department of Conservative Dentistry; School of Dentistry; Seoul National University; Seoul Korea
- Department of Conservative Dentistry; Section of Dentistry; Seoul National University Bundang Hospital; Seongnam Korea
| | - J. H. Bae
- Department of Conservative Dentistry; Section of Dentistry; Seoul National University Bundang Hospital; Seongnam Korea
| | - Y. K. Kim
- Department of Oral and Maxillofacial Surgery; Section of Dentistry; Seoul National University Bundang Hospital; Seongnam Korea
| | - H. Y. Kim
- Department of Dental Laboratory Science and Engineering; College of Health Science; Graduate School & BK21+ Program in Public Health Science; Korea University; Seoul Korea
- Department of Public Health Science; Graduate School & BK21+ Program in Public Health Science; Korea University; Seoul Korea
| | - S. K. Kim
- Department of Conservative Dentistry; School of Dentistry, Kyungpook National University; Daegu Korea
| | - B. H. Cho
- Department of Conservative Dentistry; School of Dentistry; Seoul National University and Dental Research Institute; Seoul Korea
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