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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.

Endodontic procedures can result in various complications. Separation of the endodontic instrument is a common complication of incorrect use or overuse of the instrument. However, a separated endodontic instrument may hinder cleaning and shaping during endodontic treatment procedures, which can potentially impact prognosis. Therefore, it is necessary to manage this complication by removal of the separated instruments from inside the root canal. Although several devices are used, nonsurgical removal for retreatment remains difficult. We report the case of a failed attempt to manage a separated endodontic instrument nonsurgically by a private dentist, which resulted in extrusion of the instrument beyond the root apex and its migration into the mandible. We describe a novel surgical approach involving intentional tooth replantation combined with alveolar osteotomy. There have been few reports on the management of separated endodontic instruments that were pushed out beyond the root apex. Our novel surgical approach suggests a technique for the potential removal of a separated endodontic instrument extruded beyond the root apex.

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.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.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).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.

BACKGROUND/AIMS Pre-transplant blood transfusions have previously shown a positive effect on organ allograft survival in humans and various animal species. The aims of this study were, first, to evaluate the effect of pre-transplant donor-specific blood transfusions on periodontal healing of fully developed allotransplanted teeth in monkeys; and second, to investigate the immune response against donor antigens and to determine a possible correlation between alloimmune reactions and histopathological signs of rejection. MATERIAL AND METHODS Twenty monkeys (Cercopithecus aethiops) were divided into ten pairs with similar sizes of incisors. One monkey in each pair gave three transfusions to the other monkey with 1-week intervals. One week after the last transfusion, each pair exchanged simultaneously a central maxillary incisor and a lateral mandibular incisor. The corresponding central maxillary and mandibular lateral incisors were autotransplanted to the contralateral sockets. All teeth were treated endodontically per-operatively. Histocompatibility was evaluated by mixed lymphocyte culture before the first transfusion, while alloantibodies and cell-mediated alloresponses were measured before transfusions and at 2 and 8 weeks after transplantation. All animals were sacrificed 8 weeks after tooth transplantation. Serial sections of the transplanted teeth were quantified histologically. RESULTS Mixed lymphocyte cultures showed positive reactions in 19 of 20 cases, indicating incompatibility. The majority of the monkeys developed antibodies towards the tooth donor. Cell-mediated cytotoxicity was negative in all monkeys. Histoquantification revealed a mean score of 70% normal periodontal ligament (PDL) in autotransplanted teeth, with 5% ankylosis. The allografts had a mean score of 17% normal PDL and 63% ankylosis, with no significant influence of transfusion. However, in the mandibular grafts, a tendency towards a positive transfusion effect was seen. CONCLUSIONS Donor-specific blood transfusion did not reduce ankylosis in tooth allografts. The healing of mandibular incisor tooth allografts was improved, but not that of maxillary incisors. Donor-specific antibodies showed no effect on the survival of allograft PDL.

BACKGROUND/AIM Peri-anesthetic dental trauma is a common anesthesia-related complication. It is the reason for a significant number of malpractice lawsuits against anesthetists through insurance companies. The frequency, outcomes, and risk factors related to peri-anesthetic dental trauma have been well documented. The aim of this study was to evaluate anesthetists' awareness, knowledge, and attitudes toward peri-anesthetic dental trauma. MATERIAL AND METHODS This nationwide, cross-sectional, descriptive study comprising 220 anesthetists was conducted in Turkey between June 2019 and May 2020. A specific questionnaire was created using Google Forms and delivered to 591 participants via WhatsApp. Pearson's Chi-squared test and the Fisher-Freeman-Halton tests were used to analyze the results. RESULTS The overall response rate was 37.2% (220 out of 591 participants). Of the 80.5% of the participants who encountered peri-anesthetic dental trauma during their practice, 32.8% had encountered avulsion and 32.8% reported that they had caused soft tissue injuries. More than one-third of the participants (38.9%) stated that the patient group that was the most at-risk for peri-anesthetic dental trauma was older people with missing teeth. Half of the participants (50.9%) stated that avulsed teeth could be replanted; among them, 21.8% and 11.8% specified that the ideal replantation time was

BACKGROUND/AIM The high rate of root resorption resulting from tooth replantation represents a serious clinical problem. In order to prevent ankylosis and replacement resorption, the contemporary literature highlights the importance of using a flexible stabilization for traumatized teeth. For this purpose, orthodontic devices may be promising for obtaining a better prognosis and periodontal repair. The aim of this study was to evaluate the effect of an active splinting protocol with controlled force in dog's teeth following replantation. MATERIAL AND METHODS Sixty premolar roots from three dogs were used. They were submitted to endodontic treatment, hemisected, atraumatically extracted and subsequently replanted. They were divided into four groups: Passive Stabilization (n = 20)-after 20 min in a dry medium; Active Stabilization (n = 20)-after 20 min in a dry medium; Negative control (n = 10)-immediate replantation and passive Stabilization; and Positive control (n = 10)-90 min of extra-alveolar time and passive Stabilization. The samples were collected and submitted to histologic processing. They were then evaluated for the count of inflammatory cells, expression of neurotrophin 4, osteoclasts, apoptotic cells and collagen fibres. The results were submitted to ANOVA or Kruskal-Wallis statistical tests followed by Tukey or Dunn post-tests (α = 5%). RESULTS Passive Stabilization with orthodontic brackets without traction used after replantation had the highest number of inflammatory cells (p = .0122), osteoclasts (p = .0013) and percentage of collagen fibres in the periodontal ligament (p

Transplantation and replantation of teeth are effective therapeutic approaches for tooth repositioning and avulsion, respectively. Transplantation involves transplanting an extracted tooth from the original site into another site, regenerating tissue including the periodontal ligament (PDL) and alveolar bone, around the transplanted tooth. Replantation places the avulsed tooth back to its original site, regenerating functional periodontal tissue. In clinical settings, transplantation and replantation result in favorable outcomes with regenerated PDL tissue in many cases. However, they often result in poor outcomes with two major complications: tooth ankylosis and root resorption. In tooth ankylosis, the root surface and alveolar bone are fused, reducing the PDL tissue between them. The root is subjected to remodeling processes and is partially replaced by bone. In severe cases, the resorbed root is completely replaced by bone tissue, which is called as "replacement resorption." Resorption is sometimes accompanied by infection-mediated inflammation. The molecular mechanisms of ankylosis and root resorption remain unclear, although some signaling mechanisms have been proposed. In this mini-review, we summarized the biological basis of repair mechanisms of tissues in transplantation and replantation and the pathogenesis of their healing failure. We also discussed possible therapeutic interventions to improve treatment success rates.

Objectives: The aim of this case report is to address a delayed replantation and successful regenerative endodontic procedure of an avulsed immature permanent incisor which was confirmed by TurboReg analysis. Study design: In this case, regenerative endodontic procedure was performed on an avulsed tooth with a delayed replantation in a 7 year old boy. In the emergency visit after the avulsion accident in February 2017, the tooth was replanted and one week later regenerative endodontic procedure began. After 17 months follow up, in July 2018, root wall thickness and length increase was confirmed by TurboReg analysis.Conclusion. The outcome of this treatment was evaluated by TurboReg analysis which was a remarkable increase in root length and dentinal wall thickness, despite of the delayed replantation. Clinical Significance. This case report helps to add to the literature for treatment plan in avulsion traumatic injuries.

Introduction: the avulsion of primary teeth is a disturbing and unexpected event. Description: this report describes the clinical case of a three-year-old child who suffered an avulsion and replantation of the primary upper central incisors at the site of the injury. The guardians sought treatment for the child at the Federal University of Minas Gerais after the replantation. Four months later, the child suffered a new trauma and the replanted teeth presented advanced mobility, root resorption and fistula. The clinical conduct was extraction and rehabilitation with a fixed esthetic maintainer. Discussion: the literature describes two treatment options for avulsion of primary incisors: replantation and non-replantation. According to a recent systematic review, the difficulty in obtaining a consensus regarding the best clinical conduct is due, in part, to the scarcity of publications that present not only follow-ups with clinical success, but also with failures. The outcomes of replantation can be influenced by several factors. The time elapsed between replantation and splinting, and the new episode of trauma, negatively influenced the prognosis in the present case, leading to failure. Replantation of primary incisors is not yet evidence-based treatment. Therefore, this option must be chosen with caution and in ideal situations. It requires constant clinical and radiographic monitoring for evaluation of outcomes.

Background/aim Root length is a critical factor for dental pulp regeneration following tooth replantation. The aim of this study was to analyze the effects of reducing the root length by apicoectomy on the pulp healing process using a model for tooth replantation. Material and methods After extraction of the upper first molars (M1) of 3-week-old mice, the roots from the experimental group (EG) were shortened to half to two-thirds of their length before replantation, whereas in the control group (CG) the extracted teeth were immediately repositioned into their alveolar sockets. To determine the effects of root resection on the survival of inherent pulp cells, this study included tooth transplantation with root resection using wild-type (WT) and green fluorescent protein (GFP) transgenic mice. The M1 of GFP transgenic mice were transplanted into the alveolar socket of the M1 of WT mice. The roots of the right M1 were shortened (EG), whereas the left M1 remained untreated (CG). Results Apoptotic cells in the EG significantly decreased in number compared with the CG at day 3. Cell proliferative activity in the EG was significantly higher than that in the CG in the root pulp during days 3-5, and nestin-positive odontoblast-like cells began to arrange themselves along the pulp-dentin border in the cusp area at day 5 in the EG but not in the CG. At week 2, tertiary dentin had formed throughout the pulp in the EG, whereas the combined tissue of dentin and bone occupied the pulp space in 60% of the CG. Root resection also positively affected the survival of inherent pulp cells to differentiate into odontoblast-like cells as demonstrated by transplantation using GFP transgenic mice. Conclusions Reducing the root length accelerated pulp regeneration following tooth replantation due to the better environment for revascularization.

This case report demonstrates the possibility of functional and aesthetic rehabilitation using an interdisciplinary approach in a child following avulsion of a tooth. Autotransplantation after the development of calcific metamorphosis of the pulp and acute apical periodontitis provided satisfactory repair after root canal treatment. A 7-year-old white boy avulsed the right maxillary central incisor (tooth 11). The extra-alveolar time exceeded 60 minutes, and this triggered external replacement resorption of the avulsed tooth. At 11 years of age, the child underwent tooth autotransplantation. After 4 years of follow-up, intraoral clinical and radiographic examination led to the diagnosis of calcific metamorphosis of the pulp and acute apical periodontitis. The patient had minimally invasive root canal treatment, orthodontic treatment and esthetic rehabilitation with a porcelain crown. Control periapical radiography and tomography of the autotransplanted tooth after 7 years revealed bone repair in the periapical region. This case report indicates that tooth autotransplantation can be used to replace anterior teeth after avulsion followed by replacement resorption. Interdisciplinary management helped to maintain the esthetics and function of the rehabilitated area.

This report describes the unexpected formation of root-like structures following the avulsion of immature permanent teeth without replantation. A six-year-old female patient had avulsed the four permanent mandibular incisors and the two deciduous mandibular canines. The patient was seen in an emergency health care unit but did not receive specialized treatment for tooth replantation. As follow up treatment, she received a removable prosthesis. After four years of follow-up, an image obtained by panoramic radiography showed formations similar to four root structures in the alveolus of the previously-avulsed permanent teeth. This finding was confirmed by periapical radiography and computed tomography. This case report demonstrates that in teeth with incomplete root development, even after avulsion without replantation, cells from the pulp stump may have the capacity to form mineralized structures that appear radiographically comparable to root dentin.

AIM To describe the innovative use of intentional replantation for Biodentine root reconstruction of a previously treated immature maxillary central incisor with vertically extended crown root fracture and root detachment. SUMMARY In the present case, the intentional replantation of a failing, previously treated maxillary central incisor with a vertical crown/root fracture in a 12-year-old male patient is reported. The gross extrusion of gutta-percha points beyond the apex and the pre-existing extensive, trauma related, distal cervical dentinal detachment justified the intentional replantation treatment plan as an option for tooth retention. After controlling the infection by oral administration of antibiotics, the immature tooth was extracted atraumatically and kept in gauze embedded with tooth replantation medium. The apical third of the immature fractured tooth was treated with ultrasonics and an MTA plug (MTA Angelus White, Londrina, Brazil). The distal cervical dentinal root defect was reconstructed with Biodentine (Septodont, St. Maur-des-Fosses, France). The tooth was reinserted and stabilized to the adjacent teeth for 2 weeks. The total extraoral time before replantation was 25 min. In the 10 years since the initial trauma (9 years after the intervention) radiographic and clinical evaluation revealed uneventful healing of the periapical lesion, normal mobility and no detectable signs of external replacement resorption. KEY LEARNING POINTS Intentional replantation may provide a viable treatment alternative in cases of severe complicated crown/ root fractures Biodentine may be useful in the reconstruction of external root defects in crown root fractured traumatic dental injuries.

This European Society of Endodontology (ESE) position statement on surgical extrusion, intentional replantation and tooth autotransplantation represents the consensus of an expert committee, convened by the ESE. A narrative review in the International Endodontic Journal (Plotino et al. 2020, international Endodontic Journal, 53, 1636-52) formed the basis for the position statement. The review provided detailed information on the background, clinical procedures and the outcome of surgical extrusion, intentional replantation and tooth autotransplantation techniques. The aim of the current statement is to summarize the best available evidence on these clinical techniques to provide appropriate clinical guidance to undergraduate and postgraduate students, dental practitioners, clinical teachers and researchers. The current position statement will be updated by the ESE periodically to reflect new evidence as it becomes available to provide the most current treatment guidance for clinical practice.

The absence or presence of root resorption on the root surface of a replanted tooth indicates an immune-inflammatory reaction. Since interleukin-6 (IL-6) is considered an inflammatory marker in bone resorption, this study aimed to investigate the association between clinical variables and polymorphisms in IL6, with the outcome of replanted teeth at 1-year follow-up. Altogether, 127 avulsed teeth that were replanted and had their root canals treated were selected for this study. Periapical radiographs were taken after replantation and after 1 year. Real-time PCR was used to genotype IL6 polymorphisms. Chi-square and 'Z' tests were performed to verify the association between genetic variables and the prognosis of replanted teeth (P

Background/aims Decoronation offers one of the best and most predictable clinical outcomes for dentoalveolar ankylosis. The aim of this study was to determine the factors associated with the efficacy and psychological impact of decoronation for bone preservation. Materials and methods The study included 42 paediatric patients with 42 infrapositioned replanted permanent teeth. Twelve of these teeth were decoronated. Variables such as the time of injury, stage of root development and the extent of infraposition were analysed. The vertical changes in the alveolar bone level of the decoronated teeth were assessed on radiographs using a three-point scoring system. Parents of 30 patients with teeth that were not decoronated completed a questionnaire addressing their considerations and concerns regarding the treatment of infraposition. Results Teeth with root development in stages 2 and 3 showed a significantly higher rate of severe infraposition during the follow-up visits. Decoronation was performed on 12 teeth within 1.5-5 years (mean 3.8 ± 1.3 years) after replantation and 11 of these cases developed a considerable alveolar bone level. The alveolar bone levels of boys and girls showed improvements of 2.2 and 3.2 mm, respectively. The optimal age for decoronation to have a considerable increase in bone level was 12.12 ± 0.83 years for boys and 11.25 ± 1.77 years for girls. Complicated treatments, followed by parents' lack knowledge regarding decoronation, children's fear, follow-up times, and cost were the major concerns regarding decoronation. Conclusion The optimal time for decoronation should be decided after considering the age, gender, skeletal growth pattern, and the degree of infraposition at the time of decoronation.

Background/Purpose: Intentional replantation was a conventional treatment option in surgical endodontics but usually be seen as a last resort. Therefore, the purpose of this study was to evaluate the long-term treatment outcome of intentional replantation in Taiwanese population, including the survival rates and the related prognostic factors. Methods: Subjects included 215 teeth from 199 patients who had received intentional replantation in a Taiwan medical center. Patients at age under 20 years and those follow-up periods less than 6 months were excluded. The replanted teeth were followed up for a period of 6 months–120 months. Post-treatment assessments, including tooth survival and functional status, were evaluated using both clinical and radiographic examinations. Results: Kaplan–Meier survival analysis revealed the overall tooth survival rate at 4 years was 82.8%. In bivariate analysis, both root-end filling material and enamel matrix derivative (EMD) applications were found to be significant (P

OBJECTIVES: At present there is no clear consensus whether systemic antibiotics should be administered at replantation of an avulsed permanent tooth. This systematic review and meta-analysis assessed the evidence on effectiveness and harms of the administration of systemic antibiotics at replantation of avulsed permanent teeth. METHODS: In August 2020 a systematic literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, for systematic reviews, randomized controlled trials (RCT) and observational controlled studies in MEDLINE, PreMedline, Embase, and the Cochrane databases. The population of interest were medically fit patients with a replanted avulsed tooth. Main outcomes were tooth survival, periodontal healing, pulpal revascularization as well as (severe) adverse events. These outcomes were compared in patients who did and who did not receive systemic antibiotics. The GRADE methodology was used to assess the quality of evidence. RESULTS: The search yielded no RCTs, and none of the 7 included observational studies had the prime intent to investigate the effectiveness or harms of antibiotics. According to GRADE, the overall level of evidence was very low. The meta-analyses showed non-significant associations between the administration of systemic antibiotics on the one hand and tooth survival (1 study, RR = 3.70, 95% CI: 0.63-21.69), periodontal healing (meta-analysis of 6 studies RR: 1.07; 95% CI: 0.80-1.45), and pulpal revascularization (meta-analysis of 2 studies, RR: 0.36; 95% CI: 0.05-2.41) on the other hand. CONCLUSION: Currently there is no high-quality evidence to support the use of systemic antibiotics at replantation of avulsed permanent teeth. Hence, their routine use cannot be recommended in medically fit patients. Well-designed RCTs should be a priority on the research agenda. ispartof: JOURNAL OF EVIDENCE-BASED DENTAL PRACTICE vol:22 issue:2 ispartof: location:United States status: published

Stabilization with splint is an important surgical technology in traumatic dental injuries of permanent tooth. In order to standardize the clinical application of the technique and to improve the therapeutic effects of traumatic injured teeth, the Society of Stomatological Emergency, Chinese Stomatological Association organized relevant professional experts and put forward an expert consensus on the basis of considerable discussion. The contents of the present expert consensus covered indications for tooth fixation, material selection of splints and operation methods, applying to the treatment of tooth loosening, tooth displacement and tooth avulsion replantation caused by traumatic injuries. It is also suitable for preoperative and prognosis evaluations of traumatic injured teeth before tooth fixation.恒牙外伤牙固定术是治疗外伤性牙损伤的常用方法，为规范该项技术的临床应用，提高外伤牙的治疗效果，中华口腔医学会口腔急诊专业委员会组织相关专业的专家，在反复研讨的基础上撰写了恒牙外伤牙固定术的适应证、材料选择及操作方法的专家共识，适用于牙外伤引起的牙松动、移位和脱落后再植的保存治疗，也适用于外伤牙固定前的术前评估和预后评估工作。.

Background/aim Success of tooth replantation depends on the quality and quantity of periodontal ligament (PDL) cells. The aims of this study were to evaluate Thai propolis extract as a storage medium for maintaining PDL cell viability and preserving gene expressions in PDL tissues. Materials and methods PDL cells from human premolars were tested for cytotoxicity of the extract by PrestoBlue assay to determine a non-toxic concentration. Subsequently, 96 freshly extracted premolars were allocated into different treatment groups. Control groups were freshly extracted premolars or they had been stored dry for 12 hours. Experimental avulsed teeth were created by leaving them air-dried for 30 minutes immediately after extraction, then they were immersed in Thai propolis extract, HBSS or milk for 3, 6 and 12 hours. After tooth storage, the remaining PDL cells were determined for their cell viability. RNA isolated from PDL tissues of three premolars treated similarly was analysed for periostin and S100A4 expressions using RT-qPCR. Results Thai propolis extract at 0.625 mg mL-1 promoted the greatest PDL cell viability. Tooth storage in 0.625 mg mL-1 Thai propolis extract, HBSS or milk showed no difference in maintaining cell viability. Periostin mRNA level was preserved by Thai propolis extract. Expression of S100A4 mRNA in PDL tissues stored in all tested media was dampened. Conclusions PDL cells from mock avulsed teeth stored in 0.625 mg mL-1 Thai propolis extract for 3, 6 and 12 hours remained viable and the expression of periostin was preserved. This study suggests this extract as an alternative for a tooth storage medium for up to 12 hours. However, transporting an avulsed tooth in a storage medium for extended extra-oral time might affect the PDL cell phenotypes.

Complete avulsion of teeth are one of the most serious traumatic dental injuries. The preferred treatment is tooth replantation. When teeth usually cannot be treated in time, the periodontal membrane on the root surface becomes necrotic , and the success rate of replantation is greatly reduced. How to use seed cells, growth factors and scaffold materials to promote periodontal tissue regeneration, improve periodontal membrane healing of replanted teeth, and achieve successful replantation of completely dislocated teeth is an urgent problem. Periodontal ligament stem cells (PDLSCs) express stem cell markers, have the potential to undergo multicellular differentiation and have important application value in periodontal tissue regeneration and repair. Fibroblast growth factor-2 (FGF-2), basic fibroblast growth factor (bFGF), lysobisphosphatidic acids (LPA) and other related regulatory factors promote periodontal tissue regeneration. Seed cells combined with scaffold materials can promote periodontal tissue regeneration and repair periodontal tissue defects. At present, studies have shown that PDLSCs and other seed cells have the potential for periodontal tissue regeneration and have been widely studied in experimental animal models of periodontitis and bone defects. However, there are few reports on the application of replanted teeth after complete avulsion, and its mechanism is not clear. In this paper, the research progress of periodontal tissue regeneration after total dislocation replantation is reviewed. We expect to apply periodontal tissue regeneration research to the replantation of fully dislocated teeth to achieve periodontal membrane healing of fully dislocated replanted teeth to provide a theoretical basis for future clinical work.

In the case of complete luxation with dental trauma, delayed replantation leads to a higher probability of root resorption. We evaluated the efficacy of N-acetylcysteine (NAC) as a root canal medication for trauma-associated root resorption. A rat dental trauma model was used. In the test group, mesial root pulpectomy was carried out after tooth extraction. NAC was applied as a root canal medication followed by replantation. We euthanized the rats after two weeks, excised the maxilla, and prepared thin sections, followed by H-E and TRAP staining. Furthermore, RAW264.7 cells were treated with RANKL and NAC. The effects of NAC on osteoclast differentiation were investigated by determining the numbers of osteoclasts and nuclei and quantifying osteoclast-related mRNA expression levels by real-time PCR. The level of root resorption and number of odontoclasts tended to be lower in the NAC groups than in the control group. In terms of osteoclast differentiation, the total number of osteoclasts was lower in both the 5 and 10 mmol/L NAC groups than in the control group. Real-time PCR revealed that the expression levels of RANK, NFATc1, DC-STAMP, CD47, and cathepsin K were lower in the 10 mmol/L NAC group. NAC tended to inhibit root resorption and reduce the number of odontoclasts. NAC also inhibited the expression of osteoclast-related genes. Overall, NAC reduced the number of odontoclasts, inhibited bone resorption, and influenced the inhibition of osteoclast differentiation, fusion, and functions. Therefore, we suggest that NAC may be beneficial in the treatment of root resorption. (C) 2020 Japanese Society of Pediatric Dentistry. Published by Elsevier Ltd. All rights reserved.

To evaluate denosumab, a human monoclonal antibody that mimics the effects of osteoprotegerin in bone metabolism, as a topical treatment of root surface to be used prior to delayed tooth replantation. Thirty-six rats’ right incisors were used. Teeth were extracted and divided into: delayed replantation without root surface treatment (control); delayed replantation with root surface treatment with denosumab 60 mg/mL and 30 mg/mL, respectively, for 10 min both experimentals groups. After that, the root canals were filled with calcium hydroxide and replanted. After 15 and 60 days, the animals were euthanized, and the samples were collected and processed for microscopic analysis. Histological sections were performed, and stained with HE to describe the dental characteristics, measure ankylosis, replacement resorption, and dental resorption by conventional microscopy. Also, was performed Brown & Brenn staining and immunohistochemistry for RANKL, OPG, and periostin. Denosumab 60 mg/mL reducted ankylosis (p

Background/aim The majority of traumatic dental injuries (TDI) in childhood and adolescence occur in schools. Since school teachers are often the first responders, their knowledge about the emergency management of TDI needs to be adequate. The aim of this systematic review was to assess and analyse the global status of this knowledge as reported in previous studies and to provide recommendations for future research. Methods The protocol was designed as per PRISMA guidelines and registered in PROSPERO. A broad-based search using text-words and MeSH terms was performed in established databases as per a predefined strategy. Cohort-studies, cross-sectional, case-control studies and randomized/non-randomized trials without any distinction of language and year of publication were included while those without details of sampling strategy, validity and reliability were excluded. Data extraction was performed, risk of bias assessment was done by the Joanna-Briggs-Institute's critical appraisal checklist and meta-analysis was performed for four question stems using a random effects model. Results Twenty-three studies were included for qualitative analysis. Most of the studies had been conducted in Asia from 2009 to 2019. Ten studies used case-based questionnaires, mostly adapted from previous studies. Moderate to high risk of bias was observed in 14 studies. Less than 50% of teachers had witnessed a TDI in 8 studies and >75% desired to know more about TDI management in most studies. Less than 50% of teachers in 5 out of 6 studies knew about immediate replantation of avulsed permanent teeth, 95% with 17% of teachers having previous dental-trauma first-aid training and 38% knowing about replantation within 30 minutes. Conclusion The awareness level in several areas of the world is unknown. Studies lacked well-designed questionnaires and teachers exhibited low self-belief and knowledge level in the majority of studies.

الملخص: أهداف البحث: على مدى السنوات القليلة الماضية، حققت العديد من الدراسات تأثير العلاج بالليزر على إعادة زرع الأسنان المخلوعة. تهدف هذه المقالة للتحليل المنتظم وتقييم نتائج وجودة هذه الدراسات. طرق البحث: عن طريق استخدام الكلمات المفتاحية الأساسية ''الليزر'' و''الأسنان'' و''إعادة زرع الأسنان''، تم إجراء بحث إلكتروني عبر قواعد بيانات بوب ميد وإمبيز، وشبكة المعرفة، والباحث العلمي لجوجل بواسطة باحثين. تم استبعاد أي دراسات لا تفي بالمعاير الضم لدينا. وكان سؤال الدراسة هو: هل العلاج بالليزر يؤثر على نتائج إعادة زراعة الأسنان المخلوعة؟ النتائج: تم أدراج تسع دراسات وتقييمها في هذه المراجعة. في معظم الدراسات، كان الليزر له نتائج إيجابية على منع ذوبان الجذر وتعزيز تجديد الأنسجة المحيطة باللثة. ومع ذلك، تم إعطاء ثلاث دراسات فقط جودة ''متوسطة''، في حين تم تقييم ست دراسات بأنها ذات جودة ''منخفضة''. الاستنتاجات: قد تقلل إشعاعات الليزر من ذوبان الجذر ويعطي أفضلية في تجديد الأنسجة المحيطة باللثة بعد إعادة زرع السن المخلوع. ومع ذلك، هناك حاجة إلى مزيد من الدراسات طويلة الأجل على الحيوان والبشر جيدة التصميم قبل استخدام الليزر سريريا لتحسين نتائج الأسنان المزروعة. Abstract: Objectives: Over the last few years, several studies have investigated the effect of laser treatment on the replantation of avulsed teeth. We conducted this study to systematically analyse and assess the outcomes and quality of these studies. Methods: Using the keywords ‘laser’, ‘tooth’, and ‘replantation’, two investigators conducted an electronic search of the PubMed, MEDLINE, Embase, ISI Web of Knowledge and Google Scholar databases. Any studies not meeting the inclusion criteria were excluded. The focused question was ‘Does laser treatment influence the outcomes of tooth replantation?’ Results: Nine studies were included and assessed in this review. In the majority of the selected studies, laser treatment had a positive outcome on preventing root resorption and in promoting periodontal regeneration. However, only three studies were given a quality score of ‘medium’, while six were marked as ‘low’. Conclusion: Laser irradiation may reduce root resorption and favour periodontal regeneration following replantation of the avulsed tooth. However, more well-designed long-term animal and human studies are needed before lasers can be used clinically to improve the outcomes for replanted teeth.

Tooth replantation is the treatment of choice for avulsion, even though its long-term prognosis shows great variability and few studies have adopted survival analysis to evaluate the fate of such teeth. The present study aimed to evaluate both the survival rate of replanted permanent teeth after traumatic avulsion as well as its clinical and demographic determinants.Records from 576 patients treated at the Dental Trauma Clinic at the Federal University of Minas Gerais, Brazil, were analyzed to collect clinical and radiographic data. Kaplan-Meier curves and a multivariate Cox regression model were used to estimate the probability of replanted teeth remaining functional in the mouth and to determine prognostic factors.The post-replantation survival rate was 50% after 5.5 years. Immature teeth presented an increase of 51.3% in the loss rate (P = .002). Each additional year in the patient's age at the time of trauma, up to the limit of 16 years, reduced the loss rate of replanted teeth by 15% (P .001). The storage of the avulsed teeth in milk decreased the loss rate of replanted teeth by 56.4% (P = .015) when compared with those kept dry.The overall survival rate after replantation of permanent teeeth was 50% after 5.5 years. Advanced stages of root development, together with the increase in the patient's age at the moment of trauma, up to the limit of 16 years, were good prognostic factors for tooth survival. The storage of avulsed teeth in milk was also associated with enhanced tooth survival after replantation.

Background Intubation is necessary during critical situations to reduce the risk of death. In Brazil, a need exists to determine the prevalence of tooth avulsions in emergency and urgent care. The objective of this study was to identify the causes of orotracheal intubation (OTI), the number of tooth avulsions, and the avulsed teeth that result from urgent and emergency intubation. Material and Methods The sample consisted of 116 patients (total group) in intensive care units (ICUs) distributed across Group 1 (G1), which was composed of 71 patients from an urgent-care hospital, and Group 2 (G2), which was composed of 45 patients from an emergency hospital. Clinical examinations showed dental alveolus with signs of recent exodontia in the upper and lower anterior regions. Sociodemographic data and the reason for intubation were evaluated. The Shapiro-Wilk normality test, chi-square test, Fisher’s exact test, Mann-Whitney U test, and univariate logistic regression were performed with a significance level of 5%. Results The avulsion prevalence was 4.3%, with more cases receiving emergency intubation (n=4). All avulsions occurred in adults, and a significant difference (p=0.011) was observed with regard to the elderly. A 1-year reduction in age increased the chance of tooth avulsion during intubation by 1.09 times; being female increased the chance by 2.88 times. Conclusions Pulmonary problems were the major causes of intubation, with the highest tooth avulsion prevalence observed during emergency intubation. The avulsed teeth were 11, 12, 13, 22, 32, and 33 across all cases. Key words:Tooth avulsion, tooth injuries, intubation, intensive care units, emergencies.

The aim of this study was to evaluate knowledge on pre-hospital emergency management of tooth avulsion among Croatian kindergarten teachers. A cross-sectional study was conducted among 33 educators in kindergarten (average 43.9±9.7 years). The questionnaire contained 10 close-ended questions with two or eleven possible answers. Statistical significance was determined using chi-square test. Majority of participants had no experience with tooth injury among children in kindergarten. Questions about the familiarity with the terms of a knocked-out tooth and tooth replantation and whether the knocked-out tooth should be replanted were confirmatively answered by 90.9%, 57.6% and 63.6% of participants, respectively. Only 9.1% of participants provided the correct answer that replantation should be done within 30 minutes. 78.8% of participants would choose correct medium for cleaning if avulsed tooth got dirty. Tooth would be transported in appropriate medium by 48.5% of participants. Correct answers on both the transport medium and the cleaning of knocked-out tooth were provided by 45.5% participants. 57.6% participants would seek help for replantation by visiting the nearest dentist. None of the participants had ever received any kind of information on management of a knocked-out tooth. The kindergarten teachers have a lack of knowledge for immediate response to tooth avulsion. Every kindergarten teacher should be well informed what should be done if some type of dental injury happens. The official communication between dental professionals and kindergarten teachers should be improved at local and regional level.

Made available in DSpace on 2020-12-12T01:53:46Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-06-01 Background/Aim: Anti-allergic drugs can inhibit the hard tissue resorption process, and due to similarities between root resorption and bone mechanisms, it can be inferred that these drugs may also control root resorption. The aim of this study was to analyze the effects of anti-allergic drugs used systemically on the process of root resorption following delayed tooth replantation. Materials and Methods: Thirty-two maxillary right incisors of rats were extracted and subsequently replanted. Rats were divided into four groups according to the anti-allergic drug administered: the rats in groups DEX, Q, and MO were treated systemically with dexamethasone phosphate, quercetin, and montelukast, respectively, and no systemic medication was administered to rats in group C. After 60 days, the animals were euthanized, and the specimens were processed for histomorphometric and immunohistochemical analyses. Statistical significance was set at P

This study aimed to systematically assess the outcomes of intentional replantation (IR) of teeth and to determine the survival rate, success rate, and prognostic factors related to the treatment. A search was conducted for all relevant English language articles published from January 2000 to October 2017. The search terms included "intentional replantation" and "teeth" according to the inclusion criteria. The Methodological Index for Non-randomized Studies (MINORS) was used to assess the methodological quality of included studies. Twelve studies were identified as relevant for the systematic review. In total, 896 patients with 905 teeth were examined for intentional teeth replantation. The success rate was greater than 90% in four studies (33.33%) and between 70% and 80% in five studies. At short-term follow-up (36 months), the survival rates of teeth were slightly reduced in four studies, and tended to be stable after 48 months. In conclusion, the long-term success and survival rate of IR are likely dependent upon short extraoral time, reduced pocket depth, type of tooth, type of root-end filling material, and the prevention of atraumatic tooth root damage.

Tooth avulsion is one of the urgent situations that can influence masticatory physiology, aesthetic issues and affect the patient's quality of life. For the treatment of this misfortune, a replantation or dental implant may be indicated. Objective: Faced with the possibility that new practices and/or clinical evidences have emerged in the last ten years in the use of reimplantation or implant techniques in traumatic dental avulsion, the present narrative review proposed a brief discussion, in the perspective of contributing to a more efficient therapy. and an improvement in the patient's quality of life. Methodology: The search strategies were structured from MeSH terms/ and DeCS/MeSH terms, in the /PubMed database, and manual search, for the terms: Tooth avulsion, Traumatic dental injury; Tooth replantation, Dental implantation. Articles were included, accessible in full, that addressed the technique of reimplantation or dental implant after traumatic avulsion, in humans, without language restriction and published until 2022. Letters to the editor and opinion texts were excluded. Conclusion: The practice of dental reimplantation shows few changes over the years, according to this review. It consists of a rescue treatment, even considering a careful clinical evaluation and based on already established protocols, since there is still no consensus on reimplantation in traumatic avulsion. On the other hand, procedures related to implants, often associated with the use of graft materials and membranes, have been presented as an excellent option in the correction of tooth loss. La avulsión dentaria es una de las situaciones urgentes que pueden influir en la fisiología masticatoria, cuestiones estéticas y afectar la calidad de vida del paciente. Para el tratamiento de esta desgracia puede estar indicado un reimplante o implante dental. Objetivo: Ante la posibilidad de que en los últimos diez años hayan surgido nuevas prácticas y/o evidencias clínicas en el uso de técnicas de reimplantación o implante en la avulsión dental traumática, la presente revisión narrativa propuso una breve discusión, en la perspectiva de contribuir a una terapia más eficiente. y una mejora en la calidad de vida del paciente. Metodología: Las estrategias de búsqueda se estructuraron a partir de términos MeSH/ y términos DeCS/MeSH, en la base de datos /PubMed, y búsqueda manual, para los términos: Tooth avulsion, Traumatic dental lesion; Reimplantación de dientes, Implantación dental. Se incluyeron artículos, accesibles en su totalidad, que abordaran la técnica de reimplantación o implante dental después de avulsión traumática, en humanos, sin restricción de idioma y publicados hasta 2022. Se excluyeron cartas al editor y textos de opinión. Conclusión: La práctica del reimplante dental muestra pocos cambios a lo largo de los años, según esta revisión. Consiste en un tratamiento de rescate, incluso considerando una evaluación clínica cuidadosa y basado en protocolos ya establecidos, ya que aún no hay consenso sobre el reimplante en avulsión traumática. Por otro lado, los procedimientos relacionados con los implantes, muchas veces asociados al uso de materiales de injerto y membranas, se han presentado como una excelente opción en la corrección de la pérdida dentaria. A avulsão dentária é uma das situações de urgência que pode influenciar na fisiologia mastigatória, questões estéticas e afetar a qualidade de vida do paciente. Para o tratamento deste infortúnio, pode-se indicar um reimplante ou implante dental. Objetivo: Diante da possibilidade de que novas práticas e ou evidências clínicas tenham surgido nestes últimos dez anos no emprego das técnicas de reimplante ou implante na avulsão dental traumática, a presente revisão narrativa propôs uma breve discussão, na perspectiva de contribuir para uma terapêutica mais eficiente e uma melhora da qualidade de vida do paciente. Metodologia: As estratégias de busca foram estruturadas a partir de MeSH terms/ e DeCS/MeSH terms, na base de dados da /PubMed, e busca manual, para os termos: Tooth avulsion, Traumatic dental injury; Tooth replantation, Dental implantation. Foram incluídos os artigos, acessíveis na íntegra, que abordassem a técnica do reimplante ou implante dental após avulsão traumática, em seres humanos, sem restrição idioma e publicados até 2022. Excluindo-se cartas ao editor e textos de opiniões. Conclusão: A prática de reimplante dental apresenta poucas modificações com o passar dos anos, de acordo com esta revisão. Consiste em um tratamento de resgate, mesmo debruçado em uma avaliação clínica criteriosa e pautado em protocolos já estabelecidos pois, ainda não há um consenso sobre o reimplante na avulsão traumática. Por outro lado, os procedimentos referentes aos implantes, muitas vezes associados ao uso de materiais de enxertos e membranas, tem se apresentado como excelente opção na correção de perdas dentais.

The purpose of this study was to understand, through scientific evidence, the types of root resorption arising from the reimplantation of avulsed tooth, and to analyze the factors that contribute to its development. PubMed and LILACS databases were searched using the keywords "Root resorption", "Toothreimplantation", "Incidence" and "Avulsion" using the Boolean operator "AND". The search included articles published in the database in the last five years in English. The search resulted in 461 articles, leaving 94 articles after the selection of articles published from 2016 to 2021. The selection of articles was guided by reading the titles and abstracts, and 22 articles were selected for reading in full. Finally, 8 articles were included in this integrative review, corresponding to the eligibility criteria. Despite the lack of standardization of studies, it was found that RR related to the reimplantation of avulsed teeth had a higher incidence of external RR. As for the types of external RR, the articles showed higher incidence for RR by replacement, as well as its relationship in cases of lost/extracted teeth. However, not all studies classified the factors related to RR, making it difficult to perform a subgroup analysis to determine the major causal relationship and tooth loss. Therefore, further clinical analysis studies need to be conducted in a standardized manner, so that a more accurate analysis of the incidence as well as the reasons why dental elements developed and were lost/extracted by RR can be performed. El objetivo de este estudio fue conocer, a través de la evidencia científica, los tipos de reabsorción radicular resultantes del reimplante por avulsión dental, y analizar los factores que contribuyen a su desarrollo. Se realizaron búsquedas en las bases de datos PubMed y LILACS utilizando las palabras clave "Root resorption", "Toothreimplantation", "Incidence" y "Avulsion", con la ayuda del operador booleano "AND". La búsqueda incluyó artículos publicados en la base de datos en los últimos cinco años en inglés. La búsqueda dio como resultado 461 artículos, quedando 94 tras la selección de artículos publicados entre 2016 y 2021. La selección de artículos se guió por la lectura de los títulos y resúmenes, siendo seleccionados 22 artículos para su lectura completa. Finalmente, se incluyeron 8 artículos en esta revisión integradora, correspondientes a los criterios de elegibilidad. A pesar de la falta de estandarización de los estudios, se encontró que el RR relacionado con el reimplante de dientes avulsionados mostró una mayor incidencia de RR externo. En cuanto a los tipos de RR externa, los artículos mostraron una mayor incidencia para la RR por sustitución, así como su relación en los casos de dientes perdidos/extraídos. Sin embargo, no todos los estudios clasificaron los factores relacionados con el RR, lo que dificulta un análisis de subgrupos para determinar la principal relación causal y la pérdida de dientes. Por lo tanto, es necesario que se realicen nuevos estudios de análisis clínicos de forma estandarizada, para poder realizar un análisis más preciso de la incidencia, así como de las razones por las que los elementos dentales se desarrollaron y se perdieron/extrajeron por RR. O objetivo deste estudo foi compreender, por meio de evidências científicas, os tipos de reabsorções radiculares advindas do reimplante do elemento dental avulsionado, além de analisar os fatores que contribuem para o seu desenvolvimento. Foram realizadas consultas nas bases de dados PubMed e LILACS, utilizando as palavras-chave: “Root resorption”, “Toothreimplantation”, “Incidence” e“Avulsion”,com o auxílio do operador booleano “AND”. Foram incluídos na pesquisa artigos publicados na base de dados nos últimos cinco anos m inglês. A busca resultou em 461 artigos, restando 94 após a seleção de artigos publicados de 2016 a 2021. A seleção dos artigos foi guiada pela leitura dos títulos e doresumos, sendo selecionados 22 artigos para leitura na íntegra. Por fim, 8 artigos foram incluídos nesta revisão integrativa, correspondendo aos critérios de elegibilidade. Apesar da falta de padronização dos estudos, foi visto que a RR relacionada ao reimplante de dentes avulsionados apresentou maior incidência para RR externa. Quanto aos tipos de RR externa, os artigos apresentaram maior incidência por RR por substituição, assim como sua relação nos casos dos dentes perdidos/extraídos. Contudo, nem todos os estudos classificaram os fatores relacionados à RR, dificultando uma análise de subgrupo para determinar a maior relação de causa e perda dos elementos dentários. Logo, é preciso que novos estudos de análises clínicas sejam realizados de forma padronizada, para que assim seja feita uma análise mais precisa da incidência, assim como das razões pelas quais os elementos dentais desenvolveram e foram perdidos/extraídos por RR.

To investigate the genetic association in a sample of replanted teeth, it is necessary to observe the extreme phenotypes, such as, teeth that underwent functional healing and those extracted due to severe external root resorption. Thus, this study aimed to investigate the association of age of the patients, root development, storage media, and polymorphisms in the interleukin 4 (IL4) and interleukin 6 (IL6) genes with teeth that presented extreme outcomes, as functional healing or extraction, in a group whose replantation techniques did not follow the International Association of Dental Traumatology (IADT) 2012 guidelines. Forty-three avulsed and replanted teeth that did not follow IADT 2012 guidelines and underwent functional healing or were extracted were included. Periapical radiographs employed for this study were taken soon after tooth replantation and after 1 year. For genotypic IL4 and IL6 genes analysis, DNA of oral mucosa cells was extracted. Real-time- PCR performed for genotyping polymorphisms in IL4 and IL6 genes. Clinical and genetic variables were analyzed by the Chi-square test and the “Z” test. P values < .05 were considered significant. The results showed that functional healing and extraction were associated with storage media and with the rs2243268 of IL- 4 gene polymorphisms. As conclusion, the C rs2243268 allele of IL4 gene may have a positive relationship with functional healing teeth that were replanted not following the 2012 IADT guidelines. Keeping the tooth dry is associated to a fast loss of avulsed and replanted teeth after 1-year follow-up. Resumo Para investigar a influência genética em uma amostra de dentes reimplantados, é necessário observar os fenótipos extremos, como os dentes que sofreram cura funcional e os extraídos devido à reabsorção radicular externa severa. Assim, este estudo teve como objetivo investigar a associação da idade dos pacientes, desenvolvimento radicular dos dentes, assim como o meio de transporte até o reimplante e polimorfismos nos genes da interleucina 4 (IL4) e da interleucina 6 (IL6) com dentes que apresentaram cura funcional ou extração, em um grupo cujas técnicas de reimplante não seguiu a International Association of Dental Traumatology (IADT) 2012. Foram incluídos 43 dentes avulsionados e reimplantados que não seguiram as diretrizes do IADT, e tiveram cura funcional ou foram extraídos. As radiografias periapicais utilizadas para este estudo foram feitas logo após o reimplante dentário e após 1 ano. Para a análise genotípica dos genes IL4 e IL6, foi extraído DNA de células da mucosa oral. PCR em tempo real realizou a análise dos polimorfismos dos genes. As variáveis clínicas e genéticas foram analisadas pelos testes Qui-quadrado e “Z”. Valores de p

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. Keywords: Dental trauma, dental knowledge, dental management, tooth avulsion.

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 PGI2 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.

Management of avulsed teeth after replantation often leads to an unfavorable outcome. Damage to the thin and vulnerable periodontal ligament is the key reason for failure. Cell- or stem cell-based regenerative medicine has emerged in the past two decades as a promising clinical treatment modality to improve treatment outcomes. This concept has also been tested for the management of avulsed teeth in animal models. This review focuses on the discussion of limitation of current management protocols for avulsed teeth, cell-based therapy for periodontal ligament (PDL) regeneration in small and large animals, the challenges of de novo regeneration of PDL on denuded root in the edentulous region using a mini-swine model, and establishing a prospective new clinical protocol to manage avulsed teeth based on the current progress of cell-based PDL regeneration studies. Supplementary Information The online version contains supplementary material available at 10.1186/s13287-022-02700-x.

This study aimed to investigate the fibroblast cells proliferation in periradicular tissue using mineral trioxide aggregate (MTA) and self-adhesive resin cement as the adhesive material for vertical root fracture fragments following intentional replantation.This study used 27 male New Zealand rabbits aged 8-12 weeks. The mandibular incisor of each rabbit was extracted, and to simulate vertical fracture, the incisor tooth was sectioned vertically from the cervical to the 2/3 apical. The samples were randomly divided into three groups of nine each. Group 1 (control group), no application of any material. Group 2, the fracture line was sealed using MTA. Group 3, with self-adhesive resin cement. All teeth in all groups were then inserted back (replanted) into the socket of the rabbits. Each group was further divided into three subgroups according to the duration of replantation, namely, group A: week 1, group B: week 2, and group C: week 3. Rabbits were sacrificed according to each duration of replantation for histological preparations. The number of fibroblast cells was evaluated by counting at the three viewpoints under the light-microscope (400× magnification) and Optilab camera; finally, the calculation results were averaged. Data were analyzed using a two-way ANOVA andFollowing MTA application in the third week produced the highest number of fibroblast cells (104 + 29.5) compared to other groups. Conversely, the lowest number of fibroblast cells occurred in the control group in the first week of observation (4.33 + 3.5).MTA produced the greatest fibroblast cell proliferation than self-adhesive resin cement, particularly in week 3 of vertical root fractures replantation.As the adhesive material for vertical root fracture fragments, MTA generated greater fibroblast proliferation than self-adhesive resin cement. Therefore, it is recommended to use MTA to attach vertical root fracture fragments.

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.

Dental trauma resulting in permanent tooth avulsion commonly affects the young population. The prognosis of replantation after avulsion depends on the natural history of inflammatory and replacement resorption. Several risk factors for type and onset of external resorption have been defined. This case study describes different resorptive patterns observed in two upper central incisors belonging to a single individual, avulsed in the same moment, and replanted after thirty-six hours of dry storage. The roots were analyzed by scanning electron microscopy and stereomicroscope imaging, to obtain an in-depth analysis of the resorptive pattern. The aim of this report is to: (i) underline the high variability in the incidence of root resorption after replantation across and within types of teeth and resorption; and (ii) underline the possible concurrence of different factors affecting the onset and type of resorptive pattern. In conclusion, an unpredictable pattern of resorption may account for the poor prognosis when teeth are replanted outside the current recommendations.

Dental replantation is a major problem in public health. Its prognosis depends on emergency care, but there is a lack of knowledge on it. So, this study aims to evaluate the knowledge of undergraduate students of Dentistry, Speech Therapy, Physical Education, Pedagogy, and Technologist in Radiology. One hundred and fifty one students answered 10 questions about emergency replantation care. Then, an educational lecture was performed. The same questions were asked again to the same students to reevaluate their answers. The statistical tests were employed at a significant level of p

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.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.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.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.

Autotransplantacija je postupak kojim se kod iste osobe zub ili zubni zametak prenosi iz jedne u drugu alveolu. Za autotransplantaciju najčešće se odabiru treći molari, impaktirani očnjaci ili mandibularni pretkutnjaci koji su se pokazali kao najbolja zamjena za izgubljene maksilarne sjekutiće. Najbolji rezultati očekuju se ako je transplantirani zub dosegao između 50 i 75 % svoga razvoja, a za uspjeh ovog zahvata iznimno je važno očuvanje zdravog parodontnog ligamenta transplantiranog zuba. Postotak preživljenja transplantiranih zuba je visok, a rezultate je moguće predvidjeti s relativno velikom sigurnosti. Komplikacije koje se mogu pojaviti su nekroza pulpe, resorpcija korijena zuba i ankiloza. Ova je metoda najčešće odabir u liječenju mladih pacijenata jer ne ometa rast i razvoj, a daje zadovoljavajuće estetske i funkcionalne rezultate. Cilj ovog rada je prikazati postupak autotransplantacije zuba kao moguće terapijske metode u liječenju komplikacija nastalih traumom zuba. Na mjesto središnjeg sjekutića pogođenog traumom transplantiran je drugi donji lijevi premolar. Dvije godine kasnije transplantirani zub je urednog kliničkog i radiološkog nalaza. Patološka mobilnost zuba nije uočena, gingiva je uredna, a kontura alveolarnog grebena očuvana. Pacijentica je zadovoljna estetskim rezultatima i funkcijom zuba. Uz pravilnu postavu indikacija i kiruršku tehniku autotransplantacija zuba je uspješna terapijska metoda nadoknade zuba u slučajevima kada su protetska i implantološka terapija kontraindicirane zbog nezavršenog rasta i razvoja orofacijalnih struktura pacijenta. Tooth autotransplantation is a procedure in which a tooth or tooth germ is transferred from one alveolus to another in the same person. For autotransplantation are third molars, impacted canines, or mandibular premolars are most commonly selected, which have been shown as the best replacement for lost maxillary incisors. The best results are expected if the root of the transplanted tooth has reached between 50 and 75% of its development, and the preservation of a healthy periodontal ligament of the transplanted tooth is extremely important for the success of this procedure. The survival rate of transplanted teeth is high, and the results can be predicted with relatively high certainty. Complications that may occur are pulp necrosis, tooth root resorption, and ankylosis. This method is most often chosen for treatment of young patients because it does not interfere with growth and development and provides satisfactory aesthetic and functional results. The aim of this case report is to present the success of tooth autotransplantation as a possible therapeutic method in the treatment of complications caused by dental trauma. A second mandibular left premolar was transplanted to the site of the trauma affected maxilar central incisor. Two years later, clinical and radiological examination of the transplanted tooth showed no signs of pathology. Pathological mobility was not observed, the gingiva was neat, and the contour of the alveolar ridge was preserved. The patient is satisfied with the aesthetic results and the function of the transplanted tooth. With proper indication setting and surgical technique, tooth autotransplantation is a successful therapeutic method in restoring teeth when prosthetic or implant therapy are contraindicated due to incomplete growth and development of the patient.

Tooth ankylosis is a pathological condition of periodontal ligament (PDL) restoration after tooth replantation. Platelet-derived growth factor-BB (PDGF-BB) has been proposed as a promising factor for preventing tooth ankylosis. Using rat tooth replantation model, we investigated whether PDGF-BB accelerates the repair of PDL after tooth replantation without ankylosis, and its molecular mechanisms. In PDGF-BB pretreated replanted teeth (PDGF-BB group), ankylosis was markedly reduced and functionally organized PDL collagen fibers were restored; the mechanical strength of the healing PDL was restored to an average of 76% of that in non-replanted normal teeth at 21 days. The numbers of PDGF-Rβ- and BrdU-positive cells in the periodontal tissues of the PDGF-BB group were greater than those of atelocollagen pretreated replanted teeth (AC group). Moreover, in the PDGF-BB group, the periodontal tissues had fewer osteocalcin-positive cells and decreased number of nuclear β-catenin-positive cells compared to those in the AC group. In vitro analyses showed that PDGF-BB increased the proliferation and migration of human periodontal fibroblasts. PDGF-BB downregulated mRNA expressions of RUNX2 and ALP, and inhibited upregulatory effects of Wnt3a on β-catenin, AXIN2, RUNX2, COL1A1, and ALP mRNA expressions. These findings indicate that in tooth replantation, topical PDGF-BB treatment enhances cell proliferation and migration, and inhibits canonical Wnt signaling activation in bone-tooth ankylosis, leading to occlusal loading of the PDL tissues and subsequent functional restoration of the healing PDL. This suggests a possible clinical application of PDGF-BB to reduce ankylosis after tooth replantation and promote proper regeneration of PDL.

Submitted by Jakeline Ortega (jakortega@unoeste.br) on 2022-04-07T17:37:41Z No. of bitstreams: 2 Priscila Bruna Gonçalves Lacerda_Dissertação_Odonto_26_01_2022.pdf: 2182543 bytes, checksum: 099019eb9b26a575689c62932b36359f (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Made available in DSpace on 2022-04-07T17:37:42Z (GMT). No. of bitstreams: 2 Priscila Bruna Gonçalves Lacerda_Dissertação_Odonto_26_01_2022.pdf: 2182543 bytes, checksum: 099019eb9b26a575689c62932b36359f (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2021-09-10 The aim of the present study was to evaluate the association between photobiomodulation for surface treatment and the use of probiotics as a storage media in the repair process of dental tissues after late reimplantation. Fifty rats were divided into 5 groups and had their upper right central incisors extracted and treated, as follows: Negative Control Group, teeth immersed in saline solution for 30 min; Milk Group, teeth immersed in milk for 30 min; LLLT Group, teeth immersed in saline solution for 30 min and, after, teeth were photobiomodulated; Probiotic Group, teeth immersed in Bifidumbacterium HN019 for 30 min; Probiotic + LLLT Group, teeth immersed in probiotic for 30 min and, after, teeth were photobiomodulated. The teeth were reimplanted and after 60 days the animals were euthanized and inflammatory, reabsorptive and reparative parameters were histologically analyzed. Quantity and quality of collagen fibers were evaluated histochemically. Histological evaluation showed that the Probiotic + LLLT group had an inflammatory infiltrate with expressive intensity and extension and presence of root resorptions, results similar to those of the other groups (p>0.05). The amount of mature collagen fibers was greater than the immature ones for all groups (p0.05). The association of photobiomodulation with probiotics can be an alternative treatment protocol for late tooth replantation, especially because the similar results to Milk group, traditionally recommended treatment. Within the limitations of the work and according to the parameters studied, it is concluded that the treatments used can be promising because they presented results similar to the Milk group. However, further studies should be carried out for its clinical indications. O objetivo do presente estudo foi avaliar a associação da fotobiomodulação para o tratamento da superfície e uso de probióticos como meio de estocagem no processo de reparo dos tecidos dentais após o reimplante tardio. Cinquenta ratos foram divididos em 5 grupos e tiveram seus incisivos centrais superiores direitos extraídos e tratados, de acordo: Grupo Controle Negativo, dentes imersos em soro fisiológico por 30 min; Grupo Leite, dentes imersos em leite por 30 min; Grupo LLLT, dentes imersos em soro fisiológico por 30 min e, após esse período, os dentes foram fotobiomodulados; Grupo Probiótico, dentes imersos em Bifidumbacterium HN019 por 30 min; Grupo Probiótico + LLLT, dentes imersos em probiótico por 30 min e, após esse período, os dentes foram fotobiomodulados. Após, os dentes foram reimplantados e passados 60 dias os animais foram eutanasiados e parâmetros inflamatórios, reabsortivos e reparatórios foram analisados histologicamente e a quantidade e qualidade de fibras colágenas foram avaliados histoquimicamente. A avaliação histológica mostrou que o grupo Probiótico + LLLT teve um infiltrado inflamatório com intensidade e extensão expressivos e presença de reabsorções radiculares, resultados semelhantes aos dos demais grupos (p>0.05). A quantidade de fibras colágenas maduras foi maior do que as imaturas para todos os grupos (p0.05). A associação da fotobiomodulação com o probiótico pode ser um protocolo de tratamento alternativo para reimplante dentário tardio, especialmente por ser semelhante ao grupo Leite, tratamento tradicionalmente recomendado. Dentro das limitações do trabalho e de acordo com os parâmetros estudados, conclui-se que os tratamentos empregados podem ser promissores por apresentaram resultados semelhante ao grupo Leite, podendo ser promissores. No entanto, mais estudos devem ser realizados para suas indicações clínicas.

Simplified and predictable immediate single-tooth replacement therapy can be optimised by leveraging recent advances in digital workflows that combine static surgical guidance and customised prosthesis design and fabrication. The present case report illustrates a novel approach to successfully executing immediate single-tooth replacement therapy via static computer-aided immediate implant placement and digital provisionalisation utilising angulated screw access, with a 1-year follow-up after delivery of the definitive restoration.A healthy 27-year-old woman with congenital agenesis of the mandibular second premolars and who required replacement of the mandibular left second premolar underwent immediate single-tooth replacement therapy via computer-aided, restrictive implant placement and provisionalisation using custom prosthetic components designed prior to the surgical intervention being performed.After a 6-month healing period, the provisional crown was replaced with the definitive restoration. After 1 year, the peri-implant keratinised mucosa demonstrated vertical gain in the mid-buccal portion and stability in the interproximal aspects, and no changes in marginal bone level were observed.The present case report demonstrates the successful application of novel digital tools to facilitate both surgical and prosthetic aspects of immediate single-tooth replacement therapy. Digital workflows can optimise the clinical efficiency and predictability of tooth replacement therapy with dental implants by reducing surgical and restorative chair time and increasing patient satisfaction.

Objective: To evaluate the knowledge of patients treated in a public University concerning dental avulsion and its emergency first-aid management . Material and Methods: Three hundred patients were invited to answer a questionnaire about demographic characteristics, attitude and knowledge of first-aid management of dental avulsion. Chi-square test was used to assess the association between knowledge about dental replantation and education level. Results: Female gender (66.7%) aged from 31 to 40 years (31.3%) with high school education (50.3%) predominated among all the participants. It was not found a difference between education level and management of avulsed permanent teeth (p=0.076), and 66% of the respondents were not able to do the replantation. In relation to the management of avulsed tooth, 42.7% of the respondents would brush the tooth and if the replantation was not possible, most of them would choose inappropriate media for storage. The association between the storage medium and educational level showed to be statistically significant (p=0.043) . Conclusion: It was possible to notice the lack of knowledge about this subject, and it could result in the worst prognosis. In avulsion cases, the subsequent root resorptions may lead to the loss of the child's tooth. It is important to implement educational campaigns to spread knowledge and improve success rates of permanent avulsed teeth.

Aim This case aims to detail intentional replantation as a last resort to save an otherwise hopeless premolar with perforated internal resorption and root fracture. Background Internal root resorption, progressive destruction of intraradicular dentin, is a condition that sometimes renders a tooth non-restorable. In the rare cases reported where severe internal resorption leads to root fracture, extraction of the tooth seemed to be a common treatment of choice, and a few literatures had reported endodontic surgery as an alternative treatment option. To date, there had been no report of treating internal root resorption using intentional replantation. Case description A 20-year-old male presented swelling at the buccal region of his left maxillary second premolar (#13). Clinical examination revealed a sinus tract and fractured dens evaginatus at the occlusal surface of the tooth. Radiographically, a large area of radiolucency was detected within the middle third of the root, where root fracture was present, leaving a triangular-shaped mature root apex. The condition was diagnosed as internal root resorption and root fracture. Endodontic surgery was excluded from treatment choices due to potential damage of periodontal bone. Instead, intentional replantation was performed, with the application of biomaterials including mineral trioxide aggregate (MTA) and platelet-rich fibrin (L-PRF). The tooth achieved satisfactory healing and remained asymptomatic after 2 years of follow-up. Conclusion The successful outcome of the case suggests that intentional replantation could preserve a fractured tooth caused by internal root resorption. Incorporated application of biomaterials, such as MTA and L-PRF, might as well improve the chances of saving this otherwise hopeless tooth. Clinical significance Through careful planning and execution, intentional replantation is a viable alternative treatment option to preserve a fractured tooth caused by internal root resorption, while leaving periodontal bone architecture almost intact. How to cite this article: Yang Y, Zhang B, Huang C, et al. Intentional Replantation of a Second Premolar with Internal Resorption and Root Fracture: A Case Report. J Contemp Dent Pract 2021;22(5):562-567.

Tooth transplantation is one of the treatment options for extracted teeth that can be considered before dental implantation. Although the success rate of tooth transplantation is lower than that of implantation, tooth replantation and transplantation have the great advantage of using natural teeth. Tooth replantation might be considered a promising option in some cases. In present study, the expression patterns of revascularization and pulpal healing, which are the most important for the pulp viability, were analyzed after tooth replantation and allograft in mice. The inflammatory response and root dentin resorption were observed and not different between replantation and allograft in initiation of healing process. However, bonelike tissue formation, pulp revascularization and pulp healing were faster in replantation. The difference of healing patterns between tooth replantation and allograft found in present study will be helpful to select the treatment option and to understand healing mechanism., Highlights • The expression of healing markers begins in root canal and moves to pulp cavity. • Pulp healing response becomes normal in 7 days after tooth replantation. • Overall healing process in tooth replantation is faster than allograft.