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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.

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.

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

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.

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

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.

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.

INTRODUCTION: Avulsion of teeth radically affects the integrity of the tooth and the supporting tissue, and impairs the natural dentition as a whole; thus, all efforts must be directed to the replantation of traumatically avulsed teeth. However, its success is limited due to the occurrence of external root resorption. The challenge is to follow an effective protocol that reduces the occurrence of root resorption and allow for reestablishment of the natural architecture of the periodontal tissue. Biomodulation provided by low level laser therapy provides a promising tool in managing the inflammatory process and augmentation of the reparative process. OBJECTIVES: Was to evaluate the effect of low-level laser therapy (LLLT) on the healing process of rat teeth replanted after delayed replantation. MATERIALS AND METHODS: Thirty healthy Albino male rats had their maxillary left incisors extracted; According to the root surface treatment before the replantation, the teeth were assigned randomly to two groups (n = 15): G1 (control) – no root surface treatment; G2 (study group)-laser diode treatment on the root surface. The teeth were replanted into their respective sockets after 30 minutes, mimicking the natural timing it would take to replant an avulsed tooth. G2 were treated with LLLT performed on the buccal and palatal mucosa every 48 hours for 15 days. The rats were sacrificed after 15, 30 and 45 days of replantation. The specimens were processed for histological and histomorphometric analysis to determine the average root resorption areas and to evaluate the histological events. RESULTS: Histomorphometric analysis showed that the study group (Laser irradiated group) showed lower areas of root resorption and ankylosis, than in control group (non-irradiated group); with a significant statistical difference (p > 0.05). Histological assessment showed restoration of periodontal ligament attachment and increased vascularity in the study group. CONCLUSIONS: Laser irradiation reduces external root resorption and ankylosis in delayed tooth replantation.

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.

Replacement and inflammatory resorption are serious complications associated with the delayed replantation of avulsed teeth. In this study, we aimed to assess whether deferoxamine (DFO) can suppress inflammation and osteoclastogenesis in vitro and attenuate inflammation and bone resorption in a replanted rat tooth model. Cell viability and inflammation were evaluated in RAW264.7 cells. Osteoclastogenesis was confirmed by tartrate-resistant acid phosphatase staining, reactive oxygen species (ROS) measurement, and quantitative reverse transcriptase–polymerase chain reaction in teeth exposed to different concentrations of DFO. In vivo, molars of 31 six-week-old male Sprague–Dawley rats were extracted and stored in saline (n = 10) or DFO solution (n = 21) before replantation. Micro-computed tomography (micro-CT) imaging and histological analysis were performed to evaluate inflammation and root and alveolar bone resorption. DFO downregulated the genes related to inflammation and osteoclastogenesis. DFO also reduced ROS production and regulated specific pathways. Furthermore, the results of the micro-CT and histological analyses provided evidence of the decrease in inflammation and hard tissue resorption in the DFO group. Overall, these results suggest that DFO reduces inflammation and osteoclastogenesis in a tooth replantation model, and thus, it has to be further investigated as a root surface treatment option for an avulsed tooth.

Introduction Appropriate occlusal forces can prevent ankylosis after tooth replantation or transplantation. However, the “proper occlusal forces” on periodontal ligament (PDL) healing have not yet been defined due to insufficient in vitro studies and uncertain in vitro models. Herein, we presented a mechanical vibration device as an in vitro model to determine such favorable occlusal forces. Methods Human periodontal ligament stem cells (hPDLSCs) were exposed to mechanical vibration force with 4 frequencies (30, 90, 150, and 210 rpm). Cell viability and the expression of osteogenic differentiation-related genes and proteins were tested in vitro. The calvarial transplantation experiment was performed to assess the bone formation ability of 150 rpm mechanical vibration stimulation (MVS). Results MVS at 150 and 210 rpm significantly reduced cell viability in the early stages. The 150-rpm MVS decreased osteogenic marker expression at the early time point (3 days) but had no harmful effects at the late time point (14 days). Furthermore, hPDLSC cell sheets treated with 150-rpm MVS had potential to decrease bone formation in rat calvarial defects serendipitously and facilitated functional PDL-like tissue formation. Conclusions We found that MVS at a frequency of 150 rpm could provide a strategy for a transient reduction in the osteogenic potential of hPDLSCs and promote PDL-like tissue formation. Thus, 150-rpm MVS could be used as a controllable proper occlusal force to prevent ankylosis and promote PDL healing after tooth replantation or transplantation.

Ankylosis and subsequent tooth loss is a serious complication following tooth avulsion and replantation. The aim of the study was to evaluate the risk of ankylosis of human teeth replanted after various periods of dry storage prior to replantation. The material originates from a previously reported clinical study of 400 replanted teeth.Initial treatment, clinical and radiological examination and follow-up were conducted according to a standardized protocol. PDL was not removed. Follow-up periods ranged from 0.2 to 20 years (mean 5.1 years). The risk of ankylosis was analysed using the Cox regression model including stage of root development, length of dry time and age 20 years.The risk of ankylosis significantly increased with increasing length of dry time (hazard ratio: 1.22, P = .002) and was significantly higher for teeth with mature root development than for teeth with immature root development (hazard ratio: 2.1 P .0001). The estimated risks of ankylosis after 900 days for teeth with immature root development were: dry time 20 minutes: 33.9% (95% confidence interval (CI): 25.4-42.7), dry time 20-40 minutes: 49.6% (95% CI: 37.5-64.8), dry time 40-60 minutes: 54.4% (95% CI: 37.1-71.3) and dry time 60 minutes: 60.0% (95% CI: 45.0-75.8). The risks for teeth with mature root development were: dry time 20 minutes: 59.4% (95% CI: 51.6-66.5), dry time 20-40 minutes: 78.3% (95% CI: 69.5-86.2), dry time 40-60 minutes: 81.9% (95% CI: 67.2-92.4) and dry time 60 minutes: 86.4% (95% CI: 79.7; 92.9).The risk of ankylosis rose with increasing length of dry time. However, some teeth may heal without ankylosis even after 60 minutes of dry time. Immature teeth have a lower risk of developing ankylosis. Replantation should therefore always be considered for avulsed teeth.

Background The periodontal ligament (PDL) comprises cells embedded in the extracellular matrix (ECM) and is required for periodontal healing upon tooth transplantation. However, the extent to which the ECM contributes to periodontal regeneration remains unknown. This study aimed to evaluate effects of separate PDL matrix without cells on periodontal healing. Methods Mandibular premolars extracted from six beagle dogs, were 1) left untreated, 2) decellularized, or 3) surface planed. Cytologic, histologic, scanning electron microscopy, and transmission electron microscopy analyses confirmed that detergents could be used to decellularize the PDL. An additional circumferential osteotomy was performed to replant dental roots into extraction sockets. Radiography and histology were used to evaluate periodontal regeneration 8 weeks later, with the data adjusted for multiple testing. Results In pristine extraction sites, total root resorption (P = 0.034), recovered PDL space (P = 0.012), and new cementum (P = 0.004) were greater in untreated teeth than in roots that underwent surface planing. There were no significant changes when comparing untreated teeth with teeth having a decellularized PDL (P = 0.081, P = 0.170, and P = 1.000, respectively), and decellularized teeth showed significant increase of new cementum compared to surface planed teeth (P = 0.048). In the defect area, only the recovered PDL space (P = 0.034) was greater in untreated teeth when comparing with denuded roots. Conclusion These results suggest that in addition to untreated PDL, decellularized PDL also partially supports reattachment (particularly cementogenesis) in pristine extraction sites but not in defect areas.

Dental avulsion is considered as one of the most severe types of traumatic tooth injuries because it causes damage to several structures and results in the complete displacement of the tooth from its socket in the alveolar bone. The ideal situation is to replant the tooth immediately after avulsion because the extra oral time is an important determinant for the success of the treatment and for a good prognosis. The aim of this systematic review was to identify the recommended natural storage m to store and transport avulsed tooth based on the survival capacity of periodontal ligament cells.This paper reviews the different storage media that have been evaluated for avulsed teeth based on full-length research papers retrieved from PubMed/Medline, Lilacs, BBO and SciELO electronic databases using the key words ‘storage medium’, ‘avulsion’, ‘tooth avulsion’, ‘replantation’, ‘tooth replantation’, ‘milk’ and ‘propolis’. Based on the application of inclusion and exclusion criteria, About 14 papers have been selected and critically reviewed with respect to the characteristics, efficacy and ease of access of the storage media. The review of this study shows and includes a wide array of wet storage media that have been evaluated in laboratory-based studies on PDL cells found on adult permanent teeth. Among the natural products other than milk, propolis, coconut water, green tea extract, egg white, green tea extract, Alovera gel, pomegranate juice, salvia officinalis followed by dragon blood sap (Croton Lechleri) were recommended based on the cell viability and its longevity. In an emergency, it is important for dentists to consider the circumstances of the accident, the location and suggest an appropriate transport media.

Background/Purpose: Vertical root fracture (VRF) is a complication in endodontically treated teeth. This study aimed to assess the clinical outcomes of treatment of 6 VRF teeth with intentional replantation and root fragment bonding with 4-methacryloxyethyl trimellitate anhydride/methyl methacrylate-tri-n-butyl borane (4-META/MMA-TBB) resin. Methods: A series of 6 complete VRF teeth (one incisor, one canine, one premolar, and 3 M) were treated through intentional replantation and root fragment bonding with 4-META/MMA-TBB resin. Results: This study included 6 VRF teeth in 6 patients (one man and 5 women; mean age, 44 ± 8 years). All 6 teeth had VRF in the bucco-lingual direction and one tooth had concomitant VRF in the mesio-distal direction. The root thickness was classified as thick in all 6 teeth. Of the 6 VRF teeth, 4 had biting, percussion, or palpation pain, 4 had gingival swelling, 3 had sinus tracts, 3 had discomfort, and one had tooth mobility. Radiographically, 5 of the 6 teeth had periradicular radiolucent lesions, 4 of which exhibited complete regression and one of which exhibited nearly complete regression after root fragment bonding therapy. Because all 6 treated teeth exhibited sound function in the oral cavity after a follow-up period ranging from 33 to 74 (mean, 50 ± 15) months, the clinical outcomes were all considered to be successful. Conclusion: For a VRF tooth, in addition to tooth extraction, intentional replantation combined with root fragment bonding with 4-META/MMA-TBB resin is a successful treatment modality that can be used to preserve a complete VRF tooth. Keywords: 4-methacryloxyethyl trimellitate anhydride/methyl methacrylate-tri-n-butyl borane (4-META/MMA-TBB) resin, Intentional replantation, Root fragment bonding therapy, Vertical root fracture, Clinical outcome

Aim The aim of this article is to report a successful treatment of a complicated crown-root fracture. Background The management of complicated crown-root fracture in young patients is challenging as the fracture line is below the bone crest and the pulp is exposed. Treatment options include crown lengthening, orthodontic extrusion, and intentional replantation. Case description Here, a case of complicated crown-root fracture of tooth number 11 in a ten-year-old boy is presented. Intentional replantation with 180° rotation and slight extrusion and fixation was performed. In addition, root canal therapy was done and tooth was restored with a composite resin after four weeks. The patient was asymptomatic clinically and radiographically after three-year follow-up. Conclusion Intentional replantation with 180° rotation is a valuable treatment for crown root fractures. Clinical significance The management of complicated crown-root fracture using intentional replantation with 180° rotation can help to maintain natural dentition and interdental papilla. How to cite this article Mokhtari S, Hajian S, et al. Complicated Crown-root Fracture Management Using the 180-degree Rotation Method. Int J Clin Pediatr Dent 2019;12(3):247-250.

Replacement of a single tooth in the maxillofacial aesthetic zone is a reliable treatment option. Recession of the mid-buccal mucosa, however, frequently results in a less favourable aesthetic outcome. It is possible that thickening of the buccal mucosa through connective tissue grafting would improve the final result. Therefore, this doctoral research assessed what the effect is of connective tissue grafting on the condition and aesthetics of the peri-implant tissue in single-tooth replacement in the aesthetic zone. In immediately placed and restored implants, the application of a connective tissue graft resulted in somewhat less recession of the mid-buccal mucosa. This effect was not seen in conventionally placed implants in an augmented extraction alveolus. In other words: the application of a connective tissue graft had little effect on the aesthetic result and should not be used as a standard procedure.

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

Resumen: El fracaso endodóntico, distinguido por la persistencia de una lesión inflamatoria peri-radicular en un diente previamente tratado, muestra una prevalencia del 16 a 65% de la población mundial. Ante esto, existen diversas opciones de tratamiento, incluyendo el retratamiento endodóntico no quirúrgico y la microcirugía apical. En algunas ocasiones estas opciones no son viables, surgiendo el reimplante intencional como alternativa a la extracción dentaria. Objetivo: Analizar aspectos clínicos, secuencia de tratamiento, principios técnicos y biológicos y resultados clínicos del reimplante intencional. Conclusión: En casos de enfermedad endodóntica post-tratamiento, donde no es posible el retratamiento convencional y las limitaciones anatómicas impidan realizar la microcirugía apical, el reimplante intencional puede ser considerado como alternativa viable de tratamiento.

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

The aim of this study was to evaluate the effect of platelet-rich fibrin (PRF) placed in delayed replantation of mature extracted teeth. Sixteen intentionally extracted teeth in two mature beagle dogs were selected. In one quadrant of each jaw, the extraction sockets were filled with PRF prior to replantation, and the other quadrant served as control without PRF. All extracted teeth underwent endodontic treatment and dried for 60 min. Thereafter, they were replanted with a flexible splint. After 8 weeks, the animals were euthanised, and the histological sections examined. Less inflammatory root resorption was noted in the PRF group compared to the control (P = 0.031). However, there was no significant difference between the two groups with regard to new bone formation, inflammatory status, connective tissue healing and replacement resorption (P > 0.05). Using PRF in the extracted socket before delayed replantation did not provide any significant benefit other than reduced inflammatory root resorption.

Was to analyze treatment outcomes in children with constant teeth avulsion treated in Central Research Institute of Dentistry and Maxillofacial Surgery (CRIDMS).The study comprised 39 children aged 7-16 years treated in CRIDMS in 2015-2020. In 38 cases from 39 replantation was performed more than 24 hours after trauma. Because of delayed replantation endodontic treatment was needed in 35 cases from 38 (in one case the avulsed tooth was missing). In all 38 cases replantation was followed by splinting with either resin splint made according to original technique proposed by the authors or semi-flexible splints from orthodontic wire fixed with resin composite.In one case from 39 the avulsed tooth was missing because a dentist the child first consulted was unaware of the possibility of replantation. In 38 children followed-up for 6-57 months the replanted teeth survived and were clinically asymptomatic. There were, however, obvious radiological signs of replacement resorption in 27 (71.1%) cases. Inflammatory resorption was detected in two cases (5.2%) with immature teeth undergoing apexification with calcium hydroxide.Replacement root resorption after tooth avulsion may be seen as relatively favorable outcome preserving more bone tissue than early tooth removal. The rate of replacement resorption, however, would be less in less delayed replantation. The study results proved the necessity for additional education of parents and pediatric dentists on the first aid and treatment tactics for teeth avulsion.Проанализировать опыт лечения детей с полными вывихами зубов в Центре детской челюстно-лицевой хирургии и стоматологии ФГБУ НМИЦ ЦНИИС и ЧЛХ.В 2015—2020 гг. наблюдались 39 детей 7—16 лет после полных вывихов постоянных зубов. В 38 случаях из 39 реплантация проводилась не более чем через 24 ч после травмы. В 35 случаях из 38 (исключая случай, в котором зуб был утрачен до обращения в Центр) потребовалось эндодонтическое лечение вывихнутых зубов. Всем 38 детям была выполнена реплантация и шинирование зубов гладкой пластмассовой шиной, изготовленной по оригинальной авторской методике или полужесткой шиной из ортодонтической проволоки и композита.У одного ребенка из 39 зуб был утрачен в результате незнания детского стоматолога по месту жительства о возможности реплантации. У остальных 38 детей, наблюдающихся в центре 6—57 мес, зубы сохранены и клинически бессимптомны. Однако рентгенологически у 27 (71,1%) детей наблюдаются выраженные признаки заместительной резорбции корня. Воспалительная резорбция отмечена еще у 2 (5,2%) детей с несформированными зубами в ходе апексификации с применением гидроксида кальция.Исход с заместительной резорбцией можно считать относительно благоприятным, так как постепенное замещение корня костной тканью создает значительно лучшие условия для дальнейшей имплантации, чем удаление зуба в раннем детском возрасте. Однако при более ранней реплантации процент зубов с заместительной резорбцией мог бы быть значительно ниже. Результаты исследования показывают необходимость получения практикующими детскими стоматологами дополнительных знаний и навыков по действиям в случае острой травмы зубов.

Background/Aim: The survival of an avulsed tooth highly depends on the emergency management. The aim of this study was to evaluate the risk of ankylosis for avulsed human teeth stored in saliva preceded by various dry storage conditions prior to replantation. Material and methods: Data include 74 patients (54 male and 20 female) with 89 avulsed and replanted teeth (16 immature teeth, 73 mature teeth). Patient ages ranged from 6 to 36 years (median: 13.0 years). All teeth were stored in saliva before replantation. Treatment and follow-up were performed according to a standardized procedure. Follow-up periods ranged from 7 months to 20 years (mean 5.3 years). The risk of ankylosis over time was estimated by the Aalen–Johansen method in relation to the length of dry storage and the stage of root development. The effect of risk factors (root development and length of dry time) on the risk of ankylosis was analysed by Cox regression analysis. Results: For mature teeth, dry storage for 5 min or less before saliva storage resulted in a 47.4% (95% confidence interval (CI): 32.8–60.7) ankylosis rate. When dry storage was >5 min and

BACKGROUND/AIM Tooth displacement during avulsion causes total rupture of the pulp's neurovascular supply. Revascularization and pulp healing may occur in immature teeth, which gives rise to the recommendation that root canal treatment may not be required. The aim of this study was to evaluate the prognostic factors for the pulp's response after replantation of young permanent teeth. METHODS Records from 117 patients with 133 replanted permanent immature teeth were reviewed, and pulp outcomes were classified as healing (hard tissue deposition on the dentinal walls followed by narrowing of the pulp lumen or ingrowth of bone-like tissue inside the pulp canal) or non-healing (pulp necrosis with infection). The effect of clinical and demographic co-variates on the hazards of both outcomes was assessed performing a competing risk model. RESULTS Pulp necrosis with infection was diagnosed in 78.2% of the teeth, and healing was observed in 12.8% of the teeth. A total of 12 teeth (9.0%) were censored due to prophylactic removal of the pulp or severe external root resorption caused by eruption of adjacent canines. The cs-Cox model demonstrated that the hazards of pulp healing increased in teeth with extra-alveolar periods

BACKGROUND/AIMS Tooth avulsion is the most severe traumatic tooth injury. Immediate replantation after avulsion provides the highest success rate, whereas delayed replantation with dehydration for >1 h always results in ankylosis, replacement resorption, and eventual tooth loss. The aim of this study was to investigate the geomorphologic change of ultrastructure on tooth root surfaces due to dehydration. MATERIAL AND METHODS Twenty-four sound human premolars and fully developed third molars without periodontitis were selected for the experiment. Roots were separated into 6-7 pieces with an intact root surface area (3 × 3 mm2 ) and then divided into the following groups: fresh group, prolonged dehydration groups (air drying for 1, 2, 4, 12, or 24 h), and dehydrated teeth (air drying for 2 h) treated with acid (Tris-HCl buffer or citric acid buffer). More than six pieces of root from each group were subjected to scanning electron microscopy (SEM) observation. Captured images were exported to ImageJ software to quantitatively analyze the areas covered with fibers. Statistical significance was determined by comparing the means of the different groups using t-testing or one-way analysis of variance followed by post hoc testing. RESULTS Fibrous "vegetation" covering the cementum was observed on the fresh root surface by SEM. This was destroyed by dehydration (>1 h), resulting in a root surface resembling the "Gobi Desert." The difference was statistically significant (p

Introdução: A avulsão dentária caracteriza-se pelo total deslocamento do dente para fora do seu alvéolo representando uma lesão complexa e dramática que pode afetar múltiplos tecidos. Representa uma situação de urgência, e o prognóstico depende de um tratamento rápido e apropriado. Objetivo: Este estudo tem como objetivo avaliar o nível de conhecimento dos alunos do curso de Odontologia do primeiro ano da Universidade Estadual de Maringá (UEM) sobre a avulsão dentária, abordando a forma de atuação clínica e conduta que deve ser adotada frente a esse tipo de traumatismo dentário. Material e método: Elaborou-se um questionário, contendo dados gerais e informações relacionadas a avulsão dentária. O questionário foi aplicado na aula de introdução à Endodontia aos acadêmicos do primeiro ano. As informações obtidas foram tabuladas e analisadas por meio de uma estatística descritiva. Resultados: Os resultados sugerem que o conhecimento sobre o manejo de dentes avulsionados é insuficiente entre os estudantes do primeiro ano de Odontologia. Conclusão: Dessa forma, a educação odontológica deve focar nas orientações sobre primeiros socorros em lesões odontológicas e enfatizar a necessidade de disseminar programas de treinamento e educação para os estudantes de Odontologia.Descritores: Traumatismos Dentários; Avulsão Dentária; Odontologia.ReferênciasAndreasen JO, Andreasen FM. Texto e Atlas colorido de traumatismo dental. 3ª ed. Porto Alegre: Artes Médicas; 2001.Gutmann JL, Gutmann M. Cause, incidence, and prevention of trauma to teeth. Dent Clin North Am. 1995;39:1-13.Andreasen JO, Borum MK, Jacobsen HL, Andreasen FM. Replantation of 400 avulsed permanent incisors. Factors related to periodontal ligament healing. Endod Dent Traumatol. 1995;11:76-89.Chan AWK, Wong TKS, Cheung GSP. Lay knowledge of physical education teachers about the emergency management of dental trauma in Hong Kong. Dent Traumatol 2001;17:77-85.Pohl Y, Filippi A, Kirschner H. Results after replantation of avulsed permanent teeth. II. Periodontal healing and the role of physiologic storage and antiresorptive - regenerative therapy. Dent Traumatol. 2005;21:93-101.Cohenca, N. Knowledge of oral health professionals of treatment of avulsed teeth. Dent Traumatol. 2006;296-30.Malmgren B, Malmgren O. Rate of infraposition of reimplanted ankylosed incisors related to age and growth in children and adolescents. Dent Traumatol.2002; 18:28-36.Flores MT, Andreasen JO, Bakland LK, Feiglin B, Gutmann JL, Oikarinen K et al. International Association of Dental Traumatology. Guidelines for the evaluation and management of traumatic dental injuries. Dent Traumatol. 2001;17:193-8. Ingle JI, Bakland LK, Baumgartner JC. Ingle’s endodontics. 6th ed. Hamilton, ON: B.C. Decker Inc; 2008.Lekic P, Kenny D, Moe HK, Barretti E, McCulloch CA. Relationship of clonogenic capacity to plating efficiency and vital dye staining of human periodontal ligament cells: implications for tooth replantation. J Periodontal Res. 1996;31:294-300.Lekic PC, Kenny DJ, Barrett EJ. The influence of storage conditions on the clonogenic capacity of periodontal ligament cells: implications for tooth replantation. Int Endod J. 1998;31:137-40.Layug ML, Barrett EJ, Kenny DJ. Interim storage of avulsed permanent teeth. J Can Dent Assoc. 1998;64:357-63.Lin DG, Kenny DJ, Barrett EJ, Lekic P, McCulloch CA. Storage conditions of avulsed teeth affect the phenotype of cultured human periodontal ligament cells. J Periodontal Res. 2000;35:42–50.Andreasen JO, Andreasen FM, Andersson L. Textbook and colour atlas of traumatic injuries to the teeth, 4th edn. Oxford: Blackwell Munksgaard; 2007. Andersson L, Bodin I. Avulsed human teeth replanted within 15 minutes – a long term clinical follow-up study. Endod Dent Traumatol. 1990;6:37-42.Courts FJ, Mueller WA, Tabeling HJ. Milk as an interim storage medium for avulsed teeth. Pediatr Dent. 1983;5:183-6.Ashkenazi M, Marouni M, Sarnat H. In vitro viability, mitogenicity and clonogenic capacity of periodontal ligament cells after storage in four media at room temperature. Endod Dent Traumatol. 2000;16:63-70.Hammarström L, Pierce A, Blomlöf L, Feiglin B, Lindskog S. Tooth avulsion and replantation – a review. Endod Dent Traumatol. 1986;2:1-8.Hiltz J, Trope M. Vitality of human lip fibroblasts in milk, hanks balanced salt solution and viaspan storage media. Dent Traumatol. 1991;7:69-72.Blomlöf L. Milk and saliva as possible storage media for traumatically exarticulated teeth prior to replantation. Swed Dent J Suppl. 1981;8:1-26.Huang SC, Remeikis NA, Daniel JC. Effects of long-term exposure of human periodontal ligament cells to milk and other solutions. J Endod. 1996;22:30-3.Khademi AA, Saei S, Mohajeri MR et al. A new storage medium for an avulsed tooth. J Contemp Dent Pract. 2008;9:25-32.Krasner PR. Avulsed teeth: improving the diagnosis. Dent Prod Rep. 2007;2:52-64.Fagade OO. Extra-alveolar storage media for tooth autotransplants and replants. Internet J Dent Sci. 2005;2:1-10.Udoye CI, Jafarzadeh H, Abbott PV. Transport media for avulsed teeth: A review. Aust Endod J. 2012;38:129-136.Blomlöf L, Andersson L, Lindskog S, Hedström KG, Hammarström L. Periodontal healing of replanted monkey teeth prevented from drying. Acta Odontol Scand. 1983;41:117-23.Bibby KJ, McCulloch CA. Regulation of cell volume and [Ca2+ ] in attached human fibroblasts responding to anisosmotic buffers. Am J Physiol. 1994;266:39-49Gopikrishna V, Baweja PS, Venkateshbabu N, Thomas T, Kandaswamy D. Comparison of coconut water, propolis, HBSS, and milk on PDL cell survival. J Endod. 2008;34:587-589.Gopikrishna V, Thomas T, Kandaswamy D. A quantitative analysis of coconut water: a new storage media for avulsed teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;105:61-65.Moreira-Neto JJS, Gondim JO, Raddi MSG, Pansani CA. Viability of human fibroblasts in coconut water as storage medium. Intern Endod J. 2009;42:827-830.Thomas T, Gopikrishna V, Kandaswamy D. Comparative evaluation of maintenance of cell viability of an experimental transport media “coconut water” with Hank’s balanced salt solution and milk, for transportation of an avulsed tooth: an in vitro cell culture study. J Conserv Dent. 2008;11:22-29.Souza BDM, Luckemeyer DD, Reyes-Carmona JF, Felippe WT, Simões CMO, Felippe MCS. Viability of human periodontal ligament fibroblasts in milk, Hank’s balanced salt solution and coconut water as storage media. 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Introduction Intentional replantation (IR) may offer a solution for persistent periapical lesions associated with endodontically treated teeth in select cases. This case series demonstrates the use of IR as an alternative treatment approach to both orthograde and surgical endodontic retreatment. The indications, contraindications, benefits and risks of IR are discussed, and the clinical procedure is outlined.Setting Restorative Department, University Dental Hospital of Manchester, UK.Case reports Of the 13 cases presented, the follow-up period before discharge ranged from 3-28 months. Only one tooth which presented intra-operative challenges required extraction three months after IR due to post-operative mobility.Conclusion In select cases, IR may provide a simple, less invasive and cost-effective alternative to both endodontic retreatment and extraction alone following appropriate training.

Objective: to investigate the knowledge and attitudes of general dental practitioners GDPs) on the Emergency management of avulsed teeth. The management of the avulsed teeth is well outlined in The latest trauma guideline. However, little information is available about the level of knowledge of The management of avulsed teeth among young dentists in Turkey. Material and Methods: A cross-sectional questionnaire was completed to assess the knowledge of GDPs on the emergency manage-ment of avulsed teeth. The questionnaire asked questions to 142 dental practitioners about wheth-er they have received information about the emergency management of dental trauma, whether they have intervened in cases of avulsed teeth following a dental trauma, and, finally, whether they have Given treatment of avulsed teeth. Results: The majority of GDPs had received training to treat avulsed teeth. he findings of the study showed that only 35% of GDPs recalled the critical time for treatment. The number of GDPs who had incorrect knowledge on this topic was higher and statistically signifi-cant (p < 0.001). The rates of the correct answers according to the relevant information fields were as follows: optimal storage medium (78%), type of splint (56%), splinting period (58.5%), and systemic medication after avulsion (32%).Conclusion: The results show that many GDPs had limited experi-ence in treating avulsed teeth. However, in the study, it was stressed that the knowledge of GDPs re-lated to the factors affecting the successful treatment of avulsion cases should be improved by using continuing education programs.

BACKGROUND/AIM: It is crucial to store an avulsed tooth appropriately to preserve the viability of the periodontal ligament cells prior to replantation. The aim of this systematic review was to identify the best available evidence for the effectiveness of any technique available to laypeople for storing an avulsed tooth compared with storage in milk or saliva. METHODS: The following databases were searched (September 2019): Cochrane Library, MEDLINE, and Embase. Two reviewers independently considered trial eligibility, then extracted and analyzed data, and assessed the risk of bias. The certainty of the body of evidence was appraised according to the GRADE methodology. RESULTS: Out of 4118 references, 33 studies were included and reported 23 comparisons of which 10 were synthesized in a meta-analysis. The limited evidence available favors storing an avulsed tooth in Hank's balanced salt solution (pooled SMD 2.47, 95% CI [1.59;3.34], P