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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.

Background/aim In cases of tooth avulsion, a minimal extra-alveolar dry storage period or the use of a suitable storage medium is crucial to maintaining the vitality of the periodontal ligament. Whey has similar properties to milk and has therefore been investigated as a storage medium for avulsed teeth. The aim of this study was to evaluate the repair process after replantation of rat teeth kept in whey and whole milk. Materials and methods Thirty-six male rats were divided into four groups of nine animals. The upper right incisor was extracted under general anesthesia. In Group I, the teeth were immediately replanted without treatment (positive control). In Group II, the teeth were stored in 50 mL of sweet whey. In Group III, the teeth were kept in 50 mL of long-shelf-life whole milk (UHT, Parmalat® ). In Group IV, the teeth were kept dry (negative control). After 60 minutes, the teeth in Groups II, III, and IV were replanted into their sockets. The animals were subjected to euthanasia 60 days after replantation. The specimens were stained with hematoxylin and eosin for histomorphometric analysis. Results The organization of the periodontal ligament in Group II (whey) was similar to that in Groups I (immediate replantation) and III (whole milk) (P > .05). However, some specimens in this group exhibited periodontal fibers inserted into the bone and cementum throughout the entire length of the periodontal ligament. This occurred in the group submitted to immediate replantation, whereas this histological aspect was not seen in whole milk group. Group IV (late replantation) had a higher rate of root resorption. Regarding the root repair process, it was expected that Group I (immediate) would demonstrate more favorable repair than the other groups. However, Group III (whole milk) had better results when compared to Groups II (whey) and IV (late) (P Conclusion Whey and whole milk achieved similar results and were adequate storage media for avulsed teeth.

Dental avulsion is the most severe type of dentoalveolar trauma, and the treatment of choice for this type of injury should be the replantation of the exarticulated tooth. After conducting a review of the literature and holding discussions with experienced researchers and clinical specialists from different areas, the International Association of Dental Traumatology (IADT) proposed a protocol for tooth replantation, including a recommendation for systemic antibiotic therapy (SAT) to reduce the risk of root resorption. Several antibiotics have been tested, but tetracycline and amoxicillin are, by far, the most commonly used drugs for avulsion injuries. This paper reviews the literature on the prescription of SAT in cases of immediate and delayed replantation of accidentally avulsed permanent teeth, based on a critical analysis of full-length papers retrieved from the PubMed/Medline, Bireme and SciELO electronic databases. Original research reports and literature reviews published in English-language journals between 1966 and 2016, and directly or indirectly discussing the relation between antibiotic therapy and the replantation of permanent teeth, were searched using “tooth avulsion,” “systemic antibiotic therapy” and “tooth replantation” as key words. The prescription of antibiotics for tooth replantation was found to be a controversial subject, and randomized clinical studies are needed to determine whether antibiotics for tooth replantation are actual indicated. Until the results of these studies become available, the recommendation is to use SAT for the management of permanent teeth replanted after an accidental avulsion. The best prescription option is tetracycline for 7 days, and the second best prescription option is amoxicillin for 4 to 7 days.

Made available in DSpace on 2018-12-11T17:24:04Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-03-01. Added 1 bitstream(s) on 2021-07-15T15:22:12Z : No. of bitstreams: 1 S1806-83242018000100208.pdf: 1585463 bytes, checksum: 2108f97dc0cf1e2014126e850a9da9ed (MD5) The aim of this study is to evaluate the action of paramonochlorophenol associated with Furacin followed by calcium hydroxide (CH) dressing in the control of inflammatory root resorption in cases of immediate tooth replantation with delayed endodontic treatment. A total of 28 incisors of 3 male dogs were extracted and replanted after 15 minutes, and randomly divided into 3 groups: Group I (n = 8) - endodontic treatment was performed before the extraction and replantation; Group II (n = 10) - endodontic treatment was performed 30 days after replantation and the root canal was filled with CH dressing; Group III (n = 10) - endodontic treatment was performed 30 days after replantation and root canals received temporary medication of paramonochlorophenol-Furacin followed by CH dressing. The animals were euthanized 90 days after replantation. The histomorphological events analyzed at the epithelial reattachment site were the intensity and extent of acute and chronic inflammatory processes, periodontal ligament (PDL) organization, the intensity and extent of acute and chronic inflammatory processes in the PDL space, root resorption, bone tissue, and ankylosis. Data were submitted to the Wilcoxon Signed Ranks Test for group comparison (α = 5%). In Groups I, II and III the periodontal ligament was regenerated and most of the resorption areas were repaired by newly formed cementum. The depth and extent of root resorption were significantly higher in Group II than in Group III. The use of paramonochlorophenol-furacin followed by CH dressing was more effective in controlling inflammatory root resorption after immediate tooth replantation. Universidade Estadual Paulista - Unesp, School of Dentistry, Surgery and Integrated Clinics, Araçatuba, SP, Brazil

The aim of this study was to evaluate the influence of systemic administration of antibiotics (amoxicillin and tetracycline) at the different phases of the repair process (7, 15, 30 days) in immediate rat tooth replantation. Ninety rats had their incisors extracted and stored in saline for 5 min. Next, the teeth were replanted, and the animals were assigned to three groups according to the antibiotic administered by oral gavage: control group, amoxycillin group, and tetracycline group. Euthanasia was performed at 7, 15, and 30 days after replantation. Regardless of the evaluation period, the connective tissue underlying the epithelial attachment and the periodontal ligament showed statistically significant difference relative to the acute inflammatory infiltrate, which was more intense in the control group followed by the tetracycline group. These results point to the fact that systemic antibiotic therapy (SAT) in immediate tooth replantation is beneficial to pulpal and periodontal ligament repair and that amoxycillin is an excellent option. There is a lack of randomized studies assessing how the use of systemic antibiotics could influence tooth healing after immediate replantation.

The purpose of this study was to evaluate the application of 15 % propolis and 2 % acidulated-phosphate sodium fluoride solutions on the root surface-adhered necrotic cemental periodontal ligament in delayed tooth replantation. Thirty Wistar rats (Rattus norvegicus, albinus) had their right upper incisor extracted and maintained in dry storage for 60 min. After this period, the dental papilla, enamel organ, and pulp tissue were removed, and the animals were randomly assigned to three groups: group I = immersion in saline for 10 min; group II = immersion in a 2 % acidulated-phosphate sodium fluoride solution for 10 min; and group III = immersion in a 15 % propolis and propylene glycol solution for 10 min. The root canals were filled with a calcium hydroxide paste and the teeth were replanted. Inflammatory resorption, replacement resorption, and ankylosis were observed in all groups without a statistically significant difference (p > 0.05) among them. Under the tested conditions, the application of fluoride or propolis on root surface-adhered necrotic periodontal ligament did not favor the healing process in delayed tooth replantation.

The interpretation of the set of radiographs taken during the follow-up period after tooth replantation might pose several difficulties, especially the inability to adequately reproduce the projection geometry of the exposures. This article describes a method for the geometric standardization of intraoral radiographs using a custom-made apparatus comprising a film-holder attached to an occlusal splint for the long-term follow up of dentoalveolar trauma. The method was applied in a patient who suffered an avulsion of the maxillary central incisors and had the teeth replanted after 4 h in saline storage. Endodontic treatment started 7 days after the trauma with changes of a calcium hydroxide intracanal medication every 15 days in the first 2 months and thereafter at 30-day intervals for 8 months. Root canal filling was carried out after this period. The radiographic exposures taken at the follow-up visits were standardized to identify the possible alterations during the repair process, such as root resorptions. A maxillary arch impression was made with alginate, and the model was cast in stone for fabrication of an acetate occlusal splint. The custom-made apparatus used for standardization of the radiographic exposures was fabricated by fixing a Rinn X-C-P film-holder and a 5-mm-long piece of 0.7-mm orthodontic wire to the occlusal splint with autopolymerized acrylic resin. Radiographs were taken at 4-month intervals, starting 10 months after replantation up to 76 months. The images were digitized and analysed using the Digora system. The length of the central incisors was determined to verify the reproduction of the projection geometry of the exposures and the orthodontic wire served to assess accuracy during length estimations in the radiographs. The method described in this article for geometric standardization of intraoral radiographs provided a consistent reproduction of the geometric exposure parameters, being indicated for use in the radiographic follow up of cases of dentoalveolar trauma.

Department of Surgery and Integrated Clinic Aracatuba Dental School Universidade Estadual Paulista (UNESP), Aracatuba, SP

Clinical experience has shown that most avulsed teeth are replanted after a long extra-alveolar time and dry or inadequate wet storage, causing necrosis of periodontal ligament cells. This condition invariably leads to development of external root resorption, leaving the filling material in contact with the periapical connective tissues. In this study, the periapical tissue reactions to calcium hydroxide (CH) and mineral trioxide aggregate (MTA) were evaluated after occurrence of external root resorption as an expected sequela of delayed tooth replantation. Twenty male Wistar rats (Rattus norvegicus, albinus) had their right upper incisor extracted and maintained in dry storage for 60 min. Then, the dental papilla, enamel organ, pulp tissue, and periodontal ligament were removed, and the teeth were immersed in a 2% acidulated phosphate sodium fluoride solution, pH 5.5, for 10 min. The teeth were randomly assigned into two groups (n = 10), in which the canals were filled with either a CH and saline paste (CH group) or MTA (MTA group). The sockets were irrigated with saline, and the teeth were replanted. After 80 days, it was possible to observe large areas of replacement root resorption and some areas of inflammatory root resorption in both groups. More severe inflammatory tissue reaction was observed in contact with calcium hydroxide compared with the mineral trioxide aggregate. New bone formation was more intense at the bottom of the socket in the MTA group. In conclusion, as far as periapical tissue compatibility is concerned, intracanal MTA can be considered as a viable option for root canal filling in delayed tooth replantation, in which external root resorption is an expected sequela.

Univ Estadual Paulista UNESP, Sch Dent Aracatuba, Dept Surg & Integrated Clin, Aracatuba, Brazil

This study evaluated the repair process after delayed replantation of rat teeth, using calcium hydroxide (Ca(OH)2) mixed with camphorated p-monochlorophenol (CMCP), chlorhexidine 2% (CHX), or saline as temporary root canal dressing to prevent and/or control inflammatory radicular resorption. Thirty Wistar rats (Rattus norvegicus albinos) had their right upper incisor extracted, which was bench-dried for 60 minutes. The dental papilla, the enamel organ, the dental pulp, and the periodontal ligament were removed. The teeth were immersed in 2% acidulated-phosphate sodium fluoride solution for 10 minutes. The root canals were dried with absorbent paper cones and divided into 3 groups of 10 animals according to root canal dressing used: group 1: Ca(OH)2 + saline, group 2: Ca(OH)2 + CMCP, and group 3: Ca(OH)2 + CHX 2%. Before replanting, the teeth sockets were irrigated with saline. Histological analysis revealed the presence of inflammatory resorption, replacement resorption, and ankylosis in all 3 groups. Statistical analysis showed a significant difference between group 3 and the other groups. The use of Ca(OH)2 mixed with CMCP or CHX did not show an advantage over the use of Ca(OH)2 mixed with saline in preventing and/or controlling inflammatory resorption in delayed replantation of rat teeth.

The prognosis of tooth replantation is usually related to the need of endodontic treatment, which has a direct relationship with the occurrence of root resorptions. Several studies have been undertaken in an attempt to prevent, delay, or treat these complications, which are the main causes of loss of replanted teeth. This literature review examines research evidence on intracanal dressings and root canal filling materials used in cases of tooth replantation. A comprehensive search was performed in the Medline/Pubmed, Bireme and Scielo full-text electronic journal databases to retrieve English-language articles referring to these topics that had been published between 1964 and 2010. Calcium hydroxide (CH) remains the usually recommended choice as an intracanal medicament in replanted teeth; however, there is evidence to support the initial use of a corticosteroid-antibiotic combination such as Ledermix paste to control potential early resorption, prior to the introduction of CH where the beneficial effect in the treatment of progressive root resorption has been well proven. Regarding root filling materials, CH-containing sealers are a good option because of their biological properties. Accurate diagnosis and adequate treatment plan may constitute very complex tasks, particularly in tooth avulsion because several variables are involved. In addition to the technical knowledge and clinical experience directed toward the quality of treatment, patient education may favorably influence the survival of replanted teeth.

UNESP Sao Paulo State Univ, Dept Surg & Integrated Clin, Sch Dent Aracatuba, Aracatuba, SP, Brazil

Several local factors that influence the healing process of replanted teeth have been investigated. However, it remains unclear how systemic alterations, such as diabetes mellitus, affect the prognosis of these cases. The purpose of this study was to evaluate the healing process of incisors of non-controlled diabetic rats replanted after storage in bovine long shelf-life (UHT) whole milk. Thirty-two rats were randomly assigned to receive an endovenous injection of either citrate buffer solution (group I - control; n = 16) or streptozotocin dissolved in citrate buffer solution to induce diabetes (group II; n = 16). After confirmation of the diabetic status by analysis of the glycemic levels, the maxillary right incisor of each animal was extracted and immersed in milk for 60 min. The root canals of teeth were then instrumented, and were filled with a calcium hydroxide-based dressing and replanted into their sockets. All animals received systemic antibiotic and were killed by anesthetic overdose 10 and 60 days after replantation. The specimens containing the replanted teeth were removed, fixed, decalcified, and embedded in paraffin. Semi-serial 6-microm-thick sections were obtained and stained with hematoxylin and eosin for histologic and histometric analyses. The results showed that the connective tissue adjacent to the root surface was less organized in the diabetic animals than in the control animals in both periods; the root dentin was less severely affected by root resorption in the diabetic rats; there were no significant differences between the control and diabetic groups regarding the occurrence of replacement resorption and inflammatory resorption.

Replantation is an acceptable option for treatment of an avulsed permanent tooth. Nevertheless, an extended extraoral period damages the periodontal ligament and results in external root resorption. The purpose of this study was to assess by histologic and histometric analysis, the influence of propolis 15% (natural resinous substance collected by Apis mellifera bees from various plants) and the fluoride solution used as root surface treatment on the healing process after delayed tooth replantation. Thirty Wistar (Rattus norvegicus albinus) rats were submitted to extraction of their upper right incisor. The teeth were maintained in a dry environment for 60 min. After this, the pulp was extirpated and the papilla, enamel organ and periodontal ligament were removed with scalpel. The teeth were divided into three experimental groups: Group I - teeth immersed in 20 ml of physiologic saline; Group II - teeth immersed in 20 ml of 2% acidulated phosphate sodium fluoride; Group III - teeth immersed in 20 ml of 15% propolis. After 10 min of immersion in the solutions, the root canals were dried and filled with calcium hydroxide paste and the teeth were replanted. The animals were euthanized 60 days after replantation. The results showed that similar external root resorption was seen in the propolis and fluoride groups. Teeth treated with physiologic saline tended to have more inflammatory root resorption compared with those treated with fluoride or propolis. However, the comparative analysis did not reveal statistically significant differences (P > 0.05) between the treatment modalities when used for delayed tooth replantation.

The major concern in the therapeutics of tooth replantation refers to the occurrence of root resorption and different approaches have been proposed to prevent or treat these complications. The purpose of this study was to evaluate tissue response to delayed replantation of anterior rat teeth treated endodontically using calcium hydroxide, Sealapex, and Endofill without the placement of gutta-percha cones. Thirty rats had their right upper incisor extracted and maintained in dry storage for 60 min. After removal of the dental papilla, enamel organ, pulp tissue, and periodontal ligament remnants, the teeth were immersed in 2% sodium fluoride phosphate acidulated, pH 5.5, for 10 min. The root canals were dried with absorbent paper points and the teeth were assigned to three groups (n = 10) according to the filling material. Group I - calcium hydroxide and propyleneglycol paste, Group II - Sealapex, and Group III - Endofill. The sockets were irrigated with saline and the teeth were replanted. Replacement resorption, inflammatory resorption and ankylosis were observed in all groups. Although the occurrence of inflammatory resorption was less frequent in Group I, there were no statistically significant differences among the groups. It may be concluded that compared to the paste, filling the root canals with Sealapex and Endofill sealers without the placement of gutta-percha cones did not provide better results.

One of the important factors accounting for successful delayed replantation of avulsed teeth is seemingly the type of root surface treatment. Removal of necrotic cemental periodontal ligament remnants may prevent the occurrence of external root resorption, which is the major cause of loss of teeth replanted in such conditions. The purpose of this study was to compare the efficacy of two mechanical techniques for removal of root-adhered periodontal ligament. Preservation or removal of the cementum layer concomitantly with these procedures was also assessed. Forty-five roots of healthy premolars extracted for orthodontic purposes were selected. After extraction, the teeth were kept dry at room temperature for 1 h and then immersed in saline for rehydration for an additional 10 min. Thereafter, the roots were assigned to three groups, as follows: group 1 (control)--the cemental periodontal ligament was preserved; group 2--removal of the periodontal ligament by scraping root surface with a scalpel blade (SBS); group 3--periodontal ligament remnants were removed using a Robinson bristle brush at low-speed with pumice/water slurry (RBP). The specimens were analysed histomorphometrically and examined by scanning electron microscopy. The quantitative and qualitative analyses of the results showed that the RBP technique was significantly more effective than the SBS technique for removal of the periodontal ligament remnants adhered to root surface. Both techniques preserved the cementum layer.

Accurate diagnosis and adequate treatment plan may constitute very complex tasks, particularly in tooth avulsion, because several variables are involved. In addition to the technical knowledge and clinical experience directed toward the quality of treatment, patient education may favorably influence the survival of replanted teeth. The aim of this study was to analyze the procedures used in the management of tooth avulsion by 100 dental surgeons (DSs). Thus, by means of a descriptive questionnaire, information was obtained about the profile of the professionals interviewed, procedures used in cases of tooth avulsion, and patient orientation and education. One hundred properly filled questionnaires were obtained. Descriptive statistics was used for the data, and the chi-squared statistics was employed (epi-info 3.2 software). According to the results, this type of trauma is part of the routine of 15 DSs, although 71 have reported some experience with avulsed teeth. Great deficiencies were found regarding root surface treatment and occlusal adjustment. Positive findings were related to socket treatment, adjunctive therapy, and patient education and orientation (extra-alveolar period, storage medium, manipulation of the avulsed tooth, replantation by the own patient). It was possible to conclude that 47.5% of the procedures reported by 100 professionals interviewed are adequate, and patient education is favorable in 87.7% of cases, a fact that can positively interfere with the prognosis of tooth replantation.

Systemic antibiotic therapy (SAT) has usually been recommended after tooth replantation, but its actual value has been questioned. As there are no reports in the literature about its influence on tooth replantation, the aim of this study was to evaluate the influence of systemic administration of antibiotics (amoxicillin and tetracycline) at the different phases of the repair process (7, 15, 30 days) in delayed rat tooth replantation. Ninety Wistar rats (Rattus norvegicus albinus) had their maxillary right incisors extracted and bench-dried for 60 min. The dental papilla, enamel organ, pulp tissue, and root surface-adhered periodontal ligament were removed, and the teeth were replanted. The animals received no antibiotics (n = 30) or were medicated systemically with amoxicillin (n = 30) and tetracycline (n = 30), and were euthanized after 7, 15, and 30 days. Regardless of the evaluation period, the acute inflammatory infiltrate was less intense and root resorption presented smaller extent and depth in the group treated with amoxicillin. The results suggest that SAT has a positive influence on the repair process in delayed tooth replantation and that amoxicillin is an excellent treatment option.

Made available in DSpace on 2015-08-26T19:19:11Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-06-01. Added 1 bitstream(s) on 2015-08-31T13:04:54Z : No. of bitstreams: 1 S0103-64402015000300308.pdf: 1058742 bytes, checksum: 04a2608484d31495381363a763eba1c5 (MD5) No tratamento de casos de luxação extrusiva é importante que o reposicionamento do dente extruído em seu alvéolo seja feito o mais rápido possível. Se isso não ocorrer, o coágulo periapical se torna organizado e dificulta a reposição. Neste artigo, o paciente encaminhado para a clínica de traumatismo dentário apresentava luxação extrusiva do dente 11. O paciente relatou que havia sofrido um acidente de bicicleta 12 dias antes e teve lesões dentárias. Tentou-se fazer o reposicionamento sem sucesso e uma forma alternativa de tratamento foi necessária para resolver o caso. Reimplante intencional, que é a extração do dente e seu reimplante de forma proposital, foi indicado. Esta técnica permite a remoção do coágulo e o reposicionamento correto do dente extruído. Cuidado deve ser observado quanto ao tratamento endodôntico, para a prevenção de uma reabsorção relacionada a uma infecção. Curativo de demora com hidróxido de cálcio foi realizado por 30 dias antes da obturação final. Contenção, antibióticos sistêmicos e evitar maiores danos à superfície da raiz também são importantes. O controle de 38 meses mostrou características clínicas e radiográficas de normalidade e demonstra a disponibilidade desta técnica para a adversidade no trauma. In the treatment of extrusive luxation cases, it is important that the repositioning of extruded tooth in the socket is done as soon as possible. If this does not occur, periapical clot becomes organized and makes replantation difficult reposition. In this article the patient referred to the Clinics for dental trauma sustaining extrusive luxation of the maxillary right central incisor. The patient reported having suffered a bicycle accident 12 days before, which caused traumatic tooth injuries. The repositioning was attempted without success and an alternative form of treatment was necessary to solve the case. Intentional tooth replantation, which is the deliberate extraction of the tooth and its replantation, was indicated. This technique allows clot removal and correct repositioning of the extruded tooth. Care should be taken as endodontic treatment is required for the prevention of subsequent infection-related resorption. Intracanal dressing with calcium hydroxide was used for 30 days before final root filling. Splint, systemic antibiotics and avoidance of further damage to the root surface is also important. After 49 months, showed clinical and radiographic characteristics of normality and demonstrates the availability of this technique to adversity in trauma. Universidade Estadual Paulista Araçatuba Dental School Department of Surgery and Integrated Clinics Universidade Estadual Paulista Araçatuba Dental School Department of Surgery and Integrated Clinics

Made available in DSpace on 2018-12-11T17:00:37Z (GMT). No. of bitstreams: 0 Previous issue date: 2016-05-01 Objectives The aim of the study was to analyze the effects of ovariectomy on periodontal tissues following immediate tooth replantation by histomorphometric, immunohistochemistry, and μCT analysis. Materials and methods Eighty wistar rats (Rattus norvegicus albinos) with normal estrous cycles were randomly divided into two groups: ovariectomized (OVX) and Sham. Two months after surgery, the rats' upper right incisor was extracted followed by immediate reimplantation. The animals were sacrificed after 28, 45, and 60 days healing time. Histomorphometric and immunohistochemical analysis were performed by evaluation of PCNA and TRAP straining. Results The periodontal ligament was reinserted into the bone and cementum in the both groups. The immunohistochemical analysis revealed PCNA positive cells on the periodontal ligament in both groups at 28 days. Root resorption was noted at 45 days with immunoreactive cells for TRAP present in bone and tooth surface however no statistical differences between the groups were noticed. Histomorphometric analysis showed significant difference between groups in the periodontal ligament and root resorption parameters for the sub-items: intensity of chronic inflammatory infiltrate at 60 days (p < 0.01), the organization of the periodontal ligament at 28 days (p < 0.05), depth of root resorption at 45 days (p < 0.05) and at 60 days (p < 0.001). The μCT analysis showed multiple areas of bone resorption in association with OVX at 28 and 60 days with no significant differences between times in vivo. Conclusion The ovariectomy did not have significant influence in periodontal tissue parameters following tooth reimplantation. Department of Surgery and Integrated Clinics Aracatuba Dental School Univ Estadual Paulista UNESP, 1193 - Vila Mendonca, Rua Jose Bonifacio Center for Craniofacial Regeneration College of Dental Medicine Columbia University, 630 West 168th St. Department of Basic Science Aracatuba Dental School Univ Estadual Paulista UNESP, KM 527/528 Campus Universitario, Rodovia Marechal Rondon Biosciences Institute of Botucatu UNESP Univ Estadual Paulista Department of Biomaterials and Biomimetics New York University College of Dentistry, 433 1st Ave. Department of Periodontology and Implant Dentistry New York University College of Dentistry, 345 E 24th St Division of Engineering New York University Abu Dhabi Department of Surgery and Integrated Clinics Aracatuba Dental School Univ Estadual Paulista UNESP, 1193 - Vila Mendonca, Rua Jose Bonifacio Department of Basic Science Aracatuba Dental School Univ Estadual Paulista UNESP, KM 527/528 Campus Universitario, Rodovia Marechal Rondon Biosciences Institute of Botucatu UNESP Univ Estadual Paulista

Aim The aim was to evaluate the biomechanical behavior of the supporting bony structures of replanted teeth and the periodontal ligament (PDL) of adjacent teeth when orthodontic wires with different mechanical properties are applied, with three-dimensional finite element analysis. Materials and methods Based on tomographic and microtomographic data, a three-dimensional model of the anterior maxilla with the corresponding teeth (tooth 13–tooth 23) was generated to simulate avulsion and replantation of the tooth 21. The teeth were splinted with orthodontic wire (O 0.8 mm) and composite resin. The elastic modulus of the three orthodontic wires used, that is, steel wire (FA), titanium–molybdenum wire (FTM), and nitinol wire (FN) were 200 GPa, 84 GPa, and 52 GPa, respectively. An oblique load (100 N) was applied at an angle of 45° on the incisal edge of the replanted tooth and was analyzed using Ansys Workbench software. The maximum (σmax) and minimum (σmin) principal stresses generated in the PDL, cortical and alveolar bones, and the modified von Mises (σvM) values for the orthodontic wires were obtained. Results With regard to the cortical bone and PDL, the highest σmin and σmax values for FTM, FN, and FA were checked. With regard to the alveolar bone, σmax and σmin values were highest for FA, followed by FTM and FN. The σvM values of the orthodontic wires followed the order of rigidity of the alloys, that is, FA > FTM > FN. Conclusion The biomechanical behavior of the analyzed structures with regard to all the three patterns of flexibility was similar.

Made available in DSpace on 2015-11-03T15:28:02Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-09-01. Added 1 bitstream(s) on 2015-11-04T10:15:25Z : No. of bitstreams: 1 S1806-83242014000100268.pdf: 1398126 bytes, checksum: b1b0fd610b37ee2dcb9ce19b598b1bc0 (MD5) MTA has been investigated as a root-end filling material. Its mechanism of action has some similarities to that of Ca(OH())2. The purpose of this study was to evaluate the repair process taking place in the delayed replantation of monkey teeth using calcium hydroxide and MTA as root canal filling materials. Five monkeys had their lateral incisors extracted and bench-dried for 60 minutes. After root canal preparation, the teeth were assigned to two groups according to root canal filling material: I, calcium hydroxide; and II, MTA. The same treatment sequence was followed for both groups: coronal seal, periodontal ligament removal, immersion of the tooth in 2% acidulated-phosphate sodium fluoride, irrigation of the socket with saline and replantation. Both groups exhibited replacement resorption, areas of ankylosis and absence of inflammatory root resorption. Statistically similar results (p > 0.05) were observed for both groups regarding replacement root resorption, but the groups differed significantly (p < 0.05) regarding the occurrence of ankylosis. MTA may be a viable clinical option for filling teeth submitted to delayed replantation, and is an acceptable option for treating replanted permanent teeth in order to prevent tooth resorption, particularly when dressing changes are not possible. Univ Estadual Paulista UNESP, Sch Dent, Dept Surg &Integrated Clin, Aracatuba, SP, Brazil Univ Estadual Paulista UNESP, Sch Dent, Grad Program Integrated Clin, Aracatuba, SP, Brazil Univ Estadual Paulista UNESP, Sch Dent, Dept Surg &Integrated Clin, Aracatuba, SP, Brazil Univ Estadual Paulista UNESP, Sch Dent, Grad Program Integrated Clin, Aracatuba, SP, Brazil

Objective The aim of this study was to perform a histomorphometric evaluation of the repair process in rat teeth replanted after root canals were filled with calcium hydroxide (CH) and mineral trioxide aggregate (MTA). Design Upper right incisors were extracted from 30 rats divided into three groups ( n = 10). The teeth were stored dry for 60 min, after which the pulp and periodontal ligament (PDL) were removed and immersed in acidulated-phosphate sodium fluoride solution. In Group I, the root canals were filled with saline; in Group II, they were filled with CH; and in Group III, they were filled with CH, and the foramen was sealed with an MTA plug. The teeth were replanted, and the animals were sacrificed after 60 days. The sections with teeth were removed for histological preparation (haematoxylin and eosin, H&E). The characteristics of the PDL, cementum, dentine, and alveolar bone, as well as the occurrence of inflammatory and replacement root resorption and apical sealing, were subjected to histological and morphometric analysis ( P Results Group I was the most affected by root resorption (mean = 67.05%). In Groups II and III, the resorption averaged 42.2% and 11.7%, respectively. Group III was less affected by inflammatory resorption and presented more areas of apical sealing by mineralized tissue ( P Conclusion An apical MTA plug improved the repair of the replanted tooth by decreasing surface resorption and repairing mineralized tissue in the periapical region.

Dental avulsion is the most severe type 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 an exarticulated tooth immediately after avulsion because the extraoral time is a determinant factor for treatment success and for a good prognosis. However, it is not always possible. The success of replantation depends on a number of factors that may contribute to accelerate or minimize the occurrence of root resorption or ankylosis, among which is the type and characteristics of the medium used for temporary storage during the time elapsed between avulsion and replantation. Maintaining the tooth in an adequate wet medium that can preserve, as longer as possible, the vitality of the periodontal ligament cells that remain on root surface is the key to success of replantation. Recent research has led to the development of storage media that produce conditions that closely resemble the original socket environment, with adequate osmolality (cell pressure), pH, nutritional metabolites and glucose, and thus create the best possible conditions for storage. Although these storage media can now be purchased in the form of retail products, the most common scenario is that such a product will not be readily available at the moment of the accident This paper reviews the literature on the different storage media that have been investigated for avulsed teeth based on full-length papers retrieved from PubMed/Medline, Lilacs, BBO and SciELO electronic databases using the key words ‘storage medium’, ‘transportation medium’, ‘avulsion’, ‘tooth avulsion’, ‘replantation’, ‘tooth replantation’, ‘milk’ and ‘propolis’. After application of inclusion and exclusion criteria, 39 papers were selected and critically reviewed with respect to the characteristics, efficacy and ease of access of the storage medium. The review of the literature showed that a wide array of types of wet storage media have been evaluated in laboratory studies and clinical reports, including cell and tissue culture solutions like Hank's Balanced Salt Solution (HBSS); medical/hospital products developed specifically for organ storage purposes, such as Viaspan® and Euro-Collins®; culture media, like Minimum Essential Medium (MEM); saline; natural products like water, saliva, bovine milk and its variations, propolis, green tea, Morus rubra (red mulberry), egg white and coconut water; rehydrating solutions, like Gatorade® and Ricetral, and even contact lens solutions. Based on the literature, it could be stated that, so far, apart from Based on the literature, it could be stated that, so far, apart from solutions designed specifically for storage and culture purposes, regular pasteurized whole milk is the most frequently recommended and with the best prognosis among other solutions that are likely to be available at the scene of an accident, such as water, saline or saliva. Its advantages include its high availability, ready accessibility, physiologically compatible pH and osmolality (fluid pressure) with the root-surface adhered PDL cells, presence of nutrients and growth factors. However, there is not yet a single solution that fulfills all requirements to be considered as the ideal medium for temporary storage of avulsed teeth, and research on this field should carry on. Dentre os traumatismos dento-alveolares, a avulsão dentária é a mais severa por causar danos em muitas estruturas e por consistir num deslocamento total do dente de seu alvéolo ósseo. O tratamento ideal é o reimplante dentário imediatamente após avulsão, pois o tempo extra-bucal é fator determinante para um bom prognóstico e o sucesso do tratamento. Infelizmente, isto nem sempre é possível. O sucesso do reimplante depende de muitos fatores que podem acelerar ou retardar a reabsorção radicular ou mesmo a anquilose e entre eles estão o tipo e as características do meio de armazenamento no qual esse dente foi mantido entre a avulsão e o reimplante. Manter o dente num meio úmido adequado que possa preservar pelo maior tempo possível a vitalidade das células do ligamento periodontal na superfície radicular é o elemento-chave do reimplante bem sucedido. Pesquisas recentes levaram ao desenvolvimento de meios de armazenamento que tem condições muito próximas às do alvéolo dental, possuindo osmolalidade (pressão celular) adequada, pH, metabólitos nutrientes e glicose. Embora estes meios de armazenamento possam ser adquiridos comercialmente, a situação mais comum é que o produto não esteja facilmente acessível no momento do acidente. Frente a isto, o objetivo deste artigo é apresentar uma revisão da literatura sobre diversos meios de armazenamento para dentes avulsionados, considerando suas características, efetividade e acessibilidade. Para isto, foi realizada uma busca de artigos nas bases de dados PubMed/Medline, Lilacs, BBO e Scielo por meio das palavras-chave: ‘storage media’, ‘tooth replantation’, ‘tooth avulsion’, ‘milk’ e ‘propolis’. Após a avaliação dentro dos critérios de inclusão e exclusão, 39 artigos foram selecionados e os meios de armazenamento neles descritos foram criteriosamente estudados quanto às suas características, efetividade e acessibilidade. A revisão da literatura revelou uma grande variedade de meios úmidos de estocagem avaliada em estudos laboratoriais e casos clínicos, incluindo soluções para cultura de células e tecidos, como a Hank's Balanced Salt Solution (HBSS); produtos médico-hospitalares desenvolvidos especificamente para armazenamento de órgãos, como Viaspan® e Euro-Collins®; meios de cultura como o Meio Mínimo Essencial (MEM); solução fisiológica; produtos naturais, como água, saliva, leite bovino em suas diferentes apresentações, própolis, chá verde, Morus rubra, clara de ovo e água de coco; produtos reidratantes como Gatorade® e Ricetral, até mesmo soluções para lentes de contato. Com base na literatura, pode-se afirmar que até agora, com exceção das soluções específicas para armazenamento e culturas, o leite pasteurizado integral é o mais indicado e o que tem o melhor prognóstico dentre as substâncias que estejam mais provavelmente disponíveis no local do acidente, como água, solução fisiológica ou saliva. Suas vantagens são a grande disponibilidade, fácil acesso, pH fisiologicamente compatível e osmolalidade (pressão do líquido) com as células do ligamento periodontal aderidas à superfície radicular, presença de nutrientes e fatores de crescimento. Apesar disso, o fato é que não se tem um produto que preencha todos os requisitos para ser considerado ideal para o armazenamento temporário de dentes avulsionados e as pesquisas para tanto devem prosseguir.

This study evaluated the immunohistochemical expression of OPG, RANK, and RANKL proteins in the repair after immediate and delayed replantation of rat teeth. Fifty-six Wistar rats (Rattus norvegicus albinus) had their maxillary right lateral incisor extracted and then replanted, according to the following conditions: group I (control; n = 8), teeth were not extracted; group II (n = 16), immediate replantation; group III (n = 16), delayed replantation without treatment; and group IV (n = 16), delayed replantation after root surface treatment (periodontal ligament removal and immersion in 2% acidulated-phosphate sodium fluoride) and calcium hydroxide intracanal dressing. Rats in group I were euthanized on the first day of the experiment, while the animals in the other groups were euthanized 10 and 60 days after replantation (n = 8/period). Hematoxylin and eosin-stained sections were obtained for histological analysis. The immunohistochemical analysis revealed expression of OPG and RANKL proteins in all groups and both postreplantation times, except for group II at 60 days. In the experimental groups, RANK expression was observed only at 10 days. In conclusion, there was strong immunostaining for the OPG-RANK-RANKL system at the earlier postreplantation time, suggesting a more effective participation of these proteins at the start of the healing process, as their expression decreased at 60 days.

Dental tissues have special characteristics, and its regenerative capacity is noteworthy. However, understanding the circumstances that lead to regeneration is challenging. In this study, the chronology of the healing process after immediate replantation of rat incisor teeth was examined by histological and immunohistochemical analyses within a 60-day period. Thirty-six male Wistar rats had their maxillary right incisors extracted and replanted after 15 min in saline storage. The rats were sacrificed immediately 3, 7, 15, 28, and 60 days after replantation. The histological analysis showed rupture of the periodontal ligament and formation of a blood clot, which started being replaced by a connective tissue after 3 days. At 7 days, the gingival mucosa epithelium was reinserted and areas of root resorption could be seen. At 15 days, the periodontal ligament was repaired. At 3 days, the pulp presented an absence of the odontoblast layer, which started being replaced by a connective tissue. This tissue suffered gradual calcification, filling the root canal at 28 and 60 days. The root ends were closed. The immunohistochemical analysis revealed greater expression of OP, OPG, and RANK proteins in the initial periods (0 and 3 days), while TRAP expression predominated at 28 and 60 days (P0.05). In conclusion, in delayed tooth replantation, there is great new bone formation activity in the earlier periods of the repair process, while a predominance of bone resorption and remodeling is observed in the more advanced periods.

The prognosis of tooth replantation is usually related to the need of endodontic treatment, which has a direct relationship with the occurrence of root resorptions. Several studies have been undertaken in an attempt to prevent, delay, or treat these complications, which are the main causes of loss of replanted teeth. This literature review examines research evidence on intracanal dressings and root canal filling materials used in cases of tooth replantation. A comprehensive search was performed in the Medline/Pubmed, Bireme and Scielo full-text electronic journal databases to retrieve English-language articles referring to these topics that had been published between 1964 and 2010. Calcium hydroxide (CH) remains the usually recommended choice as an intracanal medicament in replanted teeth; however, there is evidence to support the initial use of a corticosteroid-antibiotic combination such as Ledermix paste to control potential early resorption, prior to the introduction of CH where the beneficial effect in the treatment of progressive root resorption has been well proven. Regarding root filling materials, CH-containing sealers are a good option because of their biological properties. Accurate diagnosis and adequate treatment plan may constitute very complex tasks, particularly in tooth avulsion because several variables are involved. In addition to the technical knowledge and clinical experience directed toward the quality of treatment, patient education may favorably influence the survival of replanted teeth.

Made available in DSpace on 2016-01-28T16:53:51Z (GMT). No. of bitstreams: 0 Previous issue date: 2012. Added 1 bitstream(s) on 2016-01-28T17:00:59Z : No. of bitstreams: 1 ISSN2178-6011-2012-15-03-64-70.pdf: 1820584 bytes, checksum: b775ff24a8b81c6433895d5288b7074f (MD5) Objetivo: avaliar o efeito do ácido cítrico no ligamento periodontal cementário necrótico no processo de reparo do reimplante dentário tardio em rato. Material e Método: Quarenta ratos Wistar após a extração do incisivo superior direito foram divididos em 4 grupos (n=10). No Grupo I (controle), os dentes foram reimplantados após 5 min extralveolar. Nos outros grupos o reimplante foi realizado após 60 min. No Grupo II, os canais foram obturados com pasta hidróxido de cálcio e os dentes foram reimplantados sem tratamento da superfície radicular. No Grupo III, os dentes foram imersos em ácido cítrico (pH1) por 3 min, os canais foram obturados com pasta de hidróxido de cálcio e reimplantados. No Grupo IV, a superfície radicular foi friccionada com gaze embebida em ácido cítrico e os dentes reimplandos. Os aminais sofreram eutanásia 60 dias após o reimplante. Resultados: Quanto à reabsorção por substituição houve diferença estatisticamente controle e do Grupo IV quanto a anquilose. O grupo controle apresentou menor reabsorção por substituição em comparação com os outros grupos (p < 0,05). A estrutura radicular foi mais comprometida pela reabsorção por substituição e anquilose no Grupo IV quando comparado aos grupos tratamento do ligamento periodontal cementário com ácido citrico reimplante dentário tardio em rato. Objective: to evaluated the effect of treating root-adhered necrotic periodontal ligament (PDL) with citric acid on the healing process in delayed rat tooth replantation. Material and Methods: Forty Wistar rats, assigned to 4 groups (n=10), had their upper right incisor extracted and kept dry on a workbench. For Group I (control), the teeth were replanted after a 5 min extra-alveolar time. For the other groups, replantation was done after 60 min. In Group II, the root canals were filled with a calcium hydroxide-based paste and the teeth were replanted with no root surface treatment. In Group III, the teeth were immersed in citric acid (pH 1) for 3 min, the canals were filled with calcium hydroxide and the teeth were replanted. In Group IV, instead of the immersion, the roots were scrubbed with gauze soaked in citric acid and the teeth were replanted. The animals were sacrificed 60 days postoperatively. Results: Regarding replacement resorption, there was statistically significant difference (p < 0.05) between the control group and the other three groups. No statistically significant difference (p > 0.05) was found among the groups regarding the areas of inflammatory resorption. There was also a statistically significant difference (p < 0.05) between the control group and Group IV regarding ankylosis. The control group showed the least replacement resorption percent means compared to the other groups (p < 0.05). The root structure was more affected by replacement resorption and ankylosis in Group IV compared to the Groups II and III, but this difference was not significant statistically (p > 0.05). Conclusion: the treatment of root surface-adhered necrotic periodontal ligament with citric acid was not able to prevent the occurrence of ankylosis, root resorption and inflammatory resorption in delayed rat tooth replantation. Universidade Estadual Paulista Júlio de Mesquita Filho, Departamento de Cirurgia e Clínica Integrada, Faculdade de Odontologia de Araçatuba, Aracatuba, Rua José Bonifácio 1193, Vila Mendonça, CEP 16015050, SP, Brasil Universidade Estadual Paulista Júlio de Mesquita Filho, Departamento de Cirurgia e Clínica Integrada, Faculdade de Odontologia de Araçatuba, Aracatuba, Rua José Bonifácio 1193, Vila Mendonça, CEP 16015050, SP, Brasil

Clinical experience has shown that most avulsed teeth are replanted after a long extra-alveolar time and dry or inadequate wet storage, causing necrosis of periodontal ligament cells. This condition invariably leads to development of external root resorption, leaving the filling material in contact with the periapical connective tissues. In this study, the periapical tissue reactions to calcium hydroxide (CH) and mineral trioxide aggregate (MTA) were evaluated after occurrence of external root resorption as an expected sequela of delayed tooth replantation. Twenty male Wistar rats (Rattus norvegicus, albinus) had their right upper incisor extracted and maintained in dry storage for 60 min. Then, the dental papilla, enamel organ, pulp tissue, and periodontal ligament were removed, and the teeth were immersed in a 2% acidulated phosphate sodium fluoride solution, pH 5.5, for 10 min. The teeth were randomly assigned into two groups (n = 10), in which the canals were filled with either a CH and saline paste (CH group) or MTA (MTA group). The sockets were irrigated with saline, and the teeth were replanted. After 80 days, it was possible to observe large areas of replacement root resorption and some areas of inflammatory root resorption in both groups. More severe inflammatory tissue reaction was observed in contact with calcium hydroxide compared with the mineral trioxide aggregate. New bone formation was more intense at the bottom of the socket in the MTA group. In conclusion, as far as periapical tissue compatibility is concerned, intracanal MTA can be considered as a viable option for root canal filling in delayed tooth replantation, in which external root resorption is an expected sequela.

Success of tooth replantation is limited because part of the replanted tooth is lost because of progressive root resorption. This study used histomorphometry and immunohistochemistry to evaluate the effect of low-level laser therapy (LLLT) on the healing process of rat teeth replanted after different extra-oral periods, simulating immediate and delayed replantation. Sixty Wistar rats (Rattus norvegicus albinus) had their maxillary right incisors extracted and randomly assigned to six groups (n = 10): C4, C30 and C45, in which the teeth were replanted 4 min (immediate), 30 min (delayed) and 45 min (delayed) after extraction, respectively, and L4, L30 and L45, in which the teeth were replanted after the same extra-alveolar times, but the root surfaces and the alveolar wounds were irradiated with a gallium-aluminum-arsenate (GaAlAs) diode laser before replantation. The animals were sacrificed after 60 days. The anatomic pieces containing the replanted teeth were obtained and processed for either histomorphometrical analysis under optical microscopy or immunohistochemical expression of receptor activator of nuclear factor Kappa-B (RANK), and its ligand (RANKL), osteoprotegerin (OPG) and tartrate-resistant acid phosphatase (TRAP) proteins. Areas of external replacement and inflammatory root resorption were observed in all groups, without statistically significant differences (P0.05). Ankylosis was more frequent in L30 than in C30 (P0.05). RANKL immunostaining predominated over RANK and OPG immunostaining in both groups with immediate tooth replantation (P0.05). For the 45-min extra-alveolar time, however, there was greater evidence of RANK immunostaining compared to RANKL for both control and laser-treated groups (P0.05). Positive TRAP immunostaining predominated in L4 and L30 (P0.05). In conclusion, under the tested conditions, the treatment of the root surface and the alveolar wound with LLLT did not improve the healing process after immediate and delayed tooth replantation in rats.

Euro-Collins solution was developed for the preservation of organs for transplantation, whose characteristics have raised interest for its use as a storage medium for avulsed teeth before replantation. This study evaluated histologically and morphometrically the healing process of dog teeth replanted after storage in Euro-Collins solution or bovine milk.Eighty roots of 4 young adult mongrel dogs were randomly assigned to 4 groups (n = 20) and the root canals were instrumented and obturated with gutta-percha and a calcium hydroxide-based sealer. After 2 weeks, the teeth were extracted and subjected to the following protocols: GI (negative control), replantation immediately after extraction; GII (positive control), bench-drying for 2 hours before replantation; GIII and GIV, immersion in 10 mL of whole bovine milk and Euro-Collins solution at 4 degrees C, respectively, for 8 hours before replantation. The animals were sacrificed 90 days postoperatively. The pieces containing the replanted teeth were subjected to routine processing for histologic and histometric analyses under light microscopy and polarized light microscopy.Root resorption was observed in all groups. GII exhibited the greatest loss of dental structure (P.01), and inflammatory resorption was predominant in this group. Storage in milk showed poorer results than immediate replantation and storage in Euro-Collins solution (P.01). The teeth stored in Euro-Collins solution presented similar extension of root resorption and periodontal ligament reorganization to those of immediately replanted teeth.The findings of this study suggest that the Euro-Collins solution is an adequate storage medium for keeping avulsed teeth for up to 8 hours before replantation.

Immediate replantation into the socket is the ideal procedure in cases of accidental avulsion of permanent teeth. In Brazil, firefighters with special paramedic training are in charge of providing first-aid care to victims of road accidents and might have to deal with tooth avulsions. This study assessed the knowledge of firefighters regarding the emergency management of avulsed teeth. Information was collected from a questionnaire submitted to 110 volunteer firefighters in seven cities in the São Paulo State (Brazil). The results revealed that 70.9% of the respondents did not know what tooth avulsion was; 53.6% did not know what tooth replantation was or defined it incorrectly; 60% would not act properly in tooth avulsion cases; 20.9% did not consider replantation of the avulsed tooth into the socket as a treatment option; the ideal time interval for tooth replantation was unknown to 40% of the interviewees; 90% of the participants answered that they would not be able to perform tooth replantation. Among those who considered themselves unable to perform tooth replantation, 47.3% chose saline as the best storage medium for an avulsed tooth, 21.8% chose milk, 3.6% chose the patient's mouth and 20% reported not knowing where to store the tooth; 81.8% of the firefighters reported not to have ever received any specific directions on tooth replantation and 100% of them considered this knowledge a requirement for first-aid care to accident victims. In conclusion, the knowledge of the surveyed firefighters regarding emergency management after tooth avulsion was unsatisfactory in several aspects that are important for the success of replantation procedures. Firefighters with special paramedic training should be educated on how to proceed in cases of dentoalveolar traumas and tooth avulsions in order to improve treatment prognosis and increase the survival rate of replanted teeth.

Minimal extraoral dry storage period and moist storage for the avulsed tooth are identified as key steps for the treatment protocol of tooth replantation. Among the possible moist storage media, bovine milk has stood out because of its capacity of preserving the integrity of the periodontal ligament (PDL) fibers. This condition has attracted the attention to investigate the use of powdered milk, which is one of the presentation forms of bovine milk, as a feasible storage medium in cases of delayed tooth replantation. The aim of this study was to evaluate the healing process after delayed replantation of rat teeth stored in reconstituted powdered milk and long shelf-life (ultra high temperature) whole milk. Forty maxillary right rat incisors were assigned to four groups (n = 10): group I--the teeth were extracted and immediately replanted into theirs sockets; group II--the teeth were stored for 60 min in 200 ml of freshly reconstituted powdered milk; group III--the teeth were stored for 60 min in 200 ml of long shelf-life whole milk; group IV--the teeth were kept dry for the same time. All procedures were performed at room temperature. Next, the root canals of teeth in groups II, III, and IV were instrumented, filled with a calcium hydroxide-based paste, and replanted into their sockets. All animals received systemic antibiotic therapy and were killed by anesthetic overdose 60 days after replantation. The pieces containing the replanted teeth were removed, fixed, decalcified, and paraffin-embedded. Semi-serial 6-microm-thick sections were obtained and stained with hematoxylin and eosin for histomorphological analysis. There was statistically significant difference (P0.05) between groups I and IV regarding the presence of replacement resorption and PDL remnants on root surface. The powdered milk and long shelf-life whole milk presented similar results to each other and may be indicated as storage media for avulsed teeth.

This paper reports a case of tooth replantation in which the splinting was performed with stainless steel orthodontic wire and a widely marketed brand of quick-setting cyanoacrylate ester adhesive (Super Bonder). The long-term clinical and radiographic success of the case reported in this paper indicates that the splinting technique using a quick-setting cyanoacrylate ester adhesive may be a feasible option for making a rapid, simple and efficient contention of replanted teeth in situations where the routinely used materials are not readily available.

Made available in DSpace on 2022-04-28T20:41:08Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-06-01 Clinical practice has shown that most avulsed teeth are replanted after an extra-alveolar time that compromises the prognosis of replantation. In cases of delayed replantation, the use of adequate media for storage and transportation of the avulsed teeth may improve this prognosis considerably. Difficulties inherent to accidental dental avulsion include the lack of immediate access to ideal storage media, which accentuates the importance of saliva as a viable and readily available option. The authors report the case of an accidentally avulsed permanent maxillary central incisor that was kept into the patient's oral cavity from the moment of trauma until its replantation, 90 min later. Three years of follow-up revealed absence of root resorption, ankylosis or abnormal mobility, which demonstrates the feasibility of keeping avulsed teeth in saliva, at least when more indicated storage media are not available immediately. © 2008 The Authors. Department of Surgery and Integrated Clinics Faculty of Dentistry of Araçatuba São Paulo State University (UNESP), Araçatuba, SP Disciplina de Clínica Integrada Faculdade de Odontologia de Araçatuba UNESP, Rua José Bonifácio, 1193, 16015-050 Araçatuba, SP Department of Surgery and Integrated Clinics Faculty of Dentistry of Araçatuba São Paulo State University (UNESP), Araçatuba, SP Disciplina de Clínica Integrada Faculdade de Odontologia de Araçatuba UNESP, Rua José Bonifácio, 1193, 16015-050 Araçatuba, SP

The time elapsed between a trauma and tooth replantation usually ranges from 1 to 4 h. The chances of root surface damage are higher when tooth replantation is not performed immediately or if the avulsed tooth is not stored in an adequate medium. This invariably leads to necrosis of pulp tissue, periodontal ligament cells and cementum, thus increasing the possibility of root resorption, which is the main cause of loss of replanted teeth. This paper presents a comprehensive review of literature on root surface treatments performed in cases of delayed tooth replantation with necrotic cemental periodontal ligament. Journal articles retrieved from PubMed/MedLine, Bireme and Scielo databases were reviewed. It was observed that, when there are no periodontal ligament remnants and contamination is under control, replacement resorption and ankylosis are the best results and that, although these events will end up leading to tooth loss, this will happen slowly with no loss of the alveolar ridge height, which is important for future prosthesis planning.

This study analyzed mineral trioxide aggregate (MTA) as a root canal filling material for the immediate reimplantation of monkey teeth. Four adult capuchin monkeys Cebus apella were used, which had their maxillary and mandibular lateral incisors on both sides extracted and reimplanted after 15 min. During the extra-alveolar period, the teeth were kept in saline solution and after reimplantation retention was performed with a stainless steel wire and composite resin for 14 days. After 7 days, the reimplanted teeth were submitted to endodontic treatment with biomechanics up to file n. 30 and irrigation with a saturated solution of calcium hydroxide [Ca(OH)(2)], and then divided into two study groups: group I - root canal filled with a Ca(OH)(2) paste, and group II - root canal filled with MTA. Radiographic follow up was performed at 30, 60 and 90 days postoperatively, and after 180 days the animals were killed and specimens were processed for histomorphological analysis. The results revealed that most specimens of both groups presented organized periodontal ligament with no inflammation. The resorptions observed were surface resorptions and were repaired by cementum. Both MTA and Ca(OH)(2) were good root canal filling materials for immediately reimplanted teeth, providing good repair and also allowing biological sealing of some lateral canals. There was no significant difference between the study groups (alpha = 29.60%).

Although it has already been shown that enamel matrix derivative (Emdogain) promotes periodontal regeneration in the treatment of intrabony periodontal defects, there is little information concerning its regenerative capacity in cases of delayed tooth replantation. To evaluate the alterations in the periodontal healing of replanted teeth after use of Emdogain, the central incisors of 24 Wistar rats (Rattus norvegicus albinus) were extracted and left on the bench for 6 h. Thereafter, the dental papilla and the enamel organ of each tooth were sectioned for pulp removal by a retrograde way and the canal was irrigated with 1% sodium hypochlorite. The teeth were assigned to two groups: in group I, root surface was treated with 1% sodium hypochlorite for 10 min (changing the solution every 5 min), rinsed with saline for 10 min and immersed in 2% acidulated-phosphate sodium fluoride for 10 min; in group II, root surfaces were treated in the same way as described above, except for the application of Emdogain instead of sodium fluoride. The teeth were filled with calcium hydroxide (in group II right before Emdogain was applied) and replanted. All animals received antibiotic therapy. The rats were killed by anesthetic overdose 10 and 60 days after replantation. The pieces containing the replanted teeth were removed, fixated, decalcified and paraffin-embedded. Semi-serial 6-microm-thick sections were obtained and stained with hematoxylin and eosin for histologic and histometric analyses. The use of 2% acidulated-phosphate sodium fluoride provided more areas of replacement resorption. The use of Emdogain resulted in more areas of ankylosis and was therefore not able to avoid dentoalveolar ankylosis. It may be concluded that neither 2% acidulated-phosphate sodium fluoride nor Emdogain were able to prevent root resorption in delayed tooth replantation in rats.

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:58:56Z No. of bitstreams: 1 S0103-64402005000100003.pdf: 472899 bytes, checksum: f1fa924e7fc7ce3700bed4df433bd64c (MD5) Made available in DSpace on 2013-08-22T18:58:56Z (GMT). No. of bitstreams: 1 S0103-64402005000100003.pdf: 472899 bytes, checksum: f1fa924e7fc7ce3700bed4df433bd64c (MD5) Previous issue date: 2005-04-01 Made available in DSpace on 2013-09-30T19:55:10Z (GMT). No. of bitstreams: 2 S0103-64402005000100003.pdf: 472899 bytes, checksum: f1fa924e7fc7ce3700bed4df433bd64c (MD5) S0103-64402005000100003.pdf.txt: 23380 bytes, checksum: 0562fb9f244dfe63400e5ba9fc2fc9d1 (MD5) Previous issue date: 2005-04-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:43:09Z No. of bitstreams: 2 S0103-64402005000100003.pdf: 472899 bytes, checksum: f1fa924e7fc7ce3700bed4df433bd64c (MD5) S0103-64402005000100003.pdf.txt: 23380 bytes, checksum: 0562fb9f244dfe63400e5ba9fc2fc9d1 (MD5) Made available in DSpace on 2014-05-20T13:43:09Z (GMT). No. of bitstreams: 2 S0103-64402005000100003.pdf: 472899 bytes, checksum: f1fa924e7fc7ce3700bed4df433bd64c (MD5) S0103-64402005000100003.pdf.txt: 23380 bytes, checksum: 0562fb9f244dfe63400e5ba9fc2fc9d1 (MD5) Previous issue date: 2005-04-01 O objetivo deste trabalho foi avaliar microscopicamente, em reimplantes tardios de dentes de rato, os efeitos do tratamento da superfície radicular com diferentes soluções. Foram utilizados 30 ratos Rattus norvegicus albinos da linhagem Wistar que tiveram seus incisivos centrais extraídos e deixados sobre a bancada por 6 h. As polpas foram extirpadas e os canais irrigados com solução de hipoclorito de sódio a 1%. Após o preparo endodôntico, a superfície radicular de cada dente foi tratada com solução de hipoclorito de sódio a 1% por 10 min (trocada a cada 5 min) seguida de soro fisiológico por 10 min, e os dentes foram divididos em três grupos com 10 espécimes em cada um. Nos Grupos I, II e III, respectivamente, a superfície radicular foi tratada com fluoreto de sódio fosfato acidulado a 2%, vitamina C e vitamina C efervescente (2 g, Redoxon®). Após obturação com pasta de hidróxido de cálcio os dentes foram reimplantados e os animais foram sacrificados aos 10 e 60 dias. O Grupo I apresentou maiores áreas de reabsorção por substituição e anquilose. Comparando as formas de vitamina C utilizadas, a efervescente (Grupo III) foi a que apresentou resultados mais favoráveis com mais áreas de anquilose e reabsorção por substituição que áreas de reabsorção inflamatória. This study evaluated microscopically the effects of root surface treatment with three different solutions in delayed rat teeth replantation. Central incisors from 30 rats (Rattus norvegicus, albinus Wistar) were extracted and left on a bench for 6 h. The pulps were extirpated and root canals were irrigated with 1% sodium hypochlorite. After endodontic treatment, the root surfaces of all teeth were submitted to a 10-min treatment with 1% sodium hypochlorite, changed every 5 min. The teeth were then rinsed with saline for 10 min and assigned to 3 groups with ten specimens each. Groups I, II and III were treated, respectively, with 2% acidulated-phosphate sodium fluoride, vitamin C solution and effervescent vitamin C (2 g, Redoxon®). After root surface treatment, the teeth were filled with calcium hydroxide and replanted. The animals were sacrificed after 10 and 60 days. Group I (fluoride) presented the largest areas of replacement resorption and ankylosis. Comparing both vitamin C groups, Group III (effervescent vitamin C) yielded better results, showing more areas of ankylosis and replacement resorption than areas of inflammatory resorption. UNESP Faculty of Dentistry of Araçatuba Department of Surgery and Integrated Clinics UNESP Faculty of Dentistry of Araçatuba Department of Surgery and Integrated Clinics

Made available in DSpace on 2014-06-11T19:23:40Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-02-25Bitstream added on 2014-06-13T19:30:05Z : No. of bitstreams: 1 marao_hf_me_araca.pdf: 3083195 bytes, checksum: 286d537c00737b1b6f019da2785d2ccc (MD5) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) A clínica tem mostrado que a maioria dos reimplantes dentários é tardia e nessa condição há necrose das células do ligamento periodontal e as reabsorções patológicas podem se instalar e levar à perda do dente. O objetivo do trabalho foi avaliar o MTA e o Ca(OH)2, no interior dos tecidos, após a reabsorção radicular externa em reimplante tardio de dente de rato. Foram utilizados 20 ratos (Rattus norvegicus albinus) machos que tiveram o incisivo direito extraído e mantido em meio seco por 60 minutos. Em seguida, a papila dentária, o órgão do esmalte, a polpa dentária e o ligamento periodontal foram removidos. Os dentes foram imersos em solução de fluoreto de sódio fosfato acidulado a 2% pH 5,5, por 10 minutos. Em seguida os canais foram secos e divididos em 2 grupos: Grupo I - canais radiculares foram preenchidos com pasta de Ca(OH)2 e soro fisiológico e Grupo II - com MTA. Os alvéolos foram irrigados com soro fisiológico e os dentes reimplantados. Após 80 dias foi possível observar extensas áreas de reabsorção por substituição e algumas inflamatória nos dois grupos experimentais. Houve uma reação inflamatória mais intensa em contato com o Ca(OH)2 quando comparado ao MTA. No fundo do alvéolo houve maior neoformação óssea no grupo do MTA, porém não houve diferença estatisticamente significante entre os grupos. È possível concluir que o MTA pode ser uma opção clínica viável para a obturação de dentes tardiamente reimplantados sujeitos à reabsorção radicular externa devido a sua biocompatibilidade com os tecidos Clinical practice has shown that most of reimplanted teeth are late, this condition produce necrosis of periodontal ligament cells and the pathological resorption may occur and produce dental loss. The aim of this study was to assess the biological behavior of MTA and Ca(OH)2, within the tissues after external root resorption in delayed late reimplanted rat teeth. Twenty male rats (Rattus norvegicus albinus) were used. The upper right incisor was extracted and was kept in a dry environment for 60 minutes. Then, the dental papilla, the enamel organ, the dental pulp and the periodontal ligament were removed. The teeth were immersed in 2% acidulous sodium fluoride solution pH 5.5 for 10 minutes. After that, the canals were dried and divided into 2 groups: Group I - the canals were filled with Ca(OH)2 and saline and Group II - with MTA. Sockets were irrigated with saline solution and the teeth were reimplanted. After 80 days was possible to observe large areas of replacement resorption and some inflammatory root in both groups There was more intense inflammatory reaction in contact with Ca(OH)2 when compared to MTA. At the bottom of the alveolar socket, bone neoformation was greater in the group of MTA, but there was no statistically significant difference between the groups. It’s possible to conclude that MTA may be a viable clinical option for filling of late dental reimplanted subject to external root resorption due to its biocompatibility with the tissues

Made available in DSpace on 2014-06-11T19:23:45Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-12-03Bitstream added on 2014-06-13T18:51:18Z : No. of bitstreams: 1 trevisan_cl_me_araca.pdf: 4571507 bytes, checksum: e415990505fc911f3b7ce5a5b875261f (MD5) O prognóstico do reimplante dentário tardio está vinculado à necessidade do tratamento endodôntico uma vez que a necrose pulpar tem uma relação direta com o surgimento da reabsorção radicular externa do tipo inflamatória. Muitas pesquisas têm sido realizadas com o objetivo de se prevenir, retardar ou tratar essa complicação e o hidróxido de cálcio é a substância mais empregada devido às suas propriedades antimicrobiana e reparadora tecidual. O objetivo do trabalho é avaliar o processo de reparo no reimplante tardio de dentes de rato, utilizando o hidróxido de cálcio (Ca(OH)2) associado ao paramonoclorofenol canforado (PMCC) ou à clorexidina (CHX) como curativo de demora em relação ao Ca(OH)2 associado ao soro fisiológico na prevenção e/ou controle da reabsorção radicular inflamatória. Trinta ratos (Rattus norvegicus albinus) machos, divididos em 3 grupos de 10 animais, tiveram o incisivo direito extraído e mantido em meio seco por 60 minutos. Em seguida, a papila dentária, o órgão do esmalte, a polpa dentária e o ligamento periodontal foram removidos. Os dentes foram imersos em solução de fluoreto de sódio fosfato acidulado a 2% pH 5,5, por 10 minutos. Após esse procedimento, os canais foram secos com cone de papel absorvente e divididos em 3 grupos, de acordo com o curativo de demora empregado: Grupo I: canais radiculares preenchidos com pasta de Ca(OH)2 e soro fisiológico, Grupo II: com pasta de Ca(OH)2 e PMCC e Grupo III: com pasta de Ca(OH)2 e solução de CHX 2%. Os alvéolos foram irrigados com soro fisiológico e os dentes reimplantados. A análise histológica mostrou presença de reabsorção inflamatória, por substituição e anquilose nos três grupos e a análise estatística mostrou diferença estatisticamente significante entre o grupo III e os demais grupos experimentais com relação à porcentagem... The prognosis of delayed tooth replantation is linked to the need of endodontic treatment, once that necrotic pulp has a direct relationship with the rise of inflammatory external root resorption. Much research has been conducted with the objective of preventing or treating this complication and calcium hydroxide is the most commonly used substance because of its antimicrobial and tissue repairing properties. The aim of this study is to evaluate the repair process of the delayed teeth replantation in rat, treated with calcium hydroxide (Ca(OH)2) associated with camphorated p-monochlorophenol (CMCP) or chlorhexidine 2 % (CHX), and Ca(OH)2 in saline solution as temporization dressing to prevent and/or control inflammatory resorption. Thirty rats (Rattus norvegicus albinos) had extracted the right incisor and that was kept in a dry state for 60 minutes. Subsequently, the dental papilla, the enamel organ, the dental pulp and periodontal ligament were removed. The teeth were immersed in a solution of sodium fluoride acidulated 2% pH 5.5 for 10 minutes. After this procedure, the canals were dried with absorbent paper cone and divided into 3 groups, of 10 animals of which, according to the dressing: Group I: root canals filled with Ca(OH)2 and saline solution, Group II: with Ca(OH)2 and CMCP and Group III: with Ca(OH)2 and CHX 2%. The teeth sockets were irrigated with saline solution and the teeth were replanted. While histological analysis revealed the presence of inflammatory resorption, ankylosis and replacement in all three groups, statistical analysis showed a significant difference between group III and other groups. Departing from these results, it was concluded that the association between the use of Ca(OH)2 with PMCC or CHX did not show an advantage over the use of Ca(OH) 2 paste and saline solution to prevent and/or control the inflammatory root reabsorption in delayed replantation of rat teeth.

Made available in DSpace on 2014-06-11T19:31:10Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-12-05Bitstream added on 2014-06-13T19:01:32Z : No. of bitstreams: 1 saito_ctmh_dr_araca.pdf: 1370447 bytes, checksum: 0544c01b7d98b4a18130232bf544f6b0 (MD5) O sucesso do reimplante dentário, mesmo nos dias atuais, é limitado, pois grande parte dos dentes é perdida devido à reabsorção radicular progressiva, justificando a busca de novas estratégias que possam controlar esse problema. Assim, foi objetivo deste estudo, avaliar por meio de análise histomorfométrica e imunoistoquímica, a ação do laser em baixa intensidade (LLLT) sobre o processo de reparo após reimplante dentário em ratos. Sessenta ratos (Rattus norvegicus albinus, Wistar) tiveram seus incisivos superiores direitos extraídos e foram aleatoriamente divididos em seis grupos: C0, C30 e C45 considerados controles, onde o reimplante dentário foi realizado imediatamente, trinta e quarenta e cinco minutos após a exodontia respectivamente, sem nenhum tratamento do ligamento periodontal remanescente e L0, L30 e L45, onde o reimplante foi realizado nos mesmos tempos extra-alveolares dos controles, porém a superfície radicular e alvéolo, com remanescentes do ligamento periodontal, foram tratados com LLLT (Arseneto de Gálio e Alumínio) antes do reimplante. Os animais foram eutanasiados após 60 dias. Os resultados evidenciaram reabsorções radiculares externas por substituição e inflamatória em todos os grupos, não apresentando diferença significativa entre o grupo controle e tratado em cada período de tempo extra-alveolar (P>0,05). A anquilose, porém, foi maior no grupo L30 em comparação com o C30 (P0.05) between the treatment modalities when used for tooth replantation in each extra-alveolar period, but anchylosis was bigger in L30 (P

Made available in DSpace on 2014-06-11T19:23:40Z (GMT). No. of bitstreams: 0 Previous issue date: 2006-12-01Bitstream added on 2014-06-13T19:50:40Z : No. of bitstreams: 1 gulinelli_jl_me_araca.pdf: 1896250 bytes, checksum: a6ca7f08b2f54484e847f5458f7e5512 (MD5) Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) O reimplante dentário é a melhor opção para o tratamento da avulsão. Todavia, período extrabucal prolongado ocasiona danos ao ligamento periodontal, que desencadeiam processos de reabsorção radicular externa. O objetivo desse estudo foi avaliar histomorfometricamente, a viabilidade da solução de própole e a de flúor no controle da reabsorção radicular externa no processo de reparo do reimplante tardio. Trinta ratos (Rattus norvegicus albinus, variedade Wistar) tiveram seu incisivo superior direito extraído. Os dentes foram mantidos em meio seco por 60 minutos. Após esse período a papila dentária, o órgão do esmalte e o ligamento periodontal removidos com lâmina de bisturi e a polpa foi extirpada. Os dentes foram divididos em três grupos experimentais: grupo I - dentes imersos em 20 ml de solução de soro fisiológico; grupo II - dentes imersos em 20 ml de solução de fluoreto de sódio fosfato acidulado a 2%; grupo III - imersão dos dentes em 20 ml de solução de própole a 15%. Após 10 minutos de imersão nas soluções, os canais radiculares foram secos e preenchidos com pasta de hidróxido de cálcio e os dentes reimplantados. A eutanásia dos animais ocorreu 60 dias após o ato operatório. Os resultados mostraram presença de reabsorção inflamatória, por substituição e anquilose nos três grupos experimentais, não apresentando diferença significativa quando submetidos à análise comparativa, o que levou a conclusão de que o tratamento da superfície radicular com própole se mostrou semelhante ao do flúor com relação à reabsorção radicular externa. Apesar de não apresentarem diferença estatisticamente significante, houve maior quantidade de reabsorção inflamatória do soro fisiológico quando comparado ao flúor e à própole. Tooth replantation is the best option for treatment of an avulsed tooth. Nevertheless, an extended extraoral period damages the periodontal ligament, and results in external root resorption. The purpose of this study was to assess by histologic and histometric analysis, the influence of propolis and the fluoride solution used as root surface treatment on the healing process after delayed tooth replantation. Thirty Wistar (Rattus norvegicus albinus) were submitted to extraction of their upper right incisor. The teeth were maintained in a dry environment for 60 minutes. After this time the pulp was extirpated and the papilla, enamel organ and periodontal ligament were removed with scalpel. The teeth were divided in to three experimental groups: group I - teeth immersed in 20 ml of physiologic saline; group II - teeth immersed in 20 ml of 2% acidulated phosphate sodium fluoride; group III - teeth immersed in 20 ml of 15% propolis. After 10 minutes of immersion in the solutions, the root canals were dried and filled with calcium hydroxide paste and the teeth were replanted. The animals were euthanized 60 days after replantation. The results showed the similar external root resorption was seen in the propolis and fluoride groups. Teeth treated with physiologic saline tended to have more inflammatory root resorption compared to those treated with fluoride or propolis. However, the comparative analysis did not reveal any statistically signifant differences between the treatment modalities when used for delayed tooth replantation.