Search

In the context of tooth trauma, mostly the maxillary central front teeth are involved, whereby their roots are in some cases still in the developing stage (immature). Depending on the type of trauma, a necrosis of the pulp is the consequence or at least foreseeable. In order to preserve such a tooth, an endodontic therapy is inevitable. The disadvantage of conventional endodontic therapy methods of immature teeth (apexification, apexogenesis) is the root growth stop. Alternatively, the regeneration/revascularisation of the dental pulp (RP) was suggested, that allows a further root growth. The aim of this case report is to present the procedure of a RP-therapy and to suggest a step-by-step manual.

Die Langzeitprognose avulsierter Zähne hängt primär vom Verhalten am Unfallort ab. Laien sind nicht in der Lage, eine sofortige Replantation durchzuführen. Daher kommt der zellphysiologischen Lagerung avulsierter Zähne eine besondere Bedeutung zu. Das Ziel dieser Pilotstudie war es, herauszufinden, ob Frischhaltefolie das Überleben der PDL-Zellen in vitro unterstützt. Hierzu wurden gesunde humane Weisheitszähne verwendet. Diese wurden in Wurzelscheiben geschnitten und in einem der fünf Untersuchungs- medien gelagert: SOS Zahnbox ®, UHT-Milch (4°C), sterile isotone Kochsalzlösung, Leitungswasser und Frischhaltefolie. Nach einer Verweildauer von 2h, 6h und 24h im respektiven Medium wurden die Scheiben für 14d bei 37°C und 5% CO2 kultiviert. Nach 2d, 7d und 14d wurde das Zellüberleben jeder Scheibe quantitativ analysiert. Ausser dem Leitungswasser förderten alle untersuchten Medien das Zellüberleben. Zum Zeitpunkt 2h ermöglichte die Lagerung in Frischhaltefolie im Vergleich zu allen anderen Medien das höchste Zellwachstum. Zum Zeitpunkt 6h zeigten die in Frischhaltefolie gelagerten Zähne vergleichbares Zellwachstum mit denjenigen in der SOS Zahnbox®. Die Ergebnisse dieser Pilotstudie deuten darauf hin, dass die Frischhaltefolie möglicherweise als alternatives Transportmedium für eine Lagerungsdauer bis 6h verwendet werden könnte.

Root resorption may be a physiological (resorption of deciduous teeth) or a pathological process (resorption of permanent teeth). In the latter case an external and an internal form of resorption can be distinguished. Root resorption may occur on one tooth or on several teeth within a dentition and it may be caused by trauma, periodontitis, orthodontic treatment, internal bleaching, cysts, tumors, or by stimuli from a necrotic dental pulp. Current knowledge concerning the pathogenesis of root resorption and therapeutic approaches are presented. For cervical resorption, it is assumed that the stimulus for the resorbing cells originates from the bacteria within the gingival sulcus and along the affected root surface. The case presented here was initially diagnosed as chronic periodontitis of medium severity. Scaling and root planing were performed resulting in a significant improvement of the periodontal status. Two years later, following a period of irregular recall visits, the patient presented with large areas of cervical resorption on teeth 36 and 37 which made it impossible to preserve these teeth. After another six months, teeth 34 and 35 showed deep destruction caused by external root resorption, mandating the extraction of these teeth as well. Fourteen months later, external root resorptions were evident on teeth 32 and 33, and at the same time, a recurrence of the chronic periodontitis was noted. Periodontal therapy was performed under a systemic antibiotic regime. It was possible to preserve teeth 32 and 33 through surgical crown lengthening procedures. No additional resorption has been observed ever since.

The present paper describes the current treatment philosophy of dislocated or avulsed permanent teeth at our school. Splinting and medication (root canal treatment, systemic antibiotics, etc.) are targeted to minimize the initial inflammatory reaction and to reduce post-traumatic complications such as pulp necrosis and/ or external root resorption.

The treatment of displacement injuries and fractures of permanent teeth is an important emergency therapy in the dental office. Due to new sport trends and various outdoor activities, the frequency of dental trauma of children and adolescents alike is steadily rising. The standard treatment of displacement or avulsion injuires of permanent teeth is repositioning or replantation with subsequent splinting. The dental trauma splint must be flexible to allow for the physiologic movement of the repositioned or replanted teeth in order to reduce the risk for ankylosis or external root resorption. Stabilization of a repositioned tooth with a flexible splint over a short time period optimises the rehabilitation of the periodontal tissues. In the literature various splinting techniques have been described. This paper presents a new splinting technique; the Titanium Trauma Splint (TTS), which is made of pure titanium and was specifically developed for the treatment of traumatically displaced or avulsed permanent teeth. The TTS-splint has certain advantages when compared to traditional splinting techniques. These advantages are beneficial both for the dentist and patient alike.

The aim of this investigation was a critical assessment of the short- and medium-term results of replantation of immature, avulsed permanent teeth. Thirty-nine teeth were investigated after 2.5 years on average. Only 7 teeth (18%) had been replanted within 5 min after avulsion. Sixteen teeth (41%) showed revascularisation or ingrowth of alveolar bone into the pulp. Twenty-two teeth (56%) showed signs of ankylosis, 6 (15%) had been exfoliated or extracted. Seventeen teeth (77% of the ankylotic ones) exhibited an alveolar growth arrest of 1.5 mm per 10 cm body growth. By planimetric assessment, the yearly loss of root dentin by replacement resorption was about 15%. The appearance was compromised in 11 cases (33%) by severe discoloration. In spite of intense therapeutic effort and partial success, the results must be classified as unsatisfactory. In avulsions of immature permanent teeth, replantation therefore has to be considered an intermediate solution. Since the main reason for a failure is extended extra-oral unphysiologic storage, replantation by lay helpers immediately after the accident should be propagated as a first-aid treatment to improve the situation of the replanted tooth. In addition, more attention should be paid to preserving teeth in tissue cultures before replantation.

During the initial X-ray control of a 10-year-old female orthodontic patient, a late development and an inverted position of the lower left second premolar was seen. 4.3 years later the tooth with its follicle was replanted in the upright position, preserving the second deciduous molar; at that time the root development was at an early stage. At a follow-up control 4 years after the surgical procedure the replanted tooth had erupted and the sensibility response was normal. Its root, however, although completed, could not reach the length and especially the width (in the apical half) of the contralateral premolar. This relative reduction in width seems to follow a temporary thickening of that part of the root formed during the first period after replantation. The anamnestic data suggest that physiologic exfoliation of the deciduous molar took place.

In 68 patients, 79 tooth germs of the third molar were transplanted. Out of this group, 43 patients with 50 transplantations under-went a follow-up examination. All surgery was performed by one surgeon. Retrospectively, we tried to establish whether the success of postoperative healing depends on the donor and receiver regions. Crossing the jaw border clearly worsens the prognosis for transplantation. Altogether 9 transplantations turned out to be failures, 7 of which had been transplanted from the upper to the lower jaw. The results of this investigation showed incomplete root development in 34%, the necessity of endodontic treatment in 6% and enlarged periodontal pockets in 8%. Ankylosed teeth were found in 10%; we did not see any root resorptions.

The outcome of 81 of 99 patients being treated from 1980 to 1993 by transplantation of autologous teeth was investigated. The overall transplant survival rate was 91% after 1 year, 81% after 5 years and 70% after 9 years. The early loss of transplanted teeth was due to healing disorders. The long-term losses were due to caries and replacement resorption. Caries in tooth transplants has to be treated very early, because deep caries or deep drilling leads to an infection of the nutrient canals of the osteodentine. If the pulp chamber of a transplant is once obliterated by osteodentine, endodontic treatment can no longer be performed in many cases. The periodontal condition of the transplants did not differ from that of normal teeth. In 23% there was a decreased tooth mobility, caused by ankylosis of the transplant. 51% of the transplants showed occlusal disturbances but none of the patients had signs of occlusal traumatization of the teeth or of the temporomandibular joint. In comparison to success rates taken from the literature it is pointed out that tooth transplantation has a better long-term prognosis than endodontic treatment. Therefore, in young patients requiring root canal treatment, tooth transplantations should be considered.

21 autotransplanted teeth were examined by using laser Doppler flowmetry (LDF) at 1, 2, 3, 6 and 12 postoperative weeks. 20 teeth showed statistically significantly higher perfusion units up to the 6th weeks as compared to the control group. At 12 postoperative weeks, the perfusion values of the autotransplanted teeth were at the same level as those of the control group. It was possible to show a non-revascularisation of one tooth with LDF. Currently, LDF can be considered as the only practicable, non-invasive method to evaluate the revascularization of autotransplanted teeth.

The general rules for autotransplantation of human premolars in cases of traumatic loss of upper incisors are given. The basic conditions for tooth transplantation concerning the donor side as well as the recipient side are presented. Technical details and the principles of indication are outlined. If a correct technique is combined with a precise indication, the long-term results after tooth transplantation are excellent, with a more than 90% rate of success. Thus the concept of premolar transplantation to the front of the upper jaw in cases of traumatic loss of the upper incisors in children will need more attention in the future.

The alveolus of a (usually maxillary) canine tooth in a dog may fracture during fighting or in a car accident. The trauma loosens the tooth with resultant avulsion. Ten patients are reviewed, nine with maxillary and one with mandibular canine tooth avulsion, and a method for fixation and replantation is described.

The procedure described in this article is based on the surgical subtotal luxation of a tooth-containing alveolar segment and allows the repositioning of single teeth while almost regularly safeguarding tooth vitality. This procedure has proven particularly effective in the treatment of maxillary anteriors, canines and premolars. For patients preferring surgical correction to long-term orthodontic treatment this limited operative intervention allows safe orthodontic alignment. To date, relapses have not been observed in the cases treated. Stable immobilization of up to six weeks postoperatively is achieved by splinting.

Injuries to the periodontium as well as to the crowns and roots of teeth are the most common results of traumatic insults in childhood. The main problem in the fixation of luxated teeth is associated with the state of dentition and the anatomy of the deciduous and permanent teeth. In a clinical follow-up examination the quality of several splints for treating luxated teeth was evaluated. We observed that some acrylic cap splints showed marked mechanical faults and poor fit. Modification of the Construction technique could eliminate such problems.

Some decisive factors for the success of tooth replantation such as perfusion conditions or duration of storage were the subject of this biological/functional study. Evidence for a remaining vitality of the periodontal cells was derived from the pattern of cellular oxygen uptake. The use of pure water, dry storage, or even isotonic saline failed to prevent a decrease in aerobic metabolism within one hour. Storage of the teeth in the patient's blood or serum optimally fulfills the requirements for survival of the periodontium over up to 10 hours. Recommendations for the handling of isolated teeth before replantation are given.

The success of tooth replantation following traumatic avulsion depends to a large degree on the vitality of periodontal ligament cells which remain on the root surface. Loss of vitality promotes root resorption. In this study 124 freshly extracted teeth, only front teeth and premolars, were stored in dry environment for periods of 10 to 150 min. The vitality of the residual periodontal ligament tissue was tested by means of the fluorescein-diacetate reaction. The root area covered by vital tissue decreased to 90% after 30 min and to 70% after 45 min of dry storage. Between 60 and 90 min after extraction the vital tissue area decreased rapidly to about 10%.