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The etiology of surface and inflammatory root resorption after the replantation of incisors was examined in green vervet monkeys. The teeth were examined histologically and histobacteriologically for pulpal healing and root resorption 2 and 8 weeks after replantation. In contrast to surface resorption, inflammatory resorption was related to infected necrotic tissue or an infected leukocyte zone in the root canal. The following theory for surface and inflammatory resorption is presented. Damaged periodontal ligament areas and damaged parts of the root surface are attacked by a resorption process whereby resorption of cementum and dentin may occur. Inflammatory resorption or surface resorption will then occur depending on the pulpal status and the depth of the resorption cavity. If the resorption cavity penetrates the intermediate layer of cementum and contacts dentinal tubules that are in communication with infected necrotic pulp tissue or an infected leukocyte zone, then inflammatory resorption will take place as a result of the diffusion of toxic elements from the pulp canal to the resorption cavity. However, if the resorption cavity is shallow and does not penetrate the intermediate layer of cementum, a tooth that displays similar pulpal changes will elicit only surface resorption because the intermediate layer of cementum will tend to arrest the diffusion of toxic elements. Finally, if the pulp contains vital, inflamed, or noninflamed tissue or if root canal treatment has been performed, surface resorption will occur regardless of the depth of the cavity., (Copyright © 1981 American Association of Endodontists. Published by Elsevier Inc. Published by Elsevier Inc. All rights reserved.)

Background and Objectives: There is still considerable controversy regarding the possibility of submitting replanted teeth to orthodontic movement (OM). The purpose of the present study was to evaluate the tissue response after orthodontic movement on replanted teeth. Materials and Methods: Sixty Wistar rats were randomly assigned to four groups ( n = 15): G1, replantation without OM after 30 days; G2, replantation with OM after 30 days; G3, replantation without OM after 60 days, and G4, replantation with OM after 60 days. The maxillary left central incisors were extracted and the teeth were stored in milk media. After 30 min, the teeth were replanted and fixed with non-rigid immobilization. All specimens were observed after 30 and 60 days of replantation and then subdivided into two subgroups (with OM or without OM). The animals were euthanized after seven days of the OM started, and the maxillary bone blocks were processed for histological evaluation. Results: The histological results showed periodontal ligament repair in both periods studied without OM; however, ankylosis and root resorption was seen in all orthodontically moved teeth. Conclusions: The orthodontic movement did not favor tissue response in all replanted teeth, regardless of the experimental periods.

Background/aim: In addition to their anti-inflammatory and anti-osteoclastogenesis properties, adrenergic blockers may also have promising anti-resorptive effects that can prevent root resorption when teeth are replanted because of avulsion. The aim of this study was to investigate the effects of phentolamine (Ph) and propranolol (Pr) in gels on the repair process of late replanted rat incisors. A further aim was to evaluate the biocompatibility of both drugs to human periodontal ligament fibroblasts (HPDLFs)., Materials and Methods: Forty-eight maxillary right incisors were extracted from male Wistar rats, stored in paper napkins for 60 minutes, and randomly allocated to one of eight groups (n = 6). The root canal, root surface, and alveolus were treated with 0.75 µg/mL Ph gel (Ph0.75), 10 µg/mL Ph gel (Ph10), 100 µg/mL Ph gel (Ph100), 2.5 µg/mL Pr gel (Pr2.5), 10 µg/mL Pr gel (Pr10), 100 µg/mL Pr gel (Pr100), or sodium carboxymethylcellulose gel (CMC) before replantation. In the control group (CH), only the root canal was treated with calcium hydroxide paste. Thirty days following surgery, the animals were euthanized, and the right hemimaxilla was removed to perform micro-CT and histomorphometric analysis to determine osteoclastic activity. Ethanolic solutions of Ph10 and Pr10 were selected based on the in vivo study, and the viability of HPDLFs stimulated with lipopolysaccharide was determined by MTT assays., Results: The micro-CT and histomorphometric analysis revealed no significant differences among the treatments (P > .05). The presence of active osteoclasts was significantly decreased in the Ph10 and Pr10 groups (P < .05). Ph10 and Pr10 produced statistically similar cell survival rates compared to the control group (P > .05)., Conclusions: Ph10 and Pr10 significantly decreased osteoclastogenesis in delayed replanted rat teeth and were not cytotoxic toward HPDLFs., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Replantation of avulsed teeth is an invasive treatment approach where patient cooperation is required after the risks are explained to the patient or family. Although replantation of an avulsed permanent teeth is an accepted treatment approach, the long-term prognosis of the replanted teeth is still controversial. This report describes the survival of delayed replanted 15 incisors that was stored in unfavorable conditions after avulsion., Materials and Methods: Nine patients, aged 8-12 years, were referred to the Inonu University, Pediatric Dentistry Department with traumatically avulsed incisors. The parents were informed about the possible complications of a delayed replantation., Results: Forty percent of the teeth were splinted with flexible orthodontic wire and composite. The follow-up periods were varied from 24 to 48 months. The mean follow-up periods were 33.3 ± 8 months. 40% of the teeth were retained in the mouth for at least 3 years and contributed to alveolar bone development. In these cases, the most common complication (9 teeth, 60%) was replacement root resorption. Two of the 15 teeth which had wide open apices, continued to the root development., Conclusion: In this study, replanted teeth were retained in the mouth for at least 2 years and contributed to the patient's development. Therefore, this study has shown that delayed replantation of an avulsed tooth for a child is still worthwhile, even in cases of poor prognosis where the tooth had extended extra-alveolar dry storage. We believe that delayed replantation should be done because of its importance for the child's jaw and facial development., Competing Interests: None

The palatogingival groove is a developmental anomaly that typically starts near the cingulum of the maxillary incisors and extends along the roots at varying lengths and depths. Severe grooves that extend to the root apex often lead to complex combined periodontal-endodontic lesions. There are various therapeutic options available for these cases; however, the prognosis is unfavorable. Here, we report the successful surgical treatment of 3 cases of maxillary lateral incisors with severe palatogingival grooves using intentional replantation with a 2-segment restoration method. The teeth were gently extracted, resulting in minimal damage to the periodontal ligament. Under a dental operating microscope, 3 mm of the root end was resected. The palatogingival groove was removed, and root-end preparation was performed with a #700 fissure bur. The groove cavity was connected with root-end cavity to form a class II cavity. The cavity was then filled using a 2-segment restoration method (ie, dividing the cavity into 2 parts by the cementoenamel junction, the coronal portion was filled with a flowable composite while the radicular portion, including the root-end cavity, was filled with bioceramics). The tooth was then replanted into its alveolar bone and splinted with a flexible splint for 7 days. The sinus tract was closed at the 1-week postoperative visit. During subsequent recalls, the teeth showed almost complete periapical healing. In summary, intentional replantation with a 2-segment restoration method is a viable treatment modality for single-rooted teeth with a severe palatogingival groove that extends to the root apex., (Copyright © 2019 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Replantation of avulsed incisors in young children is a successful treatment modality. Almost all replanted teeth exhibit ankylosis followed by inflammatory or replacement resorption, as immediate replantation is practically rare. The purpose of the review is to report a series of cases of prolonged delay in replantation of avulsed incisors and discuss its sequelae, leading to different patterns of root resorption after a minimum follow-up period of 24 months. The present case series is a follow-up of five cases of delayed replantation (more than 24 h delay) without any root surface treatment. Extraoral endodontic therapy was performed before replantation. The avulsed teeth were stabilized using an acid-etch composite resin splint for 4 weeks. The patients were followed up at 3, 6, and 12 months interval and half-yearly thereafter, for examination of the replanted teeth clinically and radiographically. After 24-month follow-up, the replanted teeth were evaluated for gingival changes and clinical mobility. The radiographs were evaluated for external root resorption or inflammatory resorption, osseous root replacement, or replacement resorption. The case series concludes that avulsed teeth transported in dry as well as dessicated conditions and replanted after a delay of 24 h have a survival rate of more than 24 months, though there is no promising long-term prognosis. The sequelae in most of the cases are surface resorption followed by inflammatory resorption or resorption due to pulpal infection or replacement resorption., Competing Interests: There are no conflicts of interest

Background/aim: Dental avulsion damages periodontal tissues and may induce dentoalveolar ankylosis and root resorption after replantation. The aim of this work was to evaluate the effects of light-emitting diode (LED) therapy after tooth replantation., Material and Methods: The upper right incisors of 36 male Wistar rats were extracted and replanted after 15 min. The control group (Co, n = 18) was submitted to replantation and the LED group (n = 18) was submitted to replantation and LED therapy (940 nm, 4 J cm -2 ) for three consecutive days (0, 24, and 48 h). Six animals from each group were euthanized at 7, 14, and 21 days for histological analysis. The upper left incisors were used as a negative control. Data were compared using the Fisher exact test, considering P < 0.05., Results: After 7 days, the Co (73.3%) and LED (72.2%) groups presented areas of periodontal ligament necrosis. However, periodontal ligament necrosis was more frequent in the LED group at 14 (70%, P < 0.05) and 21 days (43.2%, P < 0.05) in relation to the Co group (33 and 21.6%). Inflammatory cell infiltration was more frequent in the Co group at 7 days (100%) than the LED group (24.4%, P < 0.05), but increased in the LED group after 21 days (83.3%, P < 0.05). Bone necrosis was more frequent in the LED group after 14 (79%, P < 0.05) and 21 days (60%, P < 0.005) than in the Co group (45% and 20%). Bone repair was evident in the Co group at 14 days. All of the replanted teeth had pulp necrosis., Conclusion: The results suggest that the application of LED therapy up to 48 h after tooth replantation may delay periodontal ligament repair., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

This case report describes the importance of continual examination for dental trauma and the efficacy of intentional replantation with retrograde root canal filling for a transverse root fracture in an immature incisor accompanied by subsequent periodontal-endodontic disease. In the treatment of traumatically fractured roots in immature incisors, continual examination is indispensable for the final diagnosis because roots in immature teeth are less calcified, resulting in less detailed radiological examinations. Thus, common dental trauma complications such as pulp necrosis may appear months after the initial examination. Endodontic treatment for transverse root fracture is mainly determined according to radiographic examination findings; for fractured immature roots, apexification with calcium hydroxide of the coronal fragment is generally applied. However, this method requires removal of considerable amounts of enamel and dentin to allow access to the cavity for preparation, which may increase the risk of future fractures. In contrast, intentional replantation with retrograde root canal filling does not require the removal or long-term application of calcium hydroxide. However, it requires careful extraction of the tooth, maintenance of root wetness during the extraoral procedure, rigid splinting, and oral hygiene control. Management of tooth mobility is also important in the post-replantation course.

Severely impacted and dilacerated incisors are rarely considered for surgical exposure because they may not respond favorably to orthodontic extrusion. These incisors are often extracted, resulting in the need for tooth replacement; however, prosthetic solutions are limited in growing patients. Transalveolar autotransplantation of an impacted incisor may be the only method to preserve the natural tooth and maintain the shape of the alveolus. The severely impacted upper central incisor (#9) with a developing root was diagnosed in a 9-year-old girl. The unfavorable tooth position and dilaceration of its root made orthodontic extrusion of the impacted incisor impossible. Initial orthodontic space opening at the recipient site was performed before the surgery. Transalveolar transplantation of the impacted incisor to its normal position was performed to avoid tooth extraction. The incisor was later aligned using fixed orthodontic appliances. At the 5-year follow-up, the transplanted incisor presented features that were typical of a revascularized tooth (ie, obliteration of root canal but a positive response to vitality tests). Healthy periodontal tissues and continued root development were also noted. However, the root apex, which separated from the transplant at the time of the surgery, continued formation in its initial position. Transalveolar transplantation of an unfavorably impacted upper central incisor with a dilacerated root is a successful treatment, which stands the test of time. The early stage of root development allowed revascularization of the tooth despite dilaceration of the root and detachment of its apex., (Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Background: Traumatic tooth avulsions occur most often in 7 to 9 year-old children. Replantation is considered the treatment of choice and follow-up is required in order to prevent possible complications., Case Report: A case of replantation of a maxillary immature incisor in a 9.2-year-old male is reported. Tooth 21 was stored in saliva, in the child's mouth, and it was replanted within 45 min following a bicycle accident. A flexible splint was applied from tooth 11 to tooth 63, and it was removed after 4 weeks. Pulp canal obliteration was diagnosed at the 6 months check-up visit. Pulp sensibility was positive after 3 months and absent after 5 years. During the follow-up the tooth completed its development and always presented a physiological mobility and a probing depth <3 mm. Only a minimal discoloration of the crown was observed., Conclusion: The knowledge of emergency care at the scene of dental trauma is resolutory for treatment outcome.

The treatment plan represents the final step in every diagnostic procedure and is the result of a series of assessments based on information gathered from a detailed clinical history. This clinical case reports the replacement of two central incisors that were lost because of a trauma. The advantages and disadvantages of the two treatment options (i.e. implantology or prosthetic restoration) were carefully evaluated in relation to the case in hand. Patient compliance and aesthetic requirements had been also considered. In this case, a conventional prosthetic restoration was performed using a metal-ceramic bridge, utilising full crowns between the right and left maxillary lateral incisors associated with minimal canine preparation. By this strategy, the treatment plan allows for a future implant restoration, should this become necessary., (© 2011 John Wiley & Sons A/S.)

Crown-root fracture is one of the most challenging fracture types in dental traumatology literature. Aesthetic and functional rehabilitation is the primary goal of the treatment of crown-root-fractured tooth. For this purpose, reattachment of the fragment to its original position is a good choice. This paper reports a case of an adhesive fragment reattachment of a complicated crown-root fracture with intentional replantation in a 9-year-old girl patient and 36-month follow-up., (© 2012 John Wiley & Sons A/S.)

It is possible to replant an incisor tooth completely avulsed after trauma in adults. These cases are relatively frequent among athletes. It is essential to conserve the tooth in saline solution. The time before replantation must be as short as possible. The simple technique described here, which requires a minimum of material and no dental chair, makes it possible to replant an avulsed incisor with a good success rate.

Early loss of immature permanent teeth due to pulpal necrosis secondary to trauma can have dire consequences for a child's growth and development. The treatment alternatives include surgical endodontics, traditional calcium hydroxide apexification, and mineral trioxide aggregate (MTA) apexification. These options pose potential complications, including: arrest of root development; weakened dentinal walls; and increased potential for fracture. Revascularization of the dentin-pulp complex is a new approach that involves disinfecting the root canal system followed by tissue repair and regeneration while allowing for continued root development and thickening of the lateral dentinal walls through deposition of new hard tissue. The purpose of this report was to present the revascularization of an immature permanent maxillary central incisor that had evidence of external root resorption. Six months later, internal bleaching was performed to remove cervical discoloration from the triple antibiotic paste. At 18 months, the tooth remained vital and had evidence of continued root development.

A history of traumatic dental injury to the maxillary central incisors during preadolescence or adolescence is common and may result in premature loss. Treatment options include prosthetic implant replacement, autotransplantation, and orthodontic space closure with direct composite recontouring. This case report describes the treatment of an adolescent girl who presented with a crowded Class I malocclusion complicated by a history of trauma to the maxillary central incisors. The treatment plan consisted of orthodontic space closure following loss of both maxillary central incisors and mandibular premolars. This case highlights that orthodontic space closure can be a valuable treatment option in selected Class I crowded and Class II uncrowded malocclusions, producing predictable and efficient results.

The splinting of traumatised teeth can be difficult in the emergency department where access to dentally trained clinicians and equipment may be limited. We report the use of a readily available medical tissue adhesive (n-butyl 2-cyanoacrylate) as a material for temporary dental splinting, and discuss its suitability for the task., (Copyright © 2010 British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: Avulsion or exarticulation accounts for up to 16% of all traumatic injuries. It is most common in age group of 7 to 14 years. Following the loss of anterior teeth, the replacement is necessary to maintain esthetics, phonetics and avoid arch length discrepancy. Following replantation, postoperative care and management is done in several ways., Case Report: This article reports replantation and use of laser for endodontic sterilization and healing in a 12-year-old boy., Conclusion: It is suggested that replantation of an avulsed tooth as soon as possible using appropriate splint and regular followup will show good prognosis., Clinical Significance: Laser offers itself as a good alternative to Ca(OH)₂ for root canal sterilization and improved periapical healing.

Lateral luxation is the displacement of the tooth in a direction other than axial, which is accompanied by comminution or fracture of the alveolar socket. Lateral luxation is one of the most prevalent dental injuries among the general population, resulting in up to 27% of all dental wounds. All physical activities have an associated risk of orofacial injuries due to falls, collisions, and contact with hard surfaces. Just like any other training activities, military training exercises present a significant risk of dental traumas, which comprise 2% to 8% of all military dental emergencies. The aim of this report was to present a case of a dental lateral luxation caused by the hit of a rifle stock during close combat training. The tooth was extruded from its bony lock, temporarily filled with a calcium hydroxide-based paste, replaced into its original anatomic position, and secured with Ivy loop wirings. The permanent endodontic treatment was performed 4 weeks after repositioning. At the end of the 8-months follow-up, the tooth was asymptomatic and any pathological alterations were absent.

We report a case of multiple dental traumas in a 15-year-old school boy who was hit by a stone. Clinical examinations revealed the avulsion of teeth 21, 22, and 23, an uncomplicated crown fracture of tooth 41, and a complicated crown fracture (CCF) of teeth 11, 31, and 33. An alveolar bone fracture and a root fracture in the apical third of tooth 23 were as well noted on radiographs. The avulsed teeth were replanted and rigidly splinted after an extraoral dry time of 90 min. Endodontic treatments were performed on teeth with CCFs. The dental morphology was restored using polyethylene fiber-reinforced composite resin. Endodontic obturations were performed on replanted teeth after the arrest of external root resorptions by a long-term calcium hydroxide dressing. Esthetics and function were recovered with a 2.5-year follow-up period., (© 2011 John Wiley & Sons A/S.)

A case of an avulsed upper left central incisor that was replanted after 3 h in a 7-year-old girl is presented. The tooth showed signs of an acute periapical abscess at 2 weeks after replantation. Apexification with mineral trioxide aggregate (MTA) following application of calcium hydroxide was attempted. At 3-year and 6-month follow-up, the tooth was asymptomatic with adequate clinical function. The radiograph showed resolution of the periapical lesion and apparent radiopaque tissue under MTA plug resembling root end morphology., (© 2010 John Wiley & Sons A/S.)

Objective: The purpose of this study was to evaluate the pulpal changes associated with autogenous single-rooted immature tooth transplantation in dogs, using either one, or two-stage surgical techniques., Methods: Teeth from 3 beagle dogs, 5 months old, were extracted and transplanted to mechanically prepared recipient sockets. Group (A), where the teeth were transplanted using a one-stage method to recipient beds prepared immediately before transplantation. Group (B), where the teeth were transplanted using a two-stage method in which the recipient beds were prepared and left to heal for 7 days before transplantation. Clinical examinations were done every week during 9 weeks. After 9 weeks, the animals were injected with ⁹⁹(m)Technetium hydroxylmethylene diphosphonate (⁹⁹(m)Tc-HMDP) and 3h after injection, a whole body scintigraphic acquisition was performed. After scintigraphic acquisition the animals were euthanized and the teeth extracted and its radioactivity counted in a well counter calibrated to ⁹⁹(m)Tc. With the data obtained, the percentage of activity injected was calculated for each tooth. The data for each group of teeth were evaluated and analyzed using the Mann-Whitney test (p=0.05)., Results: All the transplanted teeth in both groups survived. No statistically significant difference was found in the absorption of the ⁹⁹(m)Tc-HMDP, between the treatment groups (p=0.464) and between them and the control group (Group A vs. control p=0.713 and Group B vs. control p=0.157)., Conclusions: This study demonstrated that there was no difference between the two surgical techniques in terms of the pulp revascularization in transplanted teeth., (Published by Elsevier Ltd.)

Crown-root fractures are complex traumatic injuries that require multidisciplinary management and afford uncertain prognosis. The purpose of this clinical article was to report the case of crown-root fracture where a multidisciplinary approach was successfully executed. A 10-year-old male patient who suffered a complicated crown-root fracture on a permanent maxillary central incisor was treated using an intentional 180°-rotation replantation technique, followed by endodontic therapy and restoration with resin composite. Two years after the initial treatment, the case was stable and the tooth was restored with a resin core and a ceramic crown. This article describes how adequate multidisciplinary treatment planning, coordination, and execution are necessary for similar cases to be properly managed. It can be concluded that the intentional replantation with 180°-rotation allowed a more conservative approach, showing, in this case, a clinical success without resorption.

Herein, we describe orthodontic management for an adolescent girl with traumatic loss of the upper central incisors and maxillary protrusion. The central incisors were immediately replaced and fixed with application of a semi-rigid splint for 12 days, then endodontically treated. Severe root resorption and degeneration of periodontal tissue were noted after 4 years and the teeth were extracted, while the patient had also developed maxillary protrusion with severe crowding in the lower arch. The treatment objectives were to close the spaces by mesial movement of the buccal segment in the upper arch and eliminate crowding by extraction of the lower bicuspids. Favorable occlusion was achieved as was substitution with the lateral incisors for the lost central teeth.

This report presents the case of a 20-year-old female patient exhibiting an infraoccluded ankylosed maxillary central incisor that was avulsed and replanted after traumatic injury during childhood. To reposition the osseous and gingival margins of the ankylosed tooth to an ideal level, a new alveolar distraction device that uses anchoring miniscrews with a single tooth dento-osseous osteotomy was fabricated and the ankylosed tooth was successfully treated with exceptional patient compliance.

A 12 year-old girl presented with an avulsed maxillary central incisor for a trauma occurred two days earlier. The avulsed tooth was endodontically treated and replanted. Regardless of the ankylosis and replacement root resorption the tooth was retained for a very favourable nine-year period after trauma. In addition no severe infraposition occurred. When the extraction was necessary, despite the slight atrophy, as a result of compromised alveolar bone development due to ankylosis, an implant-supported crown was placed as definitive rehabilitation without recourse to bone augmentation procedures. In conclusion, delayed replantation in children will require long-term therapeutic commitment. In favourable cases, tooth with delayed replantation might be retained for a very long time thus avoiding the bone atrophy that would have accompanied early tooth loss and, consequently, reducing grafting requirements when a definitive implant-supported restoration will be required.

This case report describes the continued root formation following replantation and conventional root canal therapy of a traumatically avulsed open-apex tooth with suppurative apical periodontitis. A 7-year-old male patient had an avulsed upper left central incisor (tooth 21) replanted approximately 50 min after traumatic avulsion. A root canal procedure was initiated due to pulp necrosis and periapical abscess detected in the follow-up period. After endodontic treatment with calcium hydroxide (Ca(OH)(2)) dressing, a normal root length developed including an apical segment beyond the hard tissue barrier. Regeneration of the root occurred without pathology or ankylosis at 1-year of follow up.

Objective: To investigate the time lapse prior to provision of emergency dental care and appropriateness of earliest treatment provided for children with dental trauma., Design: A multi-regional prospective and cross-sectional survey., Setting: Paediatric dental departments of Liverpool, Manchester and Sheffield., Subjects: One hundred and fifty referred or emergency paediatric patients with trauma to the permanent incisors., Results: One hundred and fifty subjects were recruited. Mean age of the subjects was 11.1 years (SD = 2.6; range = 6.2-16.6); 100 were male and 50 were female. The mean time interval from injury until initial presentation to a health care professional was 22.6 hours (SD = 76.1; range = 0-672). Thirty-six percent of children (n = 54) first presented to a general dental practitioner whilst 30% (n = 45) presented to accident and emergency medical staff. Following initial assessment, a further mean time lapse of 8.1 hours (SD = 43.7; range = 0-504) was incurred in 25% of cases prior to dental referral. In 39% of subjects (n = 58/150), treatment was considered inappropriate. The most frequent example of inadequate management was failure to protect exposed dentine, which was found for 71% (n = 24/34) of complicated crown fractures and 40% (n = 25/62) of uncomplicated crown fractures., Conclusion: This study identified marked delays in the management of some paediatric dental trauma to permanent incisor teeth which, in itself, could be suboptimal. Greater educational and clinical support would seem to be warranted in this area of service provision.

Objective: Although the general mechanisms of dentinogenesis are understood, several aspects regarding tertiary dentine formation still deserve investigation, especially regarding the presence and distribution of some noncollagenous matrix proteins. As dentine matrix protein 1 (DMP 1) is present in primary dentine, it is possible that this protein may also be present in the dentine matrix secreted after injury, but there are no immunocytochemical studies attempting its detection in tertiary dentine. The aim of this study was to examine the ultrastructural immunolocalization of DMP 1 in the tertiary dentine after extrusion of the rat incisor., Study Design: Upper incisors were extruded 3mm and then repositioned into their sockets. After several periods, the incisors were fixed and processed for transmission electron microscopy and for immunocytochemistry for DMP 1., Results: Extrusion yielded both types of tertiary dentine, which varied in aspect and related cells. DMP 1 was found in the mineralized matrix of all types of dentine, presenting high affinity for collagen, but rare colloidal gold particles over predentine. DMP 1 was evident in the supranuclear region and inside the nucleus of some odontoblast-like cells., Conclusion: The observed association between DMP 1 and collagen seem to be essential for reactionary and reparative dentine formation., (Copyright 2010 Elsevier Ltd. All rights reserved.)

Introduction: After a traumatic injury to the upper central incisors of a 7-year-old patient, avulsion of tooth #9 and pulp exposure after crown fracture of tooth #8 were managed., Methods: After immediate replacement of tooth #9 in its socket, teeth were splinted for 3 weeks. No endodontic treatment was performed on tooth #9, but pulp capping was performed with mineral trioxide aggregate (Pro Root MTA; Dentsply Maillefer, Ballaigues, Switzerland) on #8, and both teeth were restored with composite resin. The teeth were monitored every 3 months for 2 years., Results: At 24 months, both teeth responded positively to electrometric tests and roots showed normal development, but an abnormal reduction in the size of the root canal space of tooth#8 was observed., Conclusion: Based on these observations, we discuss odontoblast behavior in the context of the stage of dentinogenesis and the probable disturbance of regulation of the physiologic dentinogenic secretory processes in the pathologic situation., (Copyright 2010 American Association of Endodontists. All rights reserved.)

Background: The aim of this study was to examine factors associated with avulsion injury and to specify the association between these factors and the treatment, as well as the outcomes of avulsed permanent incisors in children., Materials and Methods: The sample consisted of 51 children with 62 avulsed permanent incisors, whose injuries had been managed in the period 1998-2006. The study was prospective, recording the history of the accident, concomitant injuries, age, gender, apical maturity of the root, replantation rate, storage media, extra-alveolar duration, endodontic treatment, compliance and recall appointments response. Factors were analysed in relation to postoperative outcomes, classified as functional healing (FH), infection-related (inflammatory) resorption (IRR) and replacement resorption (RR)., Results: The average age of patients was 10.7 years (range 7-19). In 16/51 patients, tooth avulsion was caused by a road traffic accident. Avulsion was accompanied by concomitant injuries in all cases. Thirty of 62 avulsed teeth were not replanted and 32 incisors were replanted after dry storage. Time until replantation ranged between 15 min and 9 h (median 60 min). The observation period ranged from 1 to 6 years (median 2 years). FH was observed in 5/32, IRR in 20/32 and RR in 7/32 incisors. Ten teeth were extracted during 5-years of observation. Immature incisors exhibited significantly more complications compared with mature teeth (P = 0.04). Storage media and extra-alveolar duration did not significantly affect the survival of replanted teeth (P = 0.253, P = 0.350). Teeth in which endodontic treatment was in temporary phase exhibited significantly more complications in comparison with teeth with completed endodontic treatment (P = 0.0l6)., Conclusion: The combination of delayed replantation and unphysiological storage is followed by low survival. Incisors with open apices exhibited lower survival compared with incisors with closed apices. Replanted incisors that required prolonged treatment with calcium hydroxide exhibited more complications compared with incisors with completed root canal treatment.

Teeth with traumatic crown-root fractures extending subgingivally and involving the entire width of the tooth may have problems in endodontic isolation, periodontal maintenance, and restoration. A number of techniques, such as crown lengthening, and orthodontic or surgical extrusion, have been described for treatment of crown-root fractures. However, all of these techniques have limitations in terms of the extended time required for treatment, cost, and esthetic considerations. Intra-alveolar transplantation is an alternative treatment option in the management of complicated crown-root fractures. We describe a case of intra-alveolar transplantation with 180( degrees ) rotation and suture fixation. At 1-year follow-up, the replanted tooth has normal function and no obvious inflammatory root resorption on radiographic examination., (Copyright (c) 2010 Mosby, Inc. All rights reserved.)

Intrusion is defined as the axial dislodgment of the tooth into its socket and is considered one of the most severe types of dental trauma. This longitudinal outcome study was undertaken to evaluate clinically and radiographically severely intruded permanent incisors in a population of children and adolescents. All cases were treated between September 2003 and February 2008 in a dental trauma service. Clinical and radiographic data were collected from 12 patients (eight males and four females) that represented 15 permanent maxillary incisors. Mean age at the time of injury was 8 years and 9 months (range 7-14 years and 8 months). Mean time elapsed to follow-up was 26.6 months (range 10-51 months). The analysis of data showed that tooth intrusion was twice as frequent in males. The maxillary central incisors were the most commonly intruded teeth (93.3%), and falling at home was the main etiologic factor (60%). More than half of the cases (53.3%) were multiple intrusions, 73.3% of the intruded teeth had incomplete root formation and 66.6% of the teeth suffered other injuries concomitant to intrusion. Immediate surgical repositioning was the treatment of choice in 66.7% of the cases, while watchful waiting for the tooth to return to its pre-injury position was adopted in 33.3% of the cases. The teeth that suffered additional injuries to the intrusive luxation presented a fivefold increased relative risk of developing pulp necrosis. The immature teeth had six times more chances of presenting pulp canal obliteration that the mature teeth and a lower risk of developing root resorption. The most frequent post-injury complications were pulp necrosis (73.3%), marginal bone loss (60%), inflammatory root resorption (40%), pulp canal obliteration (26.7%) and replacement root resorption (20%). From the results of this study, it was not possible to determine whether the type immediate treatment had any influence on the appearance of sequelae like pulp necrosis and root resorption after intrusive luxation, but the existence of additional injuries and the stage of root development influenced the clinical case outcome in a negative and positive manner, respectively.

We developed a new regenerative treatment of tooth and periodontal defect and tooth dislocation associated with posttraumatic alveolar bone crush fracture in the region of the maxillary anterior teeth. Using this method, dislocated teeth are first extracted and crushed alveolar bone is debrided. The dislocated teeth are then reimplanted, and cancellous iliac bone (bone marrow) is grafted to the area surrounding the teeth to regenerate periodontal bone. Tooth reimplantation was completely successful in 2 cases, and periodontal bone regenerated to a sufficient height with the iliac bone graft. Compared with the general method of treatment with a prosthesis (bridge), when using this method to treat cases such as these, there is no sacrifice of healthy teeth adjacent to the defect, and sufficient esthetic and functional recovery is possible. It is thought that this method could be applied as a new treatment of alveolar bone fracture in the future.

Background: Continued development and healing of an immature permanent tooth root was reported to have occurred. The continued viability of Hertwig's root sheath was thought to be necessary and responsible. Continued development of a tooth root separate from the body of the tooth was reported, but the initiation and development associated with a replanted tooth was not observed., Methods: A 9-year-old boy sustained an avulsion injury to his upper right lateral incisor. The tooth was replanted within 5-10 minutes of the incident and was splinted approximately 30 minutes after the injury, and then monitored for 2.25 years., Results: The periodontal tissues healed well. Root development was arrested with calcific deposit evident in the pulp canal. A radio-opaque structure, apical to the tooth root, was seen to develop on the radiograph 11 weeks after the initial trauma. The opaque mass continued to develop over the next two years of observation., Conclusions: Immature permanent tooth roots show remarkable reparative powers. Clinicians need to be vigilant and close continued monitoring of traumatized immature teeth is recommended.

This case report refers to an 11-year-old boy with avulsion of the upper left central and lateral incisors. The teeth were replanted after 4 h, splinted with a semi-rigid splint for 12 days, and then endodontically treated. Severe progressive root resorption was seen after 2 years and the teeth were extracted. The boy had a normal occlusion with spacing in both jaws and slight protrusion of the anterior teeth. The treatment objectives were to close some of the spaces by mesial movement of the buccal segments in the upper jaw to minimize bone loss for a future single osseointegrated implant. Fixed appliance in combination with a removable plate was used for the mesial movements, levelling, and alignment of the upper jaw. Fixed appliance in the lower jaw and Class II traction were used for the final adjustment of the occlusion. A good occlusion with coincident upper and lower midlines and up-righted anterior teeth were achieved. A Maryland bridge was performed as a temporary solution for a future osseointegrated implant.

Dental avulsion is a common and complex injury which affects multiple oral tissues. In this case report, a 9-year-old girl patient with two traumatically avulsed maxillary central incisors with loss of periodontal tissue was presented. Treatment guidelines for avulsed permanent teeth with open apex were carried out. Bilateral laterally sliding flap procedure was performed, to repair loss of gingival soft tissue. Conventional immobilization was carried out for 6 weeks. Five months follow-up of the patient in whom replantation was performed resulted in positive sensitivity test, no symptoms of infection, pain or any discomfort and good periodontal wound healing. In conclusion, this report presents successful replantation and periodontal treatment of a patient with complex dentoalveolar injury.

Tooth avulsion represents 0.5-16% of traumatic injuries. Avulsion of a pre-eruptive left permanent maxillary incisor in a 6-year-old boy is presented. The immature tooth was replanted after rinsing with saline following 10 min dry extra-oral time. This case report describes treatment and a 2-year follow-up of the tooth. During the follow-up period, continuation of root development, pulp revascularization, and irregular dentin formation were demonstrated. The tooth is vital, functional, and esthetic. To the best of our knowledge, no such case of replantation of a pre-eruptive tooth has been reported previously.

This case report describes a successful treatment of vertically fractured tooth which was reconstructed with a self-etching dual-cured adhesive resin cement and intentionally replanted without using rotation in conjunction with a bio-absorbable barrier membrane. At a follow-up consultation 4 years later, the tooth was asymptomatic, and attachment gain and bone regeneration were observed. In addition, no ankylosis was detected clinically or radiographically.

This case report outlines the sequel and possible management of a permanent tooth traumatized through the predecessor, a maxillary right primary central incisor that was avulsed and replanted by a dentist 1 h after the trauma in a 3-year-old girl. Three years later, discoloration and fistula were present, so the primary tooth was extracted. The patient did not come to the scheduled follow-ups to perform a clinical and radiographic control of the succeeding permanent incisor, and only returned when she was 10 years old. At that moment, the impaction and dilaceration of the maxillary right permanent central incisor were observed through radiographic examination. The dilacerated permanent tooth was then surgically removed, and an esthetic fixed appliance was constructed with the crown of the extracted tooth. Positive psychological influence of the treatment on this patient was also observed.

Background: The management of trauma involving anterior permanent teeth can be very complicated, particularly when more than one type of injury occurs. In some instances the advised treatment for one type of injury may conflict with that of another. In the present case a child had an avulsion and a root fracture/avulsion., Case Report: A patient, aged 14 years at the time of the injury in 1998, had a root fracture avulsion of the maxillary right permanent central incisor (11) and an avulsion of the maxillary left permanent central incisor (21). The management strategies were conflicting with regards to the type and duration of splinting. The dilemma of either having flexible splinting (10 days) for avulsed teeth as opposed to rigid splinting for root fracture (12 weeks) teeth was an important clinical decision since, the patient had sustained both injuries together., Treatment: The patient had semi-rigid splinting of 11 for 4 weeks and 21 was released from the splint at 8 days. Initial root canal therapy was carried out using non-setting calcium hydroxide and both these teeth were obturated with gutta percha. The teeth had an extra-alveolar period of 90 minutes and were placed in milk within 15 minutes of the trauma. Previous studies indicated that an extra-alveolar period of over 45 minutes leads to a poor long-term prognosis [Andreasen et al., 2004; Boyd et al., 2000] and this case is a rare example of long-term survival of 11 and 21., Follow-Up: Regular clinical and radiographic reviews took place over ten years from the injury and both 11 and 21 are currently successfully functional in the arch.

Avulsion is a complex injury affecting the pulp, periodontal ligament and the alveolar bone. Avulsed permanent teeth can survive following replantation. However, post-traumatic external root resorption eventually resulting in loss of the traumatized tooth is a frequent finding. After replantation of the avulsed teeth, esthetic requirements can be needed. Treatment options include porcelain laminate veneers, metal-ceramic restorations and all-ceramic crowns as well as minimally invasive procedures such as direct resin composite bonding. This article describes the restoration of avulsed and replanted teeth with direct resin composite laminate veneers. Because of the fact that lost fragments were recovered with the loss of anterior esthetic, and bearing in mind the patient's psychologically affected, we considered direct resin composite laminate veneer restoration of the avulsed and replanted teeth as the best therapeutic option. The patient was satisfied with the final result.

Aim: To describe combined endodontic, surgical and orthodontic treatment of a maxillary lateral incisor fused with a supernumerary., Summary: Double tooth is a dental irregularity consequent to fusion of two or more teeth or dental gemination. The teeth most commonly involved are deciduous, but in 0.1% of cases permanent teeth are affected, in which case aesthetic, functional and periodontal problems can result. This paper reports a clinical case of a double tooth in the position of the maxillary right lateral permanent incisor. Combined orthodontic, endodontic and surgical treatment (intentional replantation) allowed the tooth to be retained without periodontal compromise and with a positive orthodontic result both immediately and 6 years following intervention. *A conservative approach that addresses periodontal, pulpal and tooth tissues, can result in the retention of a double tooth. *Maintenance of the root and alveolar bone in young adults at least until full skeletal maturation should be the main treatment objective.

This case involved the intentional reimplantation of a tooth with severe periodontal involvement using regenerative therapies. The maxillary left central incisor was intentionally extracted, enamel matrix derivative (EMD) was applied, and the tooth was repositioned accurately. The bone defect was filled with a xenograft and a demineralized freeze-dried bone allograft, and a guided tissue regeneration membrane was adapted over the site. After 5 years, a reduction in probing depth and a gain in clinical attachment were observed. Conventional radiographs and cone-beam computerized tomographs showed hard tissue improvement. Favorable clinical results were obtained with reimplantation with applied EMD, combined with regenerative therapies, for treating a tooth with severe periodontal involvement.

A case is reported of the replantation of a maxillary incisor with an immature apex following a traumatic avulsion. A 14-month follow-up clinical examination revealed the patient to be asymptomatic, the tooth to be still functional, and a recall radiograph showed no evidence of renewed periradicular breakdown. The indications for, and limitations of, replantation of an avulsed permanent incisor with an immature apex are discussed.

The purpose of this case presentation is to review the rationale for and illustrate the clinical procedures involved in intentional replantation of a maxillary central incisor following a complicated crown-root fracture. The treatment of complicated crown-root fractures in children often is compromised by a fracture below the gingival margin and/or bone. This makes isolation difficult and comprises the hermetic seal that is critical for a successful endodontic treatment. Orthodontic or surgical extrusion with gingivectomy has been suggested; however, these approaches can be expensive, time-consuming, esthetically compromising, and unsatisfactory when the fracture line is deep below the gingiva. Our presentation will discuss the treatment options for such cases and introduce the concept of intentional replantation as an option to manage complicated crown-root fractures in young permanent anterior teeth.

Aim: The aim of this article is to describe a step-by-step protocol for emergency care of a patient with a dentoalveolar injury in the anterior region of the mouth as well as the fabrication of a mouthguard to prevent future trauma., Background: Dental trauma is one of the most serious oral health problems in active children and adolescents. Care of traumatized patients requires immediate initial emergency treatment followed by integrated procedures to restore damaged oral structures along with a subsequent trauma prevention strategy. Dentoalveolar injuries in the anterior region of the mouth are often characterized by tooth avulsion and coronal fracture. They are managed using procedures such as dental splinting, endodontic therapy with its unique characteristics, and restorative techniques to re-establish function and esthetics as well as protective mouthguards., Report: A 16-year-old male presented with avulsion of his maxillary central incisors as a result of a direct, unintentional impact with an opponent during a basketball game. The teeth had been stored in physiological serum immediately following the injury and the patient received immediate care. On clinical examination, the right central incisor was fractured at the incisal third of the crown but no bone fractures were found. The teeth were reimplanted and splinted. The fractured right central incisor was restored following endodontic treatment and a mouthguard was fabricated for the patient., Summary: The dentist must be knowledgeable about the most efficient and suitable treatment for each traumatic scenario in order to provide appropriate care for dental injuries. Coordinated multi-disciplinary action is fundamental in the successful treatment of these injuries. The dental mouthguard is an effective device for protecting the teeth and supportive structures during physical activities and must be part of the protective equipment used by athletes. It is the responsibility of the dental professional to make parents, trainers, and athletic associations aware of the risks associated with physical activities without orofacial protection; this should encourage the proper use of all protective devices to prevent dentoalveolar injuries that compromise oral functions, esthetics, and increase the cost of healthcare.

Ankylosis is a predictable outcome for replanted incisors and for most severely intruded incisors. There is no treatment to arrest or reverse this periodontal ligament complication. Ankylosis of the incisors of preadolescents alters local alveolar growth and eventually produces tooth loss subsequent to resorption. Currently, clinical methods used to diagnose ankylosis in the early postinjury period include subjective assessments of percussion sound and mobility and quantitative devices such as the Periotest. This paper describes the progression of ankylosis in two preadolescent patients that sustained severe trauma to their maxillary central incisors. A number of clinical assessments for diagnosis of ankylosis were compared for their usefulness, reliability and suitability.

A 15-year-old moderately built boy reported to the dental outpatient department with a complaint of pus discharge from the upper front teeth. There was a clear history of traumatic avulsion followed by self-replantation 6 years earlier. No dental treatment was taken by the child. On clinical examination the left upper central incisor was in torsoversion (anatomical labial surface on palatal side and vice versa). The child had probably self-replanted in torsoversion. Endodontic treatment was successfully completed, and final rehabilitation was done by a porcelain crown. The case highlights the excellent results of immediate replantation even when it is done by a child. It also highlights the value of school level dental education.