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This retrospective analysis reviewed the demographics of patients sustaining dental avulsion injuries at a tertiary dental hospital in Sydney, Australia. Data were extracted from dental records of patients who presented with avulsed permanent anterior teeth and were treated between 1 January 2001 and 30 June 2021. Demographic, clinical and radiographic data from 91 patients with 117 avulsed permanent anterior teeth were available for analysis. The median age of the patients was 12 years (IQR 9.0-17.0). Males accounted for 68.4% of avulsion injuries. Non-organised sports were the most common cause of injury (42.7%). Maxillary central incisors were the most frequently avulsed tooth (83.3%). Peak prevalence of injuries occurred on the weekend. The findings from this study may reflect regional factors such as climate and participation in sport. Anticipatory guidance should be provided to patients at elevated risk of dental avulsion., (© 2024 The Author(s). Australian Endodontic Journal published by John Wiley & Sons Australia, Ltd on behalf of Australian Society of Endodontology Inc.)

Aim: Dental avulsion, the complete displacement of a tooth from its socket, is a severe dental trauma with a prevalence of 0.5% to 16% of all dental injuries. Replantation of avulsed teeth is common, yet recent studies show high failure rates and unpredictable long-term outcomes. This review examines clinical variables influencing intentional dental replantation decisions and proposes a treatment flow chart. A comprehensive literature search was conducted in PubMed-Medline, Scopus, WoS, and Cochrane databases using the keywords "tooth avulsion," "tooth replantation," and "tooth ankylosis." Inclusion criteria encompassed studies from January 2018 to February 2024. From 752 identified articles, 9 systematic reviews including 3 meta-analyses were selected for this scoping review. Immediate replantation is the gold standard for avulsed teeth, yet delayed replantation is more common in practice, impacting survival rates. Adherence to guidelines from the International Association on Dental Traumatology improves outcomes, especially in paediatric patients. Factors such as multiple caries, severe periodontal disease, advanced age, psychological conditions, immunodeficiency, and lack of cooperation are contraindications for replantation. Despite the high failure rate, replantation remains recommended in literature due to its potential advantages over prosthetic implants. This review highlights the complexities in decision-making for dental replantation, emphasising the need for a comprehensive approach considering individual clinical cases. A proposed treatment flow chart aims to support clinicians in predicting prognosis and making informed decisions. The review also underscores the link between dental trauma, poor oral health, and potential neglect in children, highlighting the importance of preventive measures and parental awareness.

The goal of autotransplantation of teeth (ATT) is to provide the patient with a functioning tooth to replace a missing one. In dentistry, this surgery has gained significant approval and popularity; nonetheless, there is still a shortage of thorough evidence about its long-term effects. Tooth transplantation has a rich historical pedigree, and the main factors determining its success are the extra-alveolar period, proper splinting, periodontal ligament treatment, and root growth stage. With its high reported survival rate, autotransplantation is a potential therapeutic option, especially when it comes to replacing damaged anterior maxillary teeth. Collaboration between orthodontists, pediatric dentists, restorative dentists, and oral and maxillofacial surgeons is necessary for the successful execution of this treatment. The extra-alveolar period, proper splinting, periodontal ligament treatment, and the stage of root growth are the main factors that determine success. Although there are many applications for autotransplantation, a good functional and cosmetic result depends on careful patient selection and a proper surgical approach. It is not practical to replace lost teeth in children and teenagers with bridgework or implants as this may interfere with the proper development of the alveolar process and other facial bones. As such, these techniques are not recommended. Alternatively, implanting a tooth from the same person without fully forming its roots might be a good substitute. This method promotes improved mastication, speech, dentofacial development, aesthetics, and arch form integrity by enabling unhindered alveolar growth and root development. Although tooth autotransplantation has not been widely used in clinical dentistry, it is currently seen as a viable option that can replace traditional prosthetics and implant rehabilitation in both financial and medical terms. This review examines several benefits, possible iatrogenic harms, side effects, and important variables that might affect the result of the transplant, in addition to suitable criteria for the best-case selection. It also offers recommendations based on the literature., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ajay et al.)

Synthetic oligodeoxynucleotides (ODNs) containing unmethylated cytosine-phosphate-guanine (CpG) motifs (CpG-ODNs) are ligand molecules for Toll-like receptor 9 (TLR9), which is expressed by odontoblasts in vitro and dental pulp cells. This study determined the effects of CpG-ODNs on pulpal immunomodulatory response and repair following injury. Briefly, the upper right first molars of three-week-old mice were extracted, immersed in Type A (D35) or B (K3) CpG-ODN solutions (0.1 or 0.8 mM) for 30 min, and then replanted. Pulpal healing and immunomodulatory activity were assessed by hematoxylin-eosin and AZAN staining, as well as immunohistochemistry. One week following the operation, inflammatory reactions occurred in all of the experimental groups; however, re-revascularization and newly formed hard tissue deposition were observed in the pulp chamber of all groups at week 2. A positive trend in the expression of immune cell markers was observed toward the CpG-ODN groups at 0.1 mM. Our data suggest that synthetic CpG-ODN solutions at low concentrations may evoke a long-lasting macrophage-TLR9-mediated pro-inflammatory, rather than anti-inflammatory, response in the dental pulp to modulate the repair process and hard tissue formation. Further studies are needed to determine the effects of current immunomodulatory agents in vitro and in vivo and develop treatment strategies for dental tissue regeneration.

Introduction: The evaluation of pulp status is crucial for avulsed immature permanent teeth after replantation. In addition to commonly used clinical and radiographic examinations providing clinical evidence, the oxygen saturation test may offer valuable assistance. The aim of this study was to analyze the efficacy of a pulse oximeter in evaluating pulp status in avulsed and replanted immature permanent teeth., Methods: A prospective observational study was performed including 51 avulsed and replanted immature permanent teeth. Routine clinical and radiographic examinations were performed and used as the basis for the diagnosis of pulp status during the 1-year follow-up period. Meanwhile, the oxygen saturation values of these teeth were recorded using a modified pulse oximeter at each visit., Results: Seven teeth completed pulp revascularization (success group), whereas 44 teeth failed to revascularize (failure group). Abnormal clinical and/or radiographic manifestations in the failure group were observed at an average period of 42.7 days, which was too late because a high incidence of inflammatory root resorption (43.18%) had occurred. For oxygen saturation tests, teeth in the success group showed an immediate postreplantation oxygen value of 70.71 ± 3.35, then an upward trend starting from the 2-week postreplantation visit, and a significantly increased final value of 81.86 ± 2.34 at the 1-year visit. In contrast, no increase trend was found for teeth in the failure group because abnormal clinical and/or radiographic manifestations emerged., Conclusions: The oxygen saturation test is a reliable diagnostic method to evaluate pulp status of avulsed teeth as early as 2 weeks after replantation., (Copyright © 2024 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Background: Intentional replantation (IR) is an emerging and cost-effective last-resort treatment for persistent apical periodontitis. Adjunctive phototherapy for IR aims to improve the management of challenging cases by enhancing disinfection, stimulating healing and promoting regeneration. Objective: We report a novel phototherapy-assisted IR protocol conducted on a compromised lateral incisor with an extensive periapical infection (Ø > 10 mm) in a 68-year-old diabetic male. Methods: The IR protocol involved pre- and postoperative photobiomodulation (660 nm, 0.2 J/cm 2 , 60 sec/site), antimicrobial photodynamic therapy of the root surface (660 nm, 0.6 J/cm 2 , 30 sec, methylene blue photosensitizer), and Er:YAG root and socket debridement (2940 nm, 21 J/cm 2 , 30 sec). The total time from extraction to replantation was 14 min 35 sec. Results: The tooth at 3.5-year follow-up remained clinically functional with radiographic resolution of the infection indicating a successful reimplantation. Conclusions: This case report demonstrated that an adjunctive phototherapy IR protocol can effectively treat a compromised tooth with extensive periapical infection.

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., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background/aim: Tooth avulsion and delayed replantation may cause inflammatory responses and root resorption of the tooth. The aim of this study is to investigate the effect of a doxycycline-loaded nitric oxide-releasing nanomatrix (DN) gel on the delayed replantation of avulsed rat teeth, with a focus on assessing the gel's potential to promote regeneration and inhibit complications associated with the replantation process., Materials and Methods: Twenty-four right maxillary first molars from male Sprague-Dawley rats were atraumatically extracted using sterile extraction forceps. The molars were dried for 1 h at room temperature (approximately 23 °C) and divided into four groups according to the root conditioning methods after extra-alveolar 60-min drying: Group 1, no root conditioning treatment prior to replantation; Group 2, soaking in 2% NaF solution for 5 min before replantation; Group 3, 5-min soaking in NO gel and injection of the gel into the alveolar socket; Group 4, 5-min soaking in DN gel and injection of the gel into the alveolar socket before replantation. The animals were euthanized four weeks after the operation and the specimens were evaluated histologically., Results: The use of NO gel alone showed better anti-inflammatory and periodontal effects than the control group, but it did not show a significant effect compared to the group using NaF. When using NO gel loaded with doxycycline, it showed a significant anti-inflammatory effect compared to the control group and showed a similar inhibitory effect to the group using NaF., Conclusions: Within the limits of this study, in delayed replantation situations, the control of inflammatory resorption and replacement resorption is an important factor for achieving a better prognosis of replanted teeth. Root surface treatment with DN gel decreased root resorption after delayed replantation.

The aim of the present clinical report is to introduce a novel surgical procedure, the 'Apical Tooth Replantation with Surgical Intrusion Technique' (ATR-SIT) for managing teeth with hopeless prognosis compromised with a severe endodontal-periodontal lesion, pathologic tooth migration, and gingival recession. Two cases are presented managing teeth diagnosed with a hopeless prognosis. ATR-SIT involves tooth extraction, extra-oral root debridement, root surface conditioning, apicectomy, retrograde filling and the application of enamel matrix derivatives prior to reimplantation. Following reimplantation, the teeth are covered with a combination of autogenous bone chips and bone substitute materials, covered with resorbable membranes. Following ATR-SIT, the patients received either orthodontic treatment or tooth-supported fixed dental prostheses. The described ATR-SIT effectively improved the initially hopeless prognosis of the teeth and maintained periodontal health over time, evidenced by favourable clinical and radiographic outcomes. ATR-SIT might be a potential alternative to tooth extraction of hopeless teeth in patients with stage IV periodontitis.

Invasive cervical resorption (ICR) is an aggressive pathological condition that can affect any permanent tooth. This process is characterized by replacement of the tooth structure with granulomatous fibrovascular or fibro-osseous tissue. Despite its asymptomatic nature, ICR can lead to tooth loss. This study reports a case of ICR in a 15-year-old boy with a history of dental trauma. The patient had a diagnosis of ICR in tooth #21. After considering the risks of an external surgical approach and exclusive endodontic treatment, intentional re-implantation combined with extraoral composite resin restoration and endodontic treatment was proposed. The procedure consisted of atraumatic tooth extraction, removal of granulomatous tissue, restoration of the cavity with composite resin, re-implantation of the tooth in the alveolus, and endodontic treatment. This approach resulted in satisfactory repair of the resorptive lesion observed in over 3 years of follow-up. This case highlights intentional re-implantation combined with appropriate endodontic treatment as a viable treatment option for ICR., Competing Interests: None.

The management of traumatic dental injuries is more a shade of gray than it is black and white because not all treatment procedures used for dental trauma management are fully evidence based. This chapter has highlighted some of the gray areas related to the treatment and outcome of traumatic dental injuries. Significant controversies in the management of luxation and avulsive injuries have been brought out. Adjunctive treatment such as antibiotic usage, tetanus vaccination, and pain management is also addressed., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background/Aim: The ideal treatment of tooth avulsion is replantation. However, replanting teeth may lead to root resorption. Fibroblast growth factor-2 (FGF-2) is a cytokine that plays an important role in wound repair and tissue regeneration. Recently, FGF-2 has been studied a potential regenerative agent to prevent root resorption and ankylosis. The aim of this review is to analyze and summarize the currently available literature focusing on using FGF-2 based regenerative modalities to improve the outcomes of tooth replantation. Materials and Methods: An electronic search was conducted via PubMed/Medline, Google Scholar and ISI Web of Knowledge, using the Medical Subject Headings (MeSH) terms "Basic fibroblast growth factor," "Fibroblast growth factor-2," "tooth replantation," and "replantation" for studies published between January 2001 and June 2021. Data was extracted and quality assessment was carried using the ARRIVE guidelines. Results: Nine animal studies were included in this review. In six studies, FGF-2 had a favorable effect on the tissue regeneration around roots of replanted teeth when compared to other treatment groups. However, quality assessment of the studies revealed many sources of bias and deficiencies in the studies. Conclusions: Within the limitations of this study, it may be concluded that FGF-2 may improve the outcomes of delayed replantation of avulsed teeth. However, more long-term animal studies, with improved experimental designs, and clinical trials are required to determine the clinical potential of the growth factor in improving the outcomes of delayed tooth replantation., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Knowledge of bibliometric indices on the avulsion of permanent teeth can help researchers to identify gaps in the literature. The aim of this study was to analyze the bibliometric characteristics of the 100 most-cited articles on the avulsion of permanent teeth., Materials and Methods: Two researchers conducted an unfiltered search in the Core Collection section of the Web of Science (WoS-CC) database. The following data were extracted: position in the citation list, total number and density of citations, title, authors, institution, country, year of publication, journal, keywords, study design, tooth storage medium, and other topics of interest. Bibliometric networks were generated and analyzed using the VOSviewer software. Descriptive analysis and a Poisson regression analysis were performed (P < .05)., Results: The number of citations per article varied between 31 and 407. The average was 70.05, and 13 articles received more than 100 citations. J.O. Andreasen (n = 13) and M. Trope (n = 15) were the authors who contributed most often to publications. The United States was the country with the highest number of articles (n = 31). Authors associated with the University of Copenhagen, Denmark (n = 9) and University of North Carolina, USA (n = 10) showed higher productivity. In vitro/animal model studies were the most frequent study designs (n = 50), and the most-discussed topic of interest was prognosis (n = 47). There was strong clustering among 13 research groups., Conclusion: Observational studies, published by authors from Europe and about prognosis or treatment presented more citation ratio in WoS-CC. Clinical studies on permanent tooth avulsion are needed to increase the quality of scientific evidence and provide insights for health professionals and public policy makers., (Copyright © 2023 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Avulsion injuries, though relatively uncommon, are one of the most serious of dentoalveolar injuries. Replantation at the scene of the incident is almost always the treatment of choice whenever possible. This paper outlines a step-by-step approach for the management of avulsion injuries, including a splinting protocol. This aims to support general dental practitioners in feeling more confident with managing these injuries.

Introduction: The intentional perforation of the pulp chamber floor before tooth replantation promotes pulpal healing by facilitating the revascularization of the pulp cavity. This study aimed to elucidate the effects of this method on the dynamics of quiescent dental pulp stem cells (DPSCs)., Methods: The right and left maxillary first molars of Crlj:CD1 mice and TetOP-histone 2B (H2B)-green fluorescent protein (GFP) mice were extracted. The left molars were immediately replanted as the control group (CG), whereas the pulp chamber floor of the right molars were perforated before the tooth was replanted as the experimental group (EG). Immunohistochemistry for Nestin and GFP, and quantitative RT-PCR for Nestin , Opn , CD11c , and Oct3/ 4 mRNA were performed., Results: The rate of Nestin-positive perimeter along the pulp-dentin border in the EG tended to be higher than that of the CG at days 5 and 7 and was significantly increased between days 3 and 7. The rate of GFP-positive cells in the EG was significantly higher than that of the CG at days 5 and/or 7 in the mesial and middle coronal pulp. CD11c mRNA in the EG at day 5 was significantly higher than that of the CG and tended to be higher than that of the CG during the observation period. Oct3/ 4 mRNA expression in the EG was significantly higher than that of the CG at day 7., Conclusions: The current experimental model demonstrated the promotion of the survival of DPSCs and their differentiation into odontoblast-like cells (OBLCs). Thus, the use of this model is expected to clarify the crosstalk mechanism between immune cells, including macrophages and dendritic cells, and DPSCs with regards to pulpal healing after tooth replantation. It also provides insight into the differentiation process of DPSCs into OBLCs., Competing Interests: The authors declare no conflicts of interest related to this study., (© 2023 The Japanese Society for Regenerative Medicine. Production and hosting by Elsevier B.V.)

Purpose: To elucidate the level of parental knowledge in Qatar regarding the management of avulsed teeth., Methods: A self-administered questionnaire was completed by 400 parents attending their children's routine dental appointments. The questionnaire comprised of items on sociodemographics, parents' prior knowledge on management of avulsion, parents' willingness to replant avulsed teeth at the site of injury, and parents' opinion as to the best format for future parental education on the management of dental trauma. Univariate and multivariate logistic regressions were employed to assess the association between sociodemographic status and knowledge in the management of avulsion., Results: The overall mean score of parents' knowledge was (23%). Only 23.3% (n = 93) of parents thought that it was possible to reinsert an avulsed permanent tooth. Out of those, only 12.9% (n = 12) indicated willingness to reinsert the tooth back into its socket, while 48.4% (n = 49) indicated that an avulsed tooth should be stored using physiological media. Less than one third (27.8%) indicated that they would seek professional help within 30 min. Males were less likely to give favourable answers when compared to females (OR = 0.43, 95% CI = 0.22-0.84). Age groups "31-40" years and "41-50" years were more likely to give favourable answers when compared to 20-30 years age group (OR = 2.8, 95% CI = 1.05-8.0and OR = 3.8, 95% CI = 1.3-11.48; respectively)., Conclusion: This study highlights critical deficiencies in parental knowledge on the management of tooth avulsion and the need to improve parents' knowledge by developing easily accessible onsite emergency management tools., (© 2023. The Author(s).)

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., (© 2022 International Endodontic Journal. Published by John Wiley & Sons Ltd.)

Background: There is a difference between patient self-assessment and professional assessment of oral health needs; therefore, the aim of the study was to investigate patients' individual needs and awareness of replacing missing teeth with prostheses and then to compare this information with professionally assessed clinical prosthetic needs in the Eastern Province of Saudi Arabia., Methods: This was a cross-sectional study conducted in the Eastern Province of Saudi Arabia. The study subjects were recruited from Imam Abdulrahman bin Faisal University in Dammam City, Primary Health Care Centers in Alhasa City and from health education campaigns in the same area. All the patients were provided with a questionnaire related to the effect of missing teeth and replacement options, then underwent a clinical examination performed by a well-trained investigator. Statistical analyses were performed using JMP data analysis software (JMP®, Version 16. SAS Institute Inc., Cary, NC, 1989-2021.) RESULTS: A total of 102 participants were included. Most of the participants (94.2%) reported their need to replace missing teeth. Most of the participants stated that losing teeth (teeth) affected their ability to chew food and their appearance (82.6% and 61.6%, respectively). Dental caries was the main reason behind teeth extraction in 77.9% of the study sample. Fixed partial prosthesis was the first treatment option preferred by 33.7%, followed by implant-supported prosthesis with 25.6% to replace the missing teeth. Only 3.5% of participants preferred not to restore the missing teeth. Professional screening showed that 48.8% of the participants had one missing anterior tooth or more, which dictates the need for esthetic restoration, and 58.1% of the participants had three missing posterior teeth or more, which dictates the need for functional restoration., Conclusions: Patient knowledge and attitudes toward replacing missing teeth in terms of their functional and esthetic needs were variable among the population in comparison to the professional assessment of patient needs. Dentists plays a major role in raising the level of awareness about missing teeth replacement. The results of this study serve as baseline data for any related future studies., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Objectives: Clinical data on retaining extensively damaged teeth using forced orthodontic extrusion followed by restorative rehabilitation are scarce, and economic evaluations are basically absent. A health economic evaluation of this method was performed based on a clinical study., Materials and Methods: In a convenience sample of individuals recruited from routine care, extensively damaged teeth were orthodontically extruded prior to restoration. Patients were followed up for up to 6 years. The health outcome was tooth retention time. Direct medical, non-medical, and indirect initial and follow-up costs were estimated using the private payer's perspective in German healthcare. Association of initial direct medical treatment costs and cofounding variables was analyzed using generalized linear models. Success and survival were secondary outcomes., Results: A total of 35 teeth in 30 patients were followed over a mean ± SD of 49 ± 19 months. Five patients (14%) dropped out during that period. Median initial costs were 1941€ (range: 1284-4392€), median costs for follow-up appointments were 215€ (range: 0-5812€), and median total costs were 2284€ (range: 1453 to 7109€). Endodontic re-treatment and placement of a post had a significant impact on total costs. Three teeth had to be extracted and in three patients orthodontic relapse was observed. The survival and success rates were 91% and 83%, respectively., Conclusions: Within the limitations of this clinical study, total treatment costs for orthodontic extrusion and subsequent restoration of extensively damaged teeth were considerable. Costs were by large generated initially; endodontic and post-endodontic therapies were main drivers. Costs for retreatments due to complications were limited, as only few complications arose., Clinical Relevance: The restoration of extensively damaged teeth after forced orthodontic extrusion comes with considerable initial treatment costs, but low follow-up costs. Overall and over the observational period and within German healthcare, costs are below those for tooth replacement using implant-supported crowns., Trial Registration: ClinicalTrials.gov Identifier: DRK S00026697)., (© 2023. The Author(s).)

The purpose of the present review was to examine success, survival and failure following intentional replantation of endodontically treated teeth with existing periapical pathosis and to determine the factors that might affect the outcome of replantation. Clinical trials, longitudinal studies, case series with >10 cases and at least 1-year follow-up were included. The average rate of success following intentional replantation was 77.23%. Meta-analysis revealed the mean weighted survival to be 85.9% (95% CI: 79.6-91.2) Common complications include inflammatory root resorption (0%-27%) and ankylosis (0%-25%). Variables influencing successful outcome include extra alveolar dry time <15 min; root-end resection (2-3 mm) and cavity preparation (3 mm); manipulation of the tooth using the crown only; and use of an appropriate storage media. The review concludes that intentional replantation is a viable treatment option with acceptable survival rates for endodontically treated teeth with periapical pathosis., (© 2022 Australian Society of Endodontology Inc.)

The criteria for successful tooth replacement in the esthetic zone is comprehensive and often complex. Merely achieving osseointegration is no longer the bar for which clinicians strive to reach in this endeavor. Achieving and maintaining hard- and soft-tissue stability as well as physiologic, scalloped soft-tissue architecture to frame cosmetic restorations is the ultimate goal of esthetic, immediate tooth replacement therapy (EITRT).

When the use of root canal retreatment and apical surgery experiences difficulty in treating endodontic diseases, intentional replantation is an optional clinical technique used to retain the tooth. A 28-year-old female complained of chewing discomfort at the mandibular second molar after undergoing root canal treatment 3 month ago. History record and radiographic examination revealed that a C-shaped root canal system was filled with gutta-percha in the mandibular second molar. A radiolucency area existed at the root furcal area with a thin canal wall in the distal and mesial roots. Intentional replantation was used to treat this tooth. The clinical and radiographic results showed that intentional replantation and nano-biomaterial application facilitated infection control, tooth retention, and periodontal tissue regeneration.

A 7-year-old girl came to the Emergency Department following an avulsion of the maxillary central incisor. The tooth was replanted and splinted. The patient was referred to a hematologist for follow-up and maintenance of adequate levels of Factor VIII., (Copyright © 2023 Elsevier Inc. All rights reserved.)

This review aimed to answer the following question "Does photobiomodulation treatment of the root surface decrease the occurrence of root resorption in reimplanted teeth?" Electronic searches were performed in the MEDLINE/PubMed, Cochrane Library, Scopus, Web of Science, Embase, and Grey Literature Report databases. Risk of bias was evaluated using SYRCLE Risk of Bias tool. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) tool was used to assess the certainty of evidence. In total, 6 studies were included. Five studies reported a reduced occurrence of root resorption in teeth that received photobiomodulation treatment of the root surface prior to replantation. Only 1 study reported contradictory results. The photobiomodulation parameters varied widely among studies. GRADE assessment showed a low certainty of evidence. It can be inferred that photobiomodulation treatment of the root surface prior to replantation of teeth can reduce the occurrence of root resorption. Nonetheless, further clinical studies are needed., Trial Registration: PROSPERO Identifier: CRD42022349891., Competing Interests: Conflict of Interest: No potential conflict of interest relevant to this article was reported., (Copyright © 2023. The Korean Academy of Conservative Dentistry.)

Background/aims: Avulsion of a permanent tooth is one of the most severe traumatic dental injuries, comprising an estimated 0.5%-16% of all dental injuries. The aim of this study was to estimate the direct financial costs of tooth avulsion in children based on stage of root maturity and the occurrence of ankylosis and to report patients' characteristics and outcomes of treatment., Materials and Methods: A retrospective review of the dental records of children ages 6-18 who sustained a permanent tooth avulsion from 2010 to 2020 was completed. Relative Value Units (RVUs) were used to calculate the estimated cost of dental trauma care over the 2-year post-injury period for five different scenarios of avulsed teeth based on the stage of root maturity, the occurrence of ankylosis and whether the tooth was replanted., Results: There were 452 avulsed permanent teeth in 348 patients. Of those, 157 teeth were included in the cost analysis. Overall, the average direct dental cost of avulsion was 46.4 RVUs equal to $1619 USD based on the 2021 conversion rate ($34.89 per RVU). Direct costs ranged between 40 RVUs ($1396) and 52.8 RVUs ($1842) depending on the root maturation and ankylosis status or whether the tooth was replanted; however, ANOVA test did not show any statistically significant differences between the mean RVUs of different groups (p = .85). Patients returned 9.5 times on average over the 2-year study period for dental trauma care after avulsion., Conclusion: The average direct cost of tooth avulsion within the limits of this study was $1619 USD. On average, patients returned for 9.5 follow-up visits after the avulsion. The stage of root maturity, the occurrence of ankylosis and whether the tooth was replanted or not were not significantly associated with the direct cost of dental care., (© 2023 The Authors. Dental Traumatology published by John Wiley & Sons Ltd.)

Objective This study aimed to investigate the knowledge, attitude, and practices (KAP) of intentional replantation among postgraduate students and endodontists in India, the United States of America, and the United Kingdom. Materials and methods The sample size was estimated using G*Power. Based on the pilot study done before with 60 participants, a sample size of 928 was obtained. The survey consisted of 22 questions, which were finalized after content validation by two endodontic experts. It was circulated through multiple online social platforms such as Instagram, Facebook, WhatsApp, and other online dental communities/channels. The respondents were questioned about the case selection, extraction methods, antibiotic therapy, patient acceptance level, operator preference, prognostic indicator, and various other steps in the intentional replantation treatment modality. The data for this KAP survey were organized in an Excel sheet, and statistical analysis was done using the Chi-squared test. Analysis of descriptive and inferential statistics was conducted using SPSS version 20.0 (IBM Inc., Armonk, New York). A p-value of <0.05 was considered significant. Results A strong statistical difference was found in the KAP of the practitioners in different countries. The vast majority (72.7%) considered intentional replantation as an adjunct treatment modality rather than a last resort. A total of 76.5% of the respondents preferred replantation of the tooth into the socket within 15 minutes, and 86.4% of the participants regarded replantation as the most cost-effective treatment modality. Ultrasonics (76.8%) was most commonly chosen for retrograde preparation, and Biodentine (60.1%; Septodont, Saint-Maur-des-Fossés, France) as root-end filling material. Conclusion It can be concluded that a broad majority of practitioners in different countries view intentional replantation as an adjunct treatment modality rather than a last resort. Thus, intentional replantation seems to be a promising option for preserving the natural dentition of teeth with high survival rates and better outcomes., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Praveen Kumar et al.)

This study aimed to compare the survival of replanted teeth that followed the 2012 or the 2020 International Association of Dental Traumatology (IADT) guidelines. Sixty-two permanent replanted teeth were retrospectively assessed (IADT 2012, n = 45; IADT 2020, n = 17). Five years after replantation (from January 2017 to December 2021), clinical and radiographic examinations were performed. A significance level of 95% was considered to evaluate the outcomes. Thirty-one teeth (50.0%) remained in their sockets and 31 (50.0%) were lost due to external root resorption. Of the 25 (40.3%) teeth replanted within one hour, 16 (64.0%) remained in their sockets, and 9 (36.0%) were lost. Twenty-two (71.0%) of all 31 lost teeth had an extra-alveolar time of more than one hour. Twelve teeth remained in their sockets without resorption: 8 (66.7%) were replanted within one hour, 2 (16.7%) followed the 2012 IADT, and 2 (16.7%) the 2020 IADT guidelines for late replantation. There was a significant difference (p <0.05) in the extra-alveolar time (< one hour), but without difference between the guidelines in late replantation (p > 0.05). Replanted teeth following both, 2012 or 2020 IADT guidelines, have similar clinical outcomes. The extra-alveolar time of less than one hour was demonstrated to be important to keep the permanent tooth in its socket.

Objectives: Shortening the root of a mouse molar prior to tooth replantation results in early revascularization in the pulp cavity and activation of the dental pulp quiescent stem cells. This study aimed to validate the effects of pulp chamber floor perforation on pulpal healing after tooth replantation as a strategy to promote early revascularization into the pulp., Methods: The maxillary first molars of three-week-old Crlj:CD1 mice were extracted and repositioned into the original socket: the left teeth were immediately replanted (control group: CG), whereas the floor of the pulp chamber of the right teeth was perforated with a tungsten carbide bur before tooth replantation (experimental group: EG). The samples were collected from three days to eight weeks postoperatively. In addition to the TUNEL assay, immunohistochemistry for Nestin, CK14, and Ki-67 was conducted., Results: In the EG, early revascularization occurred with a decrease in apoptosis and an increase in cell proliferation, facilitating pulpal healing, compared with the CG. The rate of Nestin-positive perimeter in the distal root significantly increased on days 5 and 14 and the amount of Nestin-positive hard tissue increased on day 14. However, on day 7, the number of epithelial cell rests of Malassez in the EG significantly decreased, making the EG susceptible to ankylosis at the floor., Conclusions: Intentionally perforating the floor of the pulp chamber provides a route for early revascularization, resulting in better pulpal healing after tooth replantation., Competing Interests: Conflicts of interest The authors declare no potential conflicts of interest with respect to this articles's authorship and publication., (Copyright © 2023 Japanese Association for Oral Biology. Published by Elsevier B.V. All rights reserved.)

Objectives: Tooth avulsion is defined as total tooth displacement from the alveolar socket; the best treatment is replantation of the tooth. Human milk influences body health, growth, and development related to the presence of micro and macro nutrient components. This study assessed the effects of human colostrum as a storage medium on the success of tooth replantation., Methods: The upper left incisor of 30 adult male Wistar rats was extracted, and the rats were divided into three groups according to the storage medium of the extracted tooth for replantation: Hank's balanced salt solution (HBSS), tap water, and colostrum groups. The MTT cell viability assay was conducted, and histological evaluation and histomorphometric analyses were performed on postoperative day 45 for identification of pulp necrosis, periodontal hyalinization, percentage of resorbed area, and the periodontal ligament attachment., Results: The colostrum medium showed a higher percentage of cell viability followed by HBSS with statistical significance. Histological findings of the replanted avulsed tooth that soaked in tap water as storage medium showed obvious external and internal root resorption. Pulp necrosis and periodontal ligament hyalinization and with a significant differences values in comparison to HBSS and colostrum groups ( p  > 0.05), whereas the colostrum group showed new well-reattached periodontal ligament with normal pulp and no evidence of root resorption., Conclusion: Tooth loss is minimized by using human colostrum as storage medium in replantation of an avulsed tooth after a 1 h period compared to HBSS and water., (© 2023 Taibah University. Production and hosting by Elsevier Ltd.)

Background: Delphinidin (DP), an anthocyanidin found in blueberries, has antioxidant and anti-inflammatory effects. This study aimed to investigate the efficacy of DP as a storage medium for avulsed teeth., Methods: Human periodontal ligament cells were cultured and exposed to DP solution (10, 50, and 100 μM), Dulbecco's modified Eagle's medium, Hank's balanced salt solution and tap water. Cell counting kit-8 assays were performed after 0.5, 1, 6, and 24 h to measure the cell viability. Nitric oxide assays and gelatin zymography were performed to evaluate the anti-inflammatory effects of DP. Reverse transcription-polymerase chain reaction was used to determine the expression levels of inflammatory cytokines., Results: The viability of periodontal ligament cells was greatest at 100 μM DP. At 1 h, 100 μM DP decreased nitric oxide synthesis (p < .0167). Matrix metallopeptidase-9 activity was inhibited by DP in a dose-dependent manner (p < .0167). Moreover, treatment with 100 μM DP decreased the expression levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IL-8 in periodontal ligament cells (p < .0167)., Conclusions: Within the limits of this study, DP preserved the viability and suppressed the inflammatory response of periodontal ligament cells. These findings suggest that DP could be promising for preservation of avulsed teeth., (© 2023. The Author(s).)

Introduction: The role of osteopontin (OPN) following severe injury remains to be elucidated, especially its relationship with type I collagen (encoded by the Col1a1 gene) secretion by newly-differentiated odontoblast-like cells (OBLCs). In this study, we examined the role of OPN in the process of reparative dentin formation with a focus on reinnervation and revascularization after tooth replantation in Opn knockout (KO) and wild-type (WT) mice., Methods: Maxillary first molars of 2- and 3-week-old- Opn KO and WT mice ( Opn KO 2W, Opn KO 3W, WT 2W, and WT 3W groups) were replanted, followed by fixation 3-56 days after operation. Following micro-computed tomography analysis, the decalcified samples were processed for immunohistochemistry for Ki67, Nestin, PGP 9.5, and CD31 and in situ hybridization for Col1a1 ., Results: An intense inflammatory reaction occurred to disrupt pulpal healing in the replanted teeth of the Opn KO 3W group, whereas dental pulp achieved healing in the Opn KO 2W and WT groups. The tertiary dentin in the Opn KO 3W group was significantly decreased in area compared with the Opn KO 2W and WT groups, with a significantly low percentage of Nestin-positive, newly-differentiated OBLCs during postoperative days 7-14. In the Opn KO 3W group, the blood vessels were significantly decreased in area and pulp healing was disturbed with a failure of pulpal revascularization and reinnervation., Conclusions: OPN is necessary for proper reinnervation and revascularization to deposit reparative dentin following severe injury within the dental pulp of erupted teeth with advanced root development., Competing Interests: The authors declare no conflicts of interest related to this study., (© 2022 The Japanese Society for Regenerative Medicine. Production and hosting by Elsevier B.V.)

Background/aim: The evidence for any benefit of systemic antibiotic therapy on pulp survival following extrusive luxation and avulsion is inconclusive. The aim of this study was to evaluate the effect of systemic antibiotic therapy with amoxycillin and tetracycline for 7 days on different aspects of dental pulp repair in a murine model., Material and Methods: The right maxillary incisor of 180 4 to 8-week-old male Wistar rats underwent extrusive luxation or avulsion. The animals were then treated with saline solution (control), tetracycline, or amoxicillin administered intra-gastrically for 7 days, and euthanized at 7, 15, and 30 days post-operatively. The layer of odontoblast cells, reparative dentin deposition, Hertwig's epithelial root sheath, pulp necrosis, and periapical inflammatory infiltrate were histomorphologically analyzed and scored. Mann-Whitney, Kruskal-Wallis, and Dunn tests were used to compare mean scores for the different procedures, treatments, and times (p ≤ .05)., Results: Significant differences were observed between luxated and avulsed teeth (p < .05). In luxated teeth, no differences were observed among treatments and times, except for more tertiary dentin deposition in the coronal third with the use of tetracycline compared with amoxicillin at 15 days (p < .05). In avulsed teeth, higher scores for the layer of odontoblast cells and lower scores for periapical inflammatory infiltrate at 7 days and pulp necrosis at 7 and 15 days were observed in the amoxicillin group compared to the saline and tetracycline groups (p < .05). At 30 days, however, no differences were observed among treatments., Conclusions: The use of systemic antibiotic therapy with tetracycline or amoxicillin for 7 days did not contribute to pulp repair following extrusive luxation or avulsion in rats. However, the results warrant further research into the use of amoxicillin for a more extended period of time in cases of avulsion., (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Introduction: This study evaluated the use of the prostacyclin analog iloprost as a root surface treatment agent in promoting acellular cementum (AC) formation and collagen reattachment after tooth replantation in vivo. In addition, its effect on human periodontal ligament cell (hPDLC) mineralization was assessed in vitro., Methods: First molars of 8-week-old Wistar rats were extracted. In 1 group, the root surfaces were treated with Hank's balanced salt solution (HBSS), and the other group's root surfaces were treated with 10 -6  mol/L iloprost before replantation. At day 30, maxillae were prepared for micro-computed tomographic imaging and histomorphometric analysis. The effect of iloprost on mineralization by hPDLCs was analyzed by mineralized nodule formation and quantitative polymerase chain reaction at 7 and 14 days., Results: Micro-computed tomographic imaging demonstrated a significant higher bone volume in the iloprost groups, whereas the HBSS groups had extensive bone and root resorption. Histologic analysis revealed deposition of a thick AC layer along the root in the iloprost group with well-organized periodontal ligament fibers inserted into the cementum. The HBSS group demonstrated more osteoclasts than the iloprost group. In vitro, iloprost-treated hPDLCs had a significantly increased RUNX2, OSX, BSP, and ALP gene expression that coincided with an increased deposition of mineralized nodules. These effects were abrogated by a PGI 2 receptor inhibitor., Conclusions: Our results revealed that iloprost promoted PDL regeneration in replanted molars. Furthermore, resorption of the roots was decreased, whereas AC deposition was stimulated. Iloprost-treatment increased hPDLC mineralization and was mediated by PGI2 receptor activation. These observations indicate that iloprost may be a promising root surface treatment agent., (Copyright © 2022 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

The objective of this multi-centre study was to analyse the knowledge of parents as compared to medical-doctors regarding avulsion-injuries. A validated and piloted questionnaire was circulated among two equal groups (130 participants each) of medical-doctors and the general public. Data was analysed using SPSS version 19. A total of 131 (89%) participants had a university degree and 185 (71%) had a full time employment. One hundred and eighty-seven (72%) participants reported having no previous information regarding avulsion injuries, 195 (75%) considered their level of knowledge inadequate, and 63 (24%) had a previous history of dental trauma. A statistically significant number had information regarding avulsed permanent-teeth replantation (p=0.02) but not deciduous-teeth (p=0.26), whereas only 39 (15%) were aware of the right medium for tooth storage. Having seen or sustained an avulsion-injury and a higher qualification were statistically related to correct responses for some questions. A total of 106 (41%) of the participants wanted to be educated through written-material. In conclusion, the first-aid knowledge regarding tooth avulsion injuries in our population, irrespective of their level of academic education, is poor and needs supervised training.

Background: Tooth avulsion is a common cause of tooth loss. However, there is a significant lack of knowledge about dental trauma and the appropriate emergency procedures to handle these cases., Aim: The aim of this study was to evaluate the educational effect of notebook covers illustrated with figures and informative texts about tooth avulsion and replantation in sixth-grade primary school pupils., Material and Methods: Sixth-grade pupils of two public school participated in this study. An experimental group consisting of 134 pupils received notebook covers illustrated with figures and informative texts about tooth avulsion and replantation, while a control group of 108 pupils received notebooks with neutral covers. An assessment of the educational effects on pupils was performed after 9 months, with a standardized questionnaire normally used to evaluate dental trauma. Statistical analysis was conducted with SPSS 21.0 (α = .05) for group description and comparison using chi-square and Student t tests., Results: Compared with the control group, the experimental group showed statistically significant improvements in correct meaning of dental trauma (38% vs. 58.2%); procedures to follow in the case of dental avulsion (2.8% vs. 70.9%); storing the avulsed tooth in milk (18.5% vs. 76.9%); general knowledge about dental anatomy (61.1% vs. 95.5%); and the ideal time for the tooth to remain outside the mouth prior to replantation (20.4% vs. 59.7%)., Conclusion: The use of notebook covers illustrated with figures and informative texts about dental trauma led to a significant increase in the knowledge of schoolchildren about tooth avulsion, first aid, and replantation.

Purpose: To explore the effect of healthy human periodontal ligament fibroblasts (hPDLFs) -derived exosomes on tooth resorption after delayed tooth replantation in rats and its possible mechanism., Methods: The exosomes derived from hPDLFs were isolated and identified in thirty six-week-old SD rats and randomly divided into control group and exosome group. The right maxillary first molar was extracted to establish a delayed tooth replantation model. The dislocated teeth were implanted back into the alveolar fossa after 30 minutes. 40 μL Hanks' balanced salt solution (HBSS) were injected into the periodontal tissue, and the experimental group was injected with 40 μL HBSS containing exosomes. The rats were sacrificed at 1, 2, and 4 weeks. Hematoxylin-eosin (H-E) staining was used to observe tooth resorption. Tartrate-resistant acid phosphatase(TRAP) staining was used to observe the number of osteoclasts. The expression of osteoprotegerin(OPG) in periodontal ligament was detected by immunohistochemical staining. The differences in distribution of each genotype were analyzed with SPSS 17.0 software package., Results: The identification experiment showed that extracellular vesicles were exosomes. hPDLFs-derived exosomes inhibited root resorption after delayed tooth replantation, reduced the expression of TRAP-positive osteoclasts (P＜0.05), and promoted expression of OPG in periodontal ligament (P＜0.05)., Conclusions: After delayed tooth replantation, PDLFs-derived exosomes reduce the number of osteoclasts, promote OPG expression in the periodontal ligament, and reduce tooth root resorption after replantation.

Surgical extrusion, intentional replantation and tooth autotransplantation procedures are important treatment options that clinicians may consider performing in their day-to-day clinical practice. Despite compromised teeth are generally considered for extraction, clinicians must be aware that these cases could be suitable for management by these alternative predictable treatment options. Surgical extrusion, intentional replantation or tooth autotransplantation have similar treatment protocols which includes atraumatic tooth extraction, visualisation of the root portion and replantation. Surgical extrusion is defined as the 'procedure in which the remaining tooth structure is repositioned at a more coronal/supragingival position in the same socket in which the tooth was located originally'. Intentional replantation is defined as the 'deliberate extraction of a tooth and after evaluation of root surfaces, endodontic manipulation and repair, placement of the tooth back into its original position'. Tooth autotransplantation is defined as the 'transplantation of an unerupted or erupted tooth in the same individual, from one site to another extraction site or a new surgically prepared socket'. The same team previously published a narrative review (International Endodontic Journal. 2020, 53, 1636) and European Society of Endodontology position statement (International Endodontic Journal. 2020, 54, 655) on this topic in International Endodontic Journal. The aim of the current updated review was to provide the reader a complete overview and background on these procedures, to established clear clinical protocols and step-by-step for technically perform these therapies in their clinical practice and to establish future directions on the topics. The clinicians must periodically update their knowledge about these three procedures to achieve success., (© 2022 International Endodontic Journal. Published by John Wiley & Sons Ltd.)

Introduction: In many cases, the replanted teeth may undergo resorption or ankyloses. Recent studies show that autologous platelet concentrates (APCs) may improve the outcomes of tooth replantation. The aim of this systematic review was to summarize and critically appraise the currently available literature on the use of APCs before tooth replantation., Methodology: An electronic search was conducted on the following research databases: PubMed/MEDLINE, ISI Web of Science, EMBASE and Scopus. The following medical subject heading (MeSH) keywords used were: ((tooth replantation) OR (replanted tooth) OR (teeth replantation) OR (replanted teeth)) AND ((autologous platelet concentrate) OR (platelet-rich plasma) OR (platelet-rich fibrin) OR (autologous platelet)). The studies' data was extracted, and the research' quality was rated using the CARE and ARRIVE protocols., Results: Ten case reports and three animal studies, one cell study and one study, which included both animal and in vitro experiments, were included in this review. In majority of the studies, APCs improved the outcomes of tooth replantation. However, there were various sources of bias in the most of the research, which may have influenced the results., Conclusions: Although majority of the studies indicate that APCs may improve outcomes of tooth replantation, majority of the studies contained numerous sources of bias. Additionally, the sample size of the included subjects is inadequate to predict the clinical efficacy of APCs in management of replanted teeth. Large-scale, multi-center and long-term studies are required to ascertain the efficacy of APCs in improve the outcomes of tooth replantation.

The management of avulsed teeth undergoing delayed replantation remains a clinical challenge as there are currently no effective interventions that can improve periodontal healing and prevent replacement root resorption. While several preclinical studies have reported varied success using cell-based tissue engineering to improve periodontal healing, a consensus is required before further clinical translation. Therefore, this systematic review seeks to evaluate the efficacy of cell-based therapy in promoting periodontal healing following delayed replantation in animal models. MEDLINE (PubMed) and Embase were searched on September 27, 2020. Ten studies involving rodent and dog models met the inclusion criteria. Cell sources included gingiva, periodontal ligament (PDL), bone marrow, and adipose tissues. Generally, cell-based therapy had increased the proportion of root surfaces displaying periodontal healing and concomitantly reduced the proportion presenting with replacement root resorption and ankylosis. The best outcomes were observed following treatment with PDL-derived cells of various potency. Future preclinical studies will benefit from adopting measures to minimize bias during the conduct of animal experiments and the standardization of the outcome measures reporting. This will facilitate future reviews with possible pooling of results in the form of meta-analyses, allowing a consensus to be obtained from the literature. In addition, further research will be required to shed light on the implications of using allogeneic cells as well as the optimization of cell delivery protocols. The findings of this systematic review demonstrated the therapeutic potential of certain cell-based therapies in promoting periodontal healing following delayed replantation, thus highlighting their prospective clinical benefits and translational value. Impact statement Current therapies cannot predictably promote periodontal healing following delayed replantation of an avulsed tooth, especially when there is already significant root surface damage. This review systematically assessed the literature for preclinical studies employing cell-based therapies to promote periodontal healing following delayed replantation. The results showed that certain cell-based therapies significantly increased the formation of new periodontal ligament and reduced adverse healing outcomes of replacement root resorption and ankylosis. This highlights the potential clinical benefits and translational value of cell-based therapy for the replantation of avulsed teeth.

Chondroitin sulfate proteoglycan (CSPG), one of the major extracellular matrices, plays an important part in organogenesis. Its core protein and chondroitin sulfate (CS) chain have a specific biological function. To elucidate the role of CS in the developmental and healing process of the dental pulp, we performed an experimental tooth replantation in CS N-acethylgalactosaminyltransferase-1 (T1) gene knockout (KO) mice. We also performed cell proliferation assay and qRT-PCR analysis for the WT and T1KO primary dental pulp cells using T1-siRNA technique and external CS. During tooth development, CS was diffusely expressed in the dental papilla, and with dental pulp maturation, CS disappeared from the differentiated areas, including the odontoblasts. In fully developed molars, CS was restricted to the root apex region colocalizing with Gli1-positive cells. In the healing process after tooth replantation, CD31-positive cells accumulated in the CS-positive stroma in WT molars. In T1KO molars, the appearance of Ki67- and Gli1-positive cells in the dental pulp was significantly fewer than in WT molars in the early healing stage, and collagen I-positive reparative dentin formation was not obvious in T1KO mice. In primary culture experiments, siRNA knockdown of T1 gene significantly suppressed cell proliferation in WT dental pulp cells, and the mRNA expression of cyclin D1 and CD31 was significantly upregulated by external CS in T1KO dental pulp cells. These results suggest that CS is involved in the cell proliferation and functional differentiation of dental pulp constituent cells, including vascular cells, in the healing process of dental pulp tissue after tooth injury., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: In dental avulsion, delayed replantation usually has an uncertain prognosis. After tooth replantation, complex inflammatory responses promote a return to periodontal tissue homeostasis. Various types of cytokines are produced in the inflammatory microenvironment, and these cytokines determine the periodontal tissue response. This study aimed to identify the gene expression profiles of replanted teeth and evaluate the functional differences between immediate and delayed replantation., Methods: Maxillary molars from Sprague-Dawley rats were extracted, exposed to a dry environment, and then replanted. The animals were divided into 2 groups according to the extra-oral time: immediate replantation (dry for 5 minutes) and delayed replantation (dry for 60 minutes). Either 3 or 7 days after replantation, the animals were sacrificed. Periodontal soft tissues were harvested for mRNA sequencing. Hallmark gene set enrichment analysis was performed to predict the function of gene-gene interactions. The normalized enrichment score (NES) was calculated to determine functional differences., Results: The hallmark gene sets enriched in delayed replantation at 3 days were oxidative phosphorylation (NES=2.82, Q< 0.001) and tumor necrosis factor-alpha (TNF-α) signaling via the nuclear factor kappa light chain enhancer of activated B cells (NF-κB) pathway (NES=1.52, Q= 0.034). At 7 days after delayed replantation, TNF-α signaling via the NF-κB pathway (NES=-1.82, Q= 0.002), angiogenesis (NES=-1.66, Q= 0.01), and the transforming growth factor-beta signaling pathway (NES=-1.46, Q= 0.051) were negatively highlighted., Conclusions: Differentially expressed gene profiles were significantly different between immediate and delayed replantation. TNF-α signaling via the NF-κB pathway was marked during the healing process. However, the enrichment score of this pathway changed in a time-dependent manner between immediate and delayed replantation., (Copyright © 2022. Korean Academy of Periodontology.)

Background: Excessive inflammation in the periodontal tissue after tooth replantation can lead to inflammatory root resorption and interrupt periodontal tissue regeneration. We tested the hypothesis that nuclear factor-κB decoy oligodeoxynucleotide-loaded poly lactic-co-glycolic acid nanospheres (NF-PLGA) inhibit excessive inflammation and promote healing of periodontal tissue after replantation in rats., Methods: The upper right incisors of rats were extracted, immersed in different specific solutions, and replanted. The rats were euthanized at 7, 14, and 28 days after replantation. Morphological evaluation with micro-CT and histological assessment with hematoxylin and eosin and tartrate-resistant acid phosphatase (TRAP) staining was performed. Additionally, we examined the expression of interleukin (IL)-1β, IL-6, transforming growth factor-β1 (TGF-β1), and fibroblast growth factor-2 (FGF-2) in the periodontal ligament (PDL) by performing immunohistological assessment., Results: The NF-PLGA group showed significantly greater dental root thickness than the other experimental groups. Root resorption was not observed after the application of NF-PLGA on day 7. The application of NF-PLGA also resulted in a significantly lower number of TRAP-positive osteoclasts on days 7 and 14 after replantation. Significantly lower expression of IL-1β and IL-6 and higher expression of TGF-β1 and FGF-2 were observed under the application of NF-PLGA in the PDL., Conclusions: NF-PLGA promoted the healing process by inhibiting the initial excessive inflammatory response in the PDL, preventing root resorption, and promoting periodontal tissue regeneration. The findings also suggested that the PLGA nanospheres-mediated transfection of the decoy oligodeoxynucleotides can be useful for the clinical application of replanted tooth root surfaces., (© 2021 American Academy of Periodontology.)

Introduction: In recent years, intentional replantation (IR) has received more attention for its high tooth survival rate and wide range of indications. Type IIIb dens invaginatus (DI) is 1 of the most serious types of tooth malformation and is very challenging to treat. When root end surgery is not feasible, IR may be considered as an alternative to extraction. However, there is little information available on the use of IR for type IIIb DI. Therefore, this study investigated the treatment outcomes and clinical procedures used for the treatment of type IIIb DI with IR., Methods: IR was performed to treat 10 patients with type IIIb DI with periapical lesions. Each tooth was examined clinically and radiologically. IR was selected by these patients as their treatment plan after treatment procedures were discussed. An experienced endodontist and an experienced surgeon performed all treatments using the same protocol and surgical technique. Postoperative assessments were composed of clinical and radiographic examinations, tooth survival, and functional status., Results: The follow-up period ranged from 4-39 months. After IR, 8 teeth were functioning properly with no clinical or radiologic signs of pathology. The other 2 teeth had complications after IR comprising the recurrence of periapical radiolucency and sinus tract formation in 1 patient and the development of a mucosal fenestration in another. Both of these patients received additional surgery and showed marked improvements., Conclusions: Our study evaluated the most clinical data to date and showed that IR may be a reliable alternative for type IIIb DI with a periapical lesion., (Copyright © 2022 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)