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Background: An efficient therapeutic strategy for patients with replanted teeth has been extremely challenging because complete displacement of the teeth is inevitably accompanied by severe damage to periodontal tissue. Enamel matrix derivative (EMD) shows promise for periodontal regeneration, but its effects on replanted teeth remain unknown. This study systematically summarized the biological basis of EMD in replantation dental therapy and assessed its effect on clinical prognosis., Methods: Potential studies were searched via the Cochrane Library, Web of Science and PubMed databases from inception to November 23, 2023., Results: A total of 329 patients with 375 replanted teeth met the inclusion criteria. Our pooling results indicated that EMD did not provide a numerical advantage for restoring normal PDL healing in replanted teeth (RR=0.38, P =0.161). A significantly lower extraction risk was observed in EMD-treated group than non-EMD-treated group (RR=0.47, P =0.001). Moreover, the survival rate of replanted teeth with root resorption was significantly increased by the application of EMD (RR=2.21, P =0.017). Although the pooled outcomes suggested increased incidence of surface resorption (RR=1.19, P =0.730) and decreased risk of inflammation resorption (RR=0.68, P =0.560) among replanted teeth with resorption in the EMD-treated group, neither difference was statistically significant., Conclusion: For patients with replanted teeth, EMD treatment may not result in a numerical increase in normal PDL healing. However, as a biological regulator, EMD may arrest the progression of resorption, thus reducing the risk of extraction in the early stage. Well-designed randomized trials are required to validate these results due to the poor quality of evidence.

Background/aims: The preservation of avulsed teeth is critical in dental trauma management, necessitating effective storage media to ensure viable tooth reimplantation. The urgent need for accurate information has led both professional and non-professional individuals to increasingly seek guidance from video-sharing platforms such as YouTube™ and TikTok™. These platforms have become key resources for advice on such dental emergencies, but the reliability and accuracy of this information have not yet been systematically evaluated. This study aimed to assess the quality, accuracy, and reliability YouTube™ and TikTok™ of videos regarding storage solutions for avulsion injuries., Material and Methods: A search was conducted on YouTube™ and TikTok™ on February 4th, 2023, using terms related to traumatic dental injuries, and 53 videos were included. Video demographics such as platform, duration, type, upload date, likes, and comments were recorded. Video content quality, reliability, and accuracy were measured using the Global Quality Scale (GQS), Journal of the American Medical Association (JAMA) benchmarks, and Video Information and Quality Index (VIQI). Research data were analyzed using SPSS IBM 24.0 at a 95% confidence interval., Results: In total, 53 videos were examined. The average scores were JAMA: 1.70/4.00, modified DISCERN: 54.3/80.00, GQS: 3.88/5.00, and VIQI: 13.8/20.00. According to the modified DISCERN index, there were no "very poor" or "poor" quality videos, 49.05% were "moderate," 22.6% were "good," and 28.3% were "very good." No difference was found between YouTube™ and TikTok™ videos in terms of the modified DISCERN index, JAMA scores, GQS, and VIQI scoring (p > .05)., Conclusions: Traumatic dental injuries are a common problem among children, and evaluating the reliability of available contents is becoming crucial for appropriate intervention. The study reveals that despite being sourced mainly from dental professionals, the overall quality of videos on avulsed tooth management was mediocre, underscoring the risks associated with misleading or incomplete information in such critical situations., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: An altered sensation during endodontic treatment can occur due to the extrusion of endodontic materials. This study aims to discuss intentional replantation to address paresthesia resulting from an endodontic file penetrating the inferior alveolar nerve canal and provide a protocol for managing nerve injuries in such incidents., Case Presentation: A 12-year-old girl developed paresthesia when an endodontic file separated and was inadvertently pushed through the apical foramen into the inferior alveolar nerve canal during root canal treatment of the mandibular left first molar. A CBCT scan revealed the file penetrating the canal towards the inferior border of the mandible. After considering the treatment options, intentional replantation was deemed suitable. The tooth was atraumatically extracted and preserved in sterile saline. The surgeon then carefully cleaned and irrigated the socket. The radiographic assessment confirmed successful file removal from the socket. The root ends were resected, and retrograde preparation and obturation were conducted using ultrasonic tips and mineral trioxide aggregate. The tooth was then replanted into the socket. Successful replantation was confirmed by tooth stability and an audible click. The patient was prescribed antibiotics and steroids. After completion of the endodontic treatment, a stainless steel crown was cemented. The successful intentional replantation procedure resulted in rapid improvement in the patient's condition. The normal sensation had been restored, indicating nerve recovery. At the 15-month follow-up, periapical bone healing and the eruption of the adjacent second molar were observed, affirming the treatment protocol's overall success., Conclusion: Prompt intervention and immediate intentional replantation facilitated direct inspection of the separated file within the socket. Collaboration between an oral maxillofacial surgeon and an endodontist ensures expedited and targeted treatment, leading to favorable outcomes.

Background: Jaw cysts often deeply involve adjacent tooth roots, making it difficult to preserve them. The purpose of this retrospective study was to investigate the effectiveness of an intentional replantation (IR) strategy combined with cyst enucleation in preserving cyst-involved teeth during jaw cyst removal., Materials and Methods: Fifteen patients with jaw cysts and deeply involved teeth were treated with IR and cyst enucleation. All patients received root canal therapy prior to surgery, except for one patient who received it during surgery. The involved teeth were extracted, and the root surface was carefully cleaned before IR and cyst enucleation. Patients were followed up for 12-14 months, with indicators including clinical complaints, replanted tooth stability, and root resorption., Results: No cyst recurrence was observed, and all replanted teeth survived with good local gingival condition and no marked swelling or recession. Radiographic findings showed clear periodontal space surrounding the replanted teeth. One replanted tooth exhibited slight root resorption due to occlusal trauma, but the resorption ceased after occlusal adjustment., Conclusions: IR combined with cyst enucleation is an effective strategy for thoroughly cleaning jaw cysts and preserving teeth involved in the cyst., Competing Interests: Declaration of Competing Interest We declare that none of the work contained in this manuscript is published in any language or currently under consideration at any other journal. And there are no conflicts of interest to declare. All authors have contributed to, read, and approved this submitted manuscript in its current form., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Background: Identification of tooth ankylosis before comprehensive orthodontic treatment can be challenging. This case series illustrates different presentations of tooth ankylosis, the importance of early diagnosis, the use of surgical luxation to aid orthodontic alignment of ankylosed teeth and its sequelae., Case Presentation: All three cases were adolescents: a 14-year-old girl with a highly placed upper left lateral incisor and history of general anaesthesia; a 14-year-old boy with an impacted upper right first premolar and history of dental trauma; and a 13-year-old girl with an infraoccluded upper left central incisor with history of replantation due to avulsion. Iatrogenic malocclusion developed from attempts to align these ankylosed teeth. Subsequently, surgical luxation was performed, and the ankylosed teeth were successfully aligned. However, it was associated with pulp calcification, root resorption and recurrence of ankylosis., Conclusion: Surgical luxation and orthodontic alignment of ankylosed teeth can be considered a useful short-term solution to delay the need of surgical removal and teeth replacement., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This research focused on analyzing gene expression changes in the periodontal ligament (PDL) after tooth re-plantation to identify key genes and pathways involved in healing and regeneration. Utilizing a mouse model, mRNA was extracted from the PDL at various intervals post-replantation for RNA sequencing analysis, spanning from 3 to 56 days. The results revealed significant shifts in gene expression, particularly notable on day 28, supported by hierarchical clustering and principal component analysis. Gene ontology (GO) enrichment analysis highlighted an upregulation in olfactory receptor and G protein-coupled receptor signaling pathways at this time point. These findings were validated through reverse transcription-quantitative PCR (RT-qPCR), with immunochemical staining localizing olfactory receptor gene expression to the PDL and surrounding tissues. Moreover, a scratch assay indicated that olfactory receptor genes might facilitate wound healing in human PDL fibroblasts. These results underscore the importance of the 28-day post-transplant phase as a potential "tipping point" in PDL healing and regeneration. In conclusion, this research sheds light on the potential role of olfactory receptor genes in PDL regeneration, providing a foundation for developing new therapeutic approaches in tooth replantation and transplantation, with broader implications for regenerative medicine in oral health., (© 2024. The Author(s).)

Introduction: The evaluation of pulp status is crucial for avulsed immature permanent teeth after replantation. In addition to commonly used clinical and radiographic examinations providing clinical evidence, the oxygen saturation test may offer valuable assistance. The aim of this study was to analyze the efficacy of a pulse oximeter in evaluating pulp status in avulsed and replanted immature permanent teeth., Methods: A prospective observational study was performed including 51 avulsed and replanted immature permanent teeth. Routine clinical and radiographic examinations were performed and used as the basis for the diagnosis of pulp status during the 1-year follow-up period. Meanwhile, the oxygen saturation values of these teeth were recorded using a modified pulse oximeter at each visit., Results: Seven teeth completed pulp revascularization (success group), whereas 44 teeth failed to revascularize (failure group). Abnormal clinical and/or radiographic manifestations in the failure group were observed at an average period of 42.7 days, which was too late because a high incidence of inflammatory root resorption (43.18%) had occurred. For oxygen saturation tests, teeth in the success group showed an immediate postreplantation oxygen value of 70.71 ± 3.35, then an upward trend starting from the 2-week postreplantation visit, and a significantly increased final value of 81.86 ± 2.34 at the 1-year visit. In contrast, no increase trend was found for teeth in the failure group because abnormal clinical and/or radiographic manifestations emerged., Conclusions: The oxygen saturation test is a reliable diagnostic method to evaluate pulp status of avulsed teeth as early as 2 weeks after replantation., (Copyright © 2024 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Objective: Intentional replantation (IR) is considered as a viable treatment option to preserve the teeth with apical periodontitis. This study aimed to compare the treatment outcomes of IR in teeth with or without periodontal involvement, and to investigate the influence of related factors., Methods: A total of 157 teeth with a documented history of IR between September 2012 and November 2022 and a follow-up duration of more than 1 year were included. The samples included 100 teeth with simple apical periodontitis and 57 teeth with combined periodontal-endodontic lesions (CPEL). Clinical and radiographic criteria were used to evaluate treatment outcomes including functional retention and extraction. Chi-square analyses and Fisher's exact tests were used to compare bivariate associations between outcomes and clinical or demographic variables. Kaplan-Meier analyses were used to evaluate the cumulative survival rate of the intentionally replanted teeth., Results: The overall cumulative survival rates were 93.0% at 1 year, 76.7% at 5 years, and 56.2% at 10 years. Among the 100 teeth with simple apical periodontitis, the survival rates were 93.0%, 86.7%, and 78.8% at the same time points. In contrast, 57 teeth with CPEL exhibited survival rates of 93.0%, 65.0%, and 36.9%, respectively. The primary postoperative complications that led to extraction were periodontal involvement (51.9%), tooth fracture (18.5%), external root resorption (18.5%), and persistent apical periodontitis (11.1%). The outcomes of teeth with CPEL were significantly affected by the presence of a sinus tract and crown restoration. In contrast, no significant prognostic factors were identified for teeth without periodontal involvement., Conclusion: The long-term prognosis of teeth with CPEL is significantly worse than those with simple apical periodontitis. The main reason of extraction was periodontal involvement. Regular periodontal maintenance and appropriate crown restoration may help to improve the prognosis for teeth with CPEL., (Copyright © 2024 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Objective: To investigate the clinical effect of implant-assisted dental intentional replantation (IR) for the treatment of "drifted" anterior periodontally hopeless teeth (PHT)., Methods: The present authors recruited 22 patients with stage III/IV periodontitis who suffered drifting of the maxillary anterior teeth, with a total of 25 teeth. The PHT were extracted for in vitro root canal treatment (RCT). The root surface was smoothed and the shape was trimmed, and the alveolar socket was scratched. The dental implant system was used to prepare the alveolar socket according to the direction, depth and shape of the tooth implantation. The PHT were reimplanted into the prepared alveolar socket. The periodontal indicators were analysed statistically before and after surgery., Result: Twenty-two patients who completed the full course of treatment, with a total of 25 PHT, had a successful retention rate of 88%. Mean periodontal probing depth (PPD) decreased by 2.880 ± 0.556 mm and 3.390 ± 0.634 mm at 6 months and 1 year, respectively, and clinical attachment loss (CAL) decreased by 2.600 ± 0.622 mm and 2.959 ± 0.731 mm at the same time points, respectively, showing significant improvement (P < 0.05)., Conclusion: Dental implant system-assisted IR can effectively preserve "drifted" natural PHT in patients with stage III/IV periodontitis.

Background: Tooth avulsion represents the most severe form of dental trauma, necessitating tooth replantation as the primary treatment. However, the risk of replacement root resorption (RRR) poses a significant threat to tooth retention following replantation. This study preliminarily aimed to investigate the effect of physiological occlusal force on RRR after the replantation of avulsed teeth and to explore the potential underlying mechanisms., Methods: Thirty-six 4-week-old male Sprague-Dawley rats underwent extraction and immediate replantation of their left maxillary molars. The rats were randomly divided into two major groups: the occluded (n = 18) group, where the opposite mandibular teeth were preserved; non-occluded (n = 18) group, where the opposite mandibular teeth were extracted. Within each major group, there were three subgroups corresponding to 7 days, 14 days, and 2 months, resulting in a total of six subgroups, (n = 6 per subgroup). The right maxillary first molars served as the normal control. Various periodontal characteristics were assessed using haematoxylin-eosin (H&E), tartrate-resistant acid phosphatase (TRAP) staining, and micro-computed tomography (micro-CT)., Results: Histological staining revealed that under occlusal force, the early stage (day 7) after tooth replantation mainly manifested as root surface resorption, especially in the non-occluded group, which gradually diminished over time. Cementum and periodontal ligament (PDL) repair was observed on day 14. Micro-CT analysis indicated a significant decrease in PDL width in the non-occluded group two months after replantation, consistent with the histological findings, signifying severe RRR in the non-occluded group., Conclusions: This study provides preliminary evidence that physiological occlusal force may attenuate osteoclastogenesis during the early stage of tooth replantation, thereby reducing the occurrence of RRR and promoting periodontal healing., (© 2024. The Author(s).)

Simultaneous avulsion of four or more teeth is a rare event. This case report examines the dental care given to an adult who, during a bicycle accident, experienced the avulsion of a mandibular incisor as well as all of his maxillary incisors. In the immediate aftermath of the accident, four out of the five incisors were located, promptly collected, and stored in a tooth rescue box, all within a 20-min window. Replantation and splinting were performed on the day of the accident. Endodontic treatment involved sequential intracanal dressing with an antibiotic-corticosteroid paste followed by calcium hydroxide prior to root canal obturation. 3 months post-accident, signs of external replacement resorption (ERR) began to appear in all the replanted teeth. The gap created by the missing maxillary central incisor was managed with a three-unit fixed dental prosthesis, despite the onset of ERR in the incisors used as abutment teeth. Regular follow-ups showed a relatively slow ERR progression rate over a span of nearly 6 years. The patient expressed satisfaction with both the esthetic and functional outcomes. This case, marked by multiple avulsions, underscores the importance of immediate and appropriate intervention alongside the imperative for carefully considered long-term management strategies. Given the decelerated bone remodeling rate in adults, ERR generally progresses at a slower pace than in children. Accordingly, this case demonstrates the viability of retaining replanted teeth over the long term, even when these teeth have been subjected to nonphysiological storage for extended durations, a factor known to impede periodontal healing., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Up to 25% of the tooth extraction after root canal treatment could be attributed to the vertical root fracture (VRF). The treatment choice for teeth with VRF would mostly be the extraction despite some repairing methods were also reported. The repairing treatment result of VRF would mostly depend on the fixation strength and the bioactivity of the repairing materials, especially for the posterior teeth with high masticating stresses. This case report designed a novel surgical treatment approach for the VRF of posterior teeth., Methods: a maxillary premolar with buccal-palatal complete VRF was treated with a new dual-layered repairing approach using adhesive resin + iRoot BP Plus bioceramic cement to fill the modified fracture line with retention forms through the intentional replantation., Results: At the 24-month review, the tooth showed desirable periodontal healing and normal function., Conclusions: This case report indicated that the dual-layered repairing approach might be effective for saving the posterior teeth with VRF. Nevertheless, further clinical trials are needed for its long-term result., (© 2024. The Author(s).)

Purpose: To explore the therapeutic effect of stromal cell derived factor-1α(SDF-1α) combined with platelet-poor plasma(PPP) on permanent tooth avulsion injury., Methods: One hundred and forty-four patients with permanent tooth avulsion injuries admitted to Hengshui People's Hospital from March 2020 to March 2022, with a total of 152 affected teeth were included. They were randomly divided into experimental group of 72 cases(76 teeth) and control group of 72 cases(76 teeth). The control group underwent routine replantation surgery, and the root tips were soaked and rinsed with PPP biological solution before surgery. On the basis of the control group, the experimental group implanted SDF-1α into the alveolar fossa before in vitro tooth implantation for treatment. The patients were followed up for 12 months after surgery, the success rate of implantation, degree of postoperative occlusal pain, expression of inflammatory factors in gingival fluid, serum growth factor expression, and incidence of postoperative complications were compared between the two groups. Statistical analysis was performed with SPSS 19.0 software package., Results: The success rate of replantation in the control group was 90.79%(69/76), while the experimental group was 98.68%(75/76). The success rate of replantation in the experimental group was significantly higher than that in the control group(P＜0.05). On the 2nd day, 3 months and 12 months after surgery, the pain scores of the two groups of patients gradually decreased (P＜0.05). There was no significant difference in pain scores between the two groups at each time point(P＞0.05). One month after surgery, the CRP and IL-6 levels in both groups decreased(P＜0.05), while the experimental group was significantly lower than the control group(P＜0.05). The soluble intercellular adhesion factor (sICAM-1) in both groups increased, and the experimental group was significantly higher than the control group (P＜0.05). One month after surgery, vascular endothelial growth factor(VEGF), fibroblast growth factor(FGF), transforming growth factor beta(TGF-β)and platelet derived growth factor(PDGF) were all elevated, and the experimental group was significantly higher than the control group(P＜0.05). The incidence of postoperative complications in the experimental group was significantly lower than that in the control group(P＜0.05)., Conclusions: The combination of PPP and SDF-1α in treating patients with permanent tooth avulsion injury has a high success rate of delayed replantation and a low incidence of postoperative adverse reactions.

Background/aim: There are few long-term clinical follow-up studies on human teeth replanted immediately or after storage in a suitable storage medium prior to replantation. This study aimed to assess the risk of ankylosis in avulsed human teeth replanted immediately or after storage in physiological media for a short time., Material: Data from 116 patients with 145 replanted avulsed permanent teeth were selected from a comprehensive dental trauma database in Copenhagen University Hospital. The following teeth were selected: Group 1 comprised 36 teeth replanted immediately (dry time <6 min; wet time <6 min). Group 2 comprised 61 teeth replanted after physiologic storage media (saliva and saline) (dry time <6 min; wet time >5 min; wet time ranged from 7 to 170 min, and mean wet time was 59 min). Group 3 (control) included 48 teeth replanted after dry storage (dry time > 60 min)., Method: Clinical and radiographic registrations were carried out according to a standardized protocol; follow-up ranged from 7 months to 23 years. Ankylosis was diagnosed by percussion test and radiographs and related to the conditions prior to replantation and stage of root development., Results: The overall risk of ankylosis was 17.2% [95% CI: 4.61; 29.79] for immediately replanted teeth, 55.3% [95% CI: 42.54; 68.00] for teeth stored in physiologic media before replantation, and 85.7% [95% CI: 75.70; 95.73] for teeth stored dry more than 1 h. Mature teeth showed a significantly higher risk of ankylosis than immature teeth., Conclusion: This clinical long-term study has verified earlier experimental studies showing that immediate reimplantation has the lowest risk of ankylosis. Physiologic storage media are good alternatives that also reduce the risk of ankylosis compared to dry storage, where ankylosis is more likely although not always seen. Mature teeth are significantly more likely to develop ankylosis., (© 2023 The Authors. Dental Traumatology published by John Wiley & Sons Ltd.)

Tooth avulsion is a frequently encountered dental emergency. Children are commonly reported group due to frequent sports activities, trauma, accidents and falls. Prompt emergency management is vital for long term success and to avoid morbidity. The study was aimed to assess the understanding of intern dentists about the emergency handling of avulsed teeth cases as mostly they are first responders among health care personnel. In this study a fourteen-item questionnaire with predefined responses was shared as online Google survey form with intern dentists of 5 different dental teaching hospitals of Islamabad, Pakistan. The duration of the study was 6 months (01 March 2022 to 31 August 2022). The questions were intended to collect personal information and to check level of knowledge and awareness about the management of avulsed tooth among the dental interns. The data was analyzed by statistical methods and is presented through tables and descriptive methods. In total, 152 participants completed the shared questionnaire. The vast majority (71%) of them were aware of the initial management of avulsed teeth, 49% were aware of the ideal transport medium for an avulsed tooth, (43%) were aware of the critical time for successful replantation, while (62%) had knowledge of the multiple factors responsible for the outcome of the tooth replantation. For majority of the statements, female participants had better knowledge as compared to their male counterparts. Statistically significant difference was noted for the statement " If you found the knocked-out tooth and it is dirty what will be your initial approach? " with female participants having better knowledge as compared to the male ( p value = 0.005). Based on our study results, generally dental interns are well-informed but still lack expected level of awareness regarding the proper management protocol for avulsed tooth. Hence, improvement is needed regarding the effective handling of avulsed teeth cases., Competing Interests: The authors declare no conflict of interest., (©2024 The Author(s). Published by MRE Press.)

Intentional replantation (IR) is the intentional extraction of a tooth followed by its replacement back into its socket for the purpose of performing a root-end surgery or other necessary repairs. The procedure may be considered a favorable alternative to conventional microsurgery, especially when surgical access is restricted due to specific anatomical challenges. With advancements in magnification, bioceramics, and instrumentation, IR has become a well-established, scientifically supported treatment modality and is cost-effective when compared to single-implant placement. This article discusses the rationale and indications for IR, describes treatment protocols, and reports on its outcomes.

With the development of periodontal regenerative technology, an increasing number of scholars reported that advanced periodontitis involving teeth can be preserved through intentional replantation. Intentional replantation has become the last possible method to preserve natural teeth for advance periodontitis with signs of tooth extraction. However, the indications of intentional replantation are strict, and the success of the operation is closely related to the condition of cases and the operation skills of doctors. In this article, the operation steps and criteria of intentional replantation were summarized by introducing three success cases of advanced periodontitis involving teeth preserved by intentional replantation. The relevant factors that affect the prognosis of intentional replantation in advanced periodontitis involving teeth preservation were analyzed to help clinicians preserve natural teeth.

Background/aim: There is no thorough overview of intentional tooth replantation techniques. We performed a bibliometric analysis of the development of intentional tooth replantation., Materials and Methods: A comprehensive search of the Web of Science and SCOPUS databases was conducted in February 2023. Original articles and reviews of human studies with "intentional replantation" or synonyms in the titles, abstracts, or keywords were included. A descriptive analysis of bibliographic data, co-occurrence analysis, and coupling of publications was performed. Multivariate analysis was used to explore the bibliometric parameters associated with the citation counts., Results: The study included 171 papers, which were co-authored by 500 individuals affiliated with 217 institutions from 28 countries/regions. The USA contributed the greatest number of publications, followed by China, and Japan. The USA had 694 citations, followed by Japan (210), and Turkey (210). The Journal of Endodontics and Dental Traumatology contributed the most citations. Five directions for future research were identified based on the coupling relationships of publications, including "managing vertical root fractures with adhesive resin using the intentional replantation technique," "intentional replantation for periodontally hopeless or endodontically compromised teeth," "intentional replantation for treating abnormalities of morphological development," "outcomes and prognosis factors of intentional replantation," and "treating root replacement resorption by intentional replantation." Multivariate analysis showed that the publication year, Journal Citation Reports ranking of journals, study design, and disease type were predictors of citation counts., Conclusions: This bibliometric analysis provides a comprehensive description of the intentional replantation technique. The USA published the greatest volume of papers and generated the most citations. The Journal of Endodontics and Dental Traumatology are considered the most influential. The Journal Citation Reports journal ranking (Q1, Q2), study design (case reports, cohort studies), and disease type (crown root fractures) were associated with the citation counts., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

This systematic review evaluated preclinical studies to assess whether PBM has a more favorable histological response than other treatments used before delayed replantation of avulsed teeth. This review followed the PRISMA checklist and was registered in PROSPERO. MEDLINE (PubMed), Embase, Scopus and Web of Science were searched from their inception to July 14, 2022. Data were independently extracted by two reviewers. Data were collected about species, number of animals, number and type of teeth, groups evaluated, extra-alveolar time, parameters for PBM and other study groups, presence and characteristics of containment, observation time points, evaluation methods, characteristics evaluated, and significant results. The ARRIVE and SYRCLE tools were used to assess the methodological quality and risk of bias (RoB) of the studies. After screening, six studies were included in the review synthesis. Three of the four studies that evaluated root resorption as an outcome found that PBM decreases its occurrence after delayed tooth replantation. A meta-analysis was not conducted because some data were missing in the included studies. Half of the studies evaluating ankylosis found an increase in its occurrence after PBM. Two studies evaluated inflammatory responses and found a reduction of inflammation after PBM. In general, studies had high methodological heterogeneity, intermediate reporting quality and high RoB. Despite the methodological quality and RoB limitations of the studies, the histological responses after delayed tooth replantation were more favourable in the PBM groups. Preclinical studies supported by guidelines should define laser parameters for future clinical studies., (© 2024. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

To investigate the effect of ELVAX polymer subgingival implants incorporated with echistatin peptide on incisor reimplanted tooth in rats. Forty-two male Wistars rats were divided into two groups: echistatin-treated rats (E) and control rats (C). The animals had their right maxillary incisors extracted and treated according to the International Association of Dental Traumatology replantation protocol. The extra-alveolar dry period was 30 and 60 min, and the post-surgical experimental periods were 15, 60, and 90 days. The samples were stained with H&E and analyzed for the presence of an inflammatory response, incidence of resorptions, and dental ankylosis. Results were statistically analyzed (p < 0.05). The presence of inflammatory resorption was significantly higher in group C at 30 and 60 min extra-alveolar time, in the 15-day postoperative period as compared with the E group (p < 0.05). Dental ankylosis was significantly more prevalent in group E in 30 min extra-alveolar time and 15 days postoperative period (p < 0.05). However, in 60 min extra-alveolar time and 60 days postoperative period, dental ankylosis was more prevalent in C group (p < 0.05). The use of ELVAX subgingival implants with echistatin demonstrated therapeutic potential in preventing the experimental resorption process after replantation of maxillary incisors in rats., (© 2023. The Author(s), under exclusive licence to The Society of The Nippon Dental University.)

Aim: Limiting the incidence of resorption associated with delayed replantation of avulsed teeth is critical for long-term tooth survival. In this study, we assessed whether icariin, a natural product with anti-osteoclastic properties, could reduce root resorption in a rat model of tooth replantation., Methodology: Cytocompatibility of icariin (10, 20, 40 and 80 μM) was evaluated by CCK-8 proliferation assay in vitro, and an osteoclastogenesis assay was performed to evaluate the effect of icariin on the differentiation of rat bone marrow macrophages and human peripheral blood monocytes into tartrate-resistant acid phosphatase-stained (TRAP + ) multinucleated giant cells (MNGCs). Differentiation of human periodontal ligament stem cells (hPDLSCs) treated with icariin (10 μM) was also evaluated at 5, 10 and 21 days of osteogenic induction. The first maxillary molars of five-week-old male Sprague-Dawley rats were extracted, denuded of PDL, then treated either with neutralized collagen solution (Carrier control) or icariin in collagen (3 μg/μL) before replantation into their sockets. The animals were euthanized 2 weeks post-surgery for micro-computed tomography (micro-CT) imaging and histological analyses., Results: Icariin was cytocompatible and significantly reduced the differentiation of TRAP + MNGCs in a dose-dependent manner compared to the control. Moreover, icariin enhanced alkaline phosphatase activity, expression of osteogenic marker genes and proteins, and calcium deposition in hPDLSCs. Micro-CT imaging of the replanted samples demonstrated a significantly higher volume of remaining roots in the icariin-treated group than in the control group. Histological analysis revealed a marked number of resorptive lacunae with TRAP activity in the control group, whereas icariin-treated samples showed signs of functional healing and reduced osteoclastic activity., Conclusions: Icariin was biocompatible and demonstrated potent anti-osteoclastic and pro-osteogenic properties that reduced resorption and promoted functional healing of denuded roots in a rat maxillary first molar model of replantation. These findings indicate that root surface treatment with icariin may be a clinically relevant and practical method for improving the retention and survival of teeth with compromised PDL after delayed replantation following traumatic avulsion., (© 2023 British Endodontic Society. Published by John Wiley & Sons Ltd.)

Background: Intentional replantation and dental autotransplantation are 2 similar techniques both involving atraumatic tooth extraction, visualization of the root, and replantation. They are considered as the last resort for unsalvageable teeth. The author aims to describe 2 mandibular posterior teeth with serious periapical lesions which are resolved by intentional replantation and dental autotransplantation, respectively., Case Summary: In case 1, a 45-year-old male patient received root canal treatment because of a cracked mandible right first molar with periapical lesions. An endodontic file was separated in the apical third of the mesiolingual root canal. After conventional canal filling of the other root canals, the molar was atraumatically extracted. The separated instrument was removed, the mesiolingual root received a retrograde filling and the molar was replanted. At the 3-month follow up, the patient was asymptomatic and the X-ray picture showed no detectable root resorption and ankylosis. In case 2, a 29-year-old woman reported discomfort during occlusal loading after a root canal treatment and a coronal restoration of the mandibular right first molar. Radiographs showed a low-density shadow in the mesial apical and in the root furcation area of the mandibular first molar so the patient was diagnosed as chronic periapical periodontitis. After the removal of the affected tooth, the extraction socket was thoroughly debrided and irrigated. The intact mandibular right third molar with similar dimensions was extracted by minimally invasive procedure and transplanted. The donor tooth was fixed by a fiber-splint for 1 month and a root canal treatment was performed 2 weeks after surgery. After 1 year, clinical and radiographical examination revealed functional and periodontal healing., Conclusions: These 2 reports present the successful management of intentional replantation and dental autotransplantation. Both procedures are recommended after nonsurgical endodontic treatment, especially when apical microsurgery is not an option, for example because of difficult accessibility or patient preference., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Aim: This case report aimed to present a novel surgical technique involving orthodontics luxation of the offended tooth using miniscrew prior to performing intentional replantation (IR) to remove an extruded separated instrument that injured the inferior alveolar nerve (IAN)., Background: Intentional replantation is a dental procedure that involves extracting a tooth, managing the root canal, and then reinserting the tooth back into its socket. This procedure is typically used as a last resort when other treatment options have failed or are not possible. Intentional replantation can be successful in preserving the tooth and preventing tooth loss, but it is important to note that there are risks involved. Maintaining the viability of the periodontal ligament (PDL) is a pivotal step to achieve a favorable outcome., Case Description: A 15-year-old female patient came to the clinic complaining of electric-like pain in the left mandibular posterior area that radiated to the left ear and sometimes caused a headache. Upon clinical and radiographic evaluation, extruded endodontic file from the mesial root of the left first molar that penetrated the IAN canal was noticed. Nonsurgical root canal retreatment was performed, which failed to retrieve the separated file. Orthodontics luxation of the offended tooth was done 2 weeks before the surgical intervention using a miniscrew to induce PDL inflammation, which increased the tooth mobility and PDL volume, facilitating the atraumatic extraction and reduced the risk of complications, such as root resorption and ankylosis. Then, IR was performed, and the extruded file was successfully retrieved. Three months follow-up showed complete recovery of the endodontics-related IAN injury symptoms. Preapical radiographic evaluation and cone-beam computed tomography scan showed complete healing of the periapical radiolucency/area of low density and complete formation of the PDL space and lamina dura around the resected roots., Conclusion: This novel approach using a miniscrew suggests a noninvasive technique that minimizes the damage to the offended tooth surrounding tissues as well as minimizing the morbidity of the adjacent teeth and the vital anatomical structures., Clinical Significance: Multidisciplinary comprehensive preplanning of complicated cases is essential to maximize treatment efficiency. The orthodontic extrusion facilitates the extraction process that helps in preserving the PDL, and ultimately increases the survivability of the teeth. How to cite this article: Alharbi MA, Alghamdi BA, Alswajy WA, et al . A Novel Approach for Orthodontic Extrusion Prior to Intentional Replantation: A Case Report. J Contemp Dent Pract 2023;24(11):895-901.

Objectives: This study aimed to evaluate and analyze the current situation of dentists in Guangdong pro-vince regarding the management of avulsed incisors, thereby providing a reference for making treatment strategies for avulsed incisors in the future., Methods: A total of 712 dentists with different educational backgrounds and working conditions in Guangdong province were randomly selected to conduct an online questionnaire survey on the cognition of children with avulsed incisors from April 2022 to May 2022. The data were recorded by Excel software and statistics were analyzed on Stata/SE 15.1., Results: A total of 712 dentists were investigated and 701 questionnaires were collected (98.46%). In addition, 65.9% of investigators came from the Department of Stomatology in a First-class Hospital or Stomatological Hospital. The results showed that the average number of avulsed teeth consulted by dentists was less than 20 per year. Although 99.7% of respondents considered normal saline as a suitable storage medium, 3.1% and 23.8% of them had a misunderstanding that the tap/alcohol could be used for root cleaning. Moreover, 93.4% was the correct selection rate of the treatment plan for processing on root surfaces before replanting by investigators. The correct selection rate of the duration using elastic fixation was only 10.7%. Meanwhile, 42.9% of investigators refused to inoculate tetanus immunoglobulin after teeth replanting. Emergency management of dental avulsion (EM) and clinical management of dental avulsion (CM) answered correctly with average scores of 14.60±11.85 and 14.48±2.67, respectively. Multivariate linear regression analysis revealed that working years were negatively correlated with EM and CM scores ( P <0.05). There was a positive correlation between CM and EM scores with the number of avulsion cases treated by physicians each year ( P <0.05). In terms of the EM score of dentists' learning attitude, investigators who had received enough knowledge were higher than those who had not and insufficient knowledge reserved, and the difference was statistically significant ( P <0.05). The scores of investigators who thought they had a certain degree of knowledge about dental trauma were higher than those who thought they "did not understand", and the difference was statistically significant ( P <0.05). In terms of CM scores, investigators who thought the knowledge of dental trauma was "very helpful" had higher scores than those who thought it was "not helpful", and the difference was statistically significant ( P <0.05). The scores of the investigators who thought they had "relatively sufficient knowledge" of dental trauma were higher than those who thought they had "no knowledge" or "insufficient know-ledge", and the difference was statistically significant ( P <0.05)., Conclusions: The overall accuracy of the management of avulsed incisors among dentists was low in Guangdong province. Dentists were more likely to have a higher rate of accuracy choice in treatment options for luxation injury and avulsion to enhance the prognosis of replanted teeth.

Intentional replantation involves a combination of periodontics, endodontics, prosthodontics and oral surgery. Crown-root fracture management is still complicated nowadays. A fracture line extending longitudinally to the subgingival area and intruding bioogical width could affect infection control, gingival health and crown restoration. In the present study, we present two cases. Case 1 involved a 23-year-old man who presented at our hospital with crown-root fracture of the maxillary left central incisor. A radiographic image of the tooth revealed a fracture line under the alveolar crest. The fractured tooth was treated with intentional replantation with 180-degree rotation, root canal treatment and veneer restoration. The patient was followed up for 60 months. The replanted tooth functioned well, and no symptoms of resorption or ankylosis were observed by radiographic examination. Case 2 involved a 20-year-old woman who was referred to our hospital for crown-root fracture of her maxillary teeth. A radiographic examination revealed complicated crown-root fracture of the maxillary right lateral incisor and both maxillary central incisors. The central incisors were treated with intentional replantation with 180-degree rotation. At the 48-month follow-up, the fractured teeth were found to have regained normal function based on clinical and radiographic examination. Limited case reports are available on a long-term follow-up of intentional replantation with 180-degree rotation. These two cases, particularly case 2, presented optimal healing after 4 years with unideal crown-root ratios. This case report suggests that this old method of preserving teeth with crown-root fractures can be used as a last resort to save teeth owing to its timesaving and microinvasive procedure.

Objectives: Shortening the root of a mouse molar prior to tooth replantation results in early revascularization in the pulp cavity and activation of the dental pulp quiescent stem cells. This study aimed to validate the effects of pulp chamber floor perforation on pulpal healing after tooth replantation as a strategy to promote early revascularization into the pulp., Methods: The maxillary first molars of three-week-old Crlj:CD1 mice were extracted and repositioned into the original socket: the left teeth were immediately replanted (control group: CG), whereas the floor of the pulp chamber of the right teeth was perforated with a tungsten carbide bur before tooth replantation (experimental group: EG). The samples were collected from three days to eight weeks postoperatively. In addition to the TUNEL assay, immunohistochemistry for Nestin, CK14, and Ki-67 was conducted., Results: In the EG, early revascularization occurred with a decrease in apoptosis and an increase in cell proliferation, facilitating pulpal healing, compared with the CG. The rate of Nestin-positive perimeter in the distal root significantly increased on days 5 and 14 and the amount of Nestin-positive hard tissue increased on day 14. However, on day 7, the number of epithelial cell rests of Malassez in the EG significantly decreased, making the EG susceptible to ankylosis at the floor., Conclusions: Intentionally perforating the floor of the pulp chamber provides a route for early revascularization, resulting in better pulpal healing after tooth replantation., Competing Interests: Conflicts of interest The authors declare no potential conflicts of interest with respect to this articles's authorship and publication., (Copyright © 2023 Japanese Association for Oral Biology. Published by Elsevier B.V. All rights reserved.)

Background and Objectives ; This study aimed to evaluate the clinical outcomes and bone changes before and after intentional replantation (IR) for periodontally compromised teeth by using cone-beam computed tomography (CBCT). Materials and Methods ; Fourteen periodontally involved teeth were selected for IR. A preoperative orthodontic procedure was performed to apply luxation, and the tooth was then gently extracted. Retrograde filling of the root-end canal was performed. Once the tooth was repositioned in the socket, it was splinted with the adjacent tooth. After three months, prosthetic restoration was performed. Results ; Clinical parameters and CBCT images were obtained before and after the IR procedure. The height of the alveolar bone was measured on the CBCT images by using software. Most preoperative symptoms, including pain, mobility, probing depth (PD) and bleeding on probing (BOP), significantly decreased after IR (pain: 4.71 to 1.00; mobility: 1.36 to 0.29; PD: 5.60 to 2.85; BOP: 3.50 to 0.79). CBCT analysis indicated an increase in bone height after IR (the amount of change: maxilla, 4.00; mandible, 1.95). Conclusions ; A previous study reported that IR for periodontally involved teeth is quite limited. However, in this study, IR of periodontally compromised teeth showed favorable results in clinical and radiographic evaluations, suggesting that IR may be an alternative to extraction of teeth with periodontal disease.

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.

Objectives: At present there is no clear consensus whether systemic antibiotics should be administered at replantation of an avulsed permanent tooth. This systematic review and meta-analysis assessed the evidence on effectiveness and harms of the administration of systemic antibiotics at replantation of avulsed permanent teeth., Methods: In August 2020 a systematic literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, for systematic reviews, randomized controlled trials (RCT) and observational controlled studies in MEDLINE, PreMedline, Embase, and the Cochrane databases. The population of interest were medically fit patients with a replanted avulsed tooth. Main outcomes were tooth survival, periodontal healing, pulpal revascularization as well as (severe) adverse events. These outcomes were compared in patients who did and who did not receive systemic antibiotics. The GRADE methodology was used to assess the quality of evidence., Results: The search yielded no RCTs, and none of the 7 included observational studies had the prime intent to investigate the effectiveness or harms of antibiotics. According to GRADE, the overall level of evidence was very low. The meta-analyses showed non-significant associations between the administration of systemic antibiotics on the one hand and tooth survival (1 study, RR = 3.70, 95% CI: 0.63-21.69), periodontal healing (meta-analysis of 6 studies RR: 1.07; 95% CI: 0.80-1.45), and pulpal revascularization (meta-analysis of 2 studies, RR: 0.36; 95% CI: 0.05-2.41) on the other hand., Conclusion: Currently there is no high-quality evidence to support the use of systemic antibiotics at replantation of avulsed permanent teeth. Hence, their routine use cannot be recommended in medically fit patients. Well-designed RCTs should be a priority on the research agenda., (Copyright © 2022 Elsevier Inc. All rights reserved.)

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

Stabilization with splint is an important surgical technology in traumatic dental injuries of permanent tooth. In order to standardize the clinical application of the technique and to improve the therapeutic effects of traumatic injured teeth, the Society of Stomatological Emergency, Chinese Stomatological Association organized relevant professional experts and put forward an expert consensus on the basis of considerable discussion. The contents of the present expert consensus covered indications for tooth fixation, material selection of splints and operation methods, applying to the treatment of tooth loosening, tooth displacement and tooth avulsion replantation caused by traumatic injuries. It is also suitable for preoperative and prognosis evaluations of traumatic injured teeth before tooth fixation.

The management of avulsed teeth undergoing delayed replantation remains a clinical challenge as there are currently no effective interventions that can improve periodontal healing and prevent replacement root resorption. While several preclinical studies have reported varied success using cell-based tissue engineering to improve periodontal healing, a consensus is required before further clinical translation. Therefore, this systematic review seeks to evaluate the efficacy of cell-based therapy in promoting periodontal healing following delayed replantation in animal models. MEDLINE (PubMed) and Embase were searched on September 27, 2020. Ten studies involving rodent and dog models met the inclusion criteria. Cell sources included gingiva, periodontal ligament (PDL), bone marrow, and adipose tissues. Generally, cell-based therapy had increased the proportion of root surfaces displaying periodontal healing and concomitantly reduced the proportion presenting with replacement root resorption and ankylosis. The best outcomes were observed following treatment with PDL-derived cells of various potency. Future preclinical studies will benefit from adopting measures to minimize bias during the conduct of animal experiments and the standardization of the outcome measures reporting. This will facilitate future reviews with possible pooling of results in the form of meta-analyses, allowing a consensus to be obtained from the literature. In addition, further research will be required to shed light on the implications of using allogeneic cells as well as the optimization of cell delivery protocols. The findings of this systematic review demonstrated the therapeutic potential of certain cell-based therapies in promoting periodontal healing following delayed replantation, thus highlighting their prospective clinical benefits and translational value. Impact statement Current therapies cannot predictably promote periodontal healing following delayed replantation of an avulsed tooth, especially when there is already significant root surface damage. This review systematically assessed the literature for preclinical studies employing cell-based therapies to promote periodontal healing following delayed replantation. The results showed that certain cell-based therapies significantly increased the formation of new periodontal ligament and reduced adverse healing outcomes of replacement root resorption and ankylosis. This highlights the potential clinical benefits and translational value of cell-based therapy for the replantation of avulsed teeth.

Background: Excessive inflammation in the periodontal tissue after tooth replantation can lead to inflammatory root resorption and interrupt periodontal tissue regeneration. We tested the hypothesis that nuclear factor-κB decoy oligodeoxynucleotide-loaded poly lactic-co-glycolic acid nanospheres (NF-PLGA) inhibit excessive inflammation and promote healing of periodontal tissue after replantation in rats., Methods: The upper right incisors of rats were extracted, immersed in different specific solutions, and replanted. The rats were euthanized at 7, 14, and 28 days after replantation. Morphological evaluation with micro-CT and histological assessment with hematoxylin and eosin and tartrate-resistant acid phosphatase (TRAP) staining was performed. Additionally, we examined the expression of interleukin (IL)-1β, IL-6, transforming growth factor-β1 (TGF-β1), and fibroblast growth factor-2 (FGF-2) in the periodontal ligament (PDL) by performing immunohistological assessment., Results: The NF-PLGA group showed significantly greater dental root thickness than the other experimental groups. Root resorption was not observed after the application of NF-PLGA on day 7. The application of NF-PLGA also resulted in a significantly lower number of TRAP-positive osteoclasts on days 7 and 14 after replantation. Significantly lower expression of IL-1β and IL-6 and higher expression of TGF-β1 and FGF-2 were observed under the application of NF-PLGA in the PDL., Conclusions: NF-PLGA promoted the healing process by inhibiting the initial excessive inflammatory response in the PDL, preventing root resorption, and promoting periodontal tissue regeneration. The findings also suggested that the PLGA nanospheres-mediated transfection of the decoy oligodeoxynucleotides can be useful for the clinical application of replanted tooth root surfaces., (© 2021 American Academy of Periodontology.)

Management of avulsed teeth after replantation often leads to an unfavorable outcome. Damage to the thin and vulnerable periodontal ligament is the key reason for failure. Cell- or stem cell-based regenerative medicine has emerged in the past two decades as a promising clinical treatment modality to improve treatment outcomes. This concept has also been tested for the management of avulsed teeth in animal models. This review focuses on the discussion of limitation of current management protocols for avulsed teeth, cell-based therapy for periodontal ligament (PDL) regeneration in small and large animals, the challenges of de novo regeneration of PDL on denuded root in the edentulous region using a mini-swine model, and establishing a prospective new clinical protocol to manage avulsed teeth based on the current progress of cell-based PDL regeneration studies., (© 2022. The Author(s).)

To investigate the genetic association in a sample of replanted teeth, it is necessary to observe the extreme phenotypes, such as, teeth that underwent functional healing and those extracted due to severe external root resorption. Thus, this study aimed to investigate the association of age of the patients, root development, storage media, and polymorphisms in the interleukin 4 (IL4) and interleukin 6 (IL6) genes with teeth that presented extreme outcomes, as functional healing or extraction, in a group whose replantation techniques did not follow the International Association of Dental Traumatology (IADT) 2012 guidelines. Forty-three avulsed and replanted teeth that did not follow IADT 2012 guidelines and underwent functional healing or were extracted were included. Periapical radiographs employed for this study were taken soon after tooth replantation and after 1 year. For genotypic IL4 and IL6 genes analysis, DNA of oral mucosa cells was extracted. Real-time- PCR performed for genotyping polymorphisms in IL4 and IL6 genes. Clinical and genetic variables were analyzed by the Chi-square test and the "Z" test. P values < .05 were considered significant. The results showed that functional healing and extraction were associated with storage media and with the rs2243268 of IL- 4 gene polymorphisms. As conclusion, the C rs2243268 allele of IL4 gene may have a positive relationship with functional healing teeth that were replanted not following the 2012 IADT guidelines. Keeping the tooth dry is associated to a fast loss of avulsed and replanted teeth after 1-year follow-up.

This article reports a clinical case of an 8-year-old boy who sustained avulsion of the maxillary right central incisor and the maxillary left lateral incisor. The avulsed teeth were kept in adverse extraoral dry conditions for 1 h from the moment of trauma until their replantation. The prognosis of tooth replantation is dependent on multiple factors such as methods of teeth storage in vitro, endodontic intervention, extra-oral time, and type of retention employed. The main reasons for root resorption in this case may be the extra-oral time, the initial replantation, or the delayed endodontic treatment., (Copyright © 2020 Elsevier GmbH. All rights reserved.)

This retrospective clinical study investigated the survival probability of avulsed and replanted permanent teeth in relation to functional healing, replacement and inflammatory resorption. The explorative data analysis included data from 36 patients and 49 replanted permanent teeth with a minimum observation time of 60 days; the patients were generally treated according to the current guidelines of the International Association of Dental Traumatology at the university hospital in Munich, Germany, between 2004 and 2017. The mean observation period was 3.5 years. Functional healing was observed in 26.5% (N = 13/49) of the included avulsion cases. In comparison, replacement resorption affected 51.0% (N = 25/49) of the replanted teeth, of which 24.0% (N = 6/25) were lost over the course of years (mean, 6.1 years). In contrast, inflammatory resorption resulted in the early loss of all replanted teeth (mean, 1.7 years) and affected 22.5% (N = 11/49) of all the monitored teeth. Therefore, it can be concluded that tooth avulsion remains a severe dental injury with an unpredictable prognosis. This topic demands further fundamental research aiming to maintain and/or regenerate the periodontal ligament after tooth avulsion, particularly in association with non-physiological tooth rescue.

Stromal cell derived factor-1 (SDF-1) and basic fibroblast growth factor (bFGF) were reported to induce the differentiation of bone marrow stem cells (BMSCs) into cells with characteristics of periodontal ligament fibroblasts. Thus SDF-1 and bFGF may play a positive role in BMSCs-mediated periodontal ligament regeneration. Here, the methylthiazolyldiphenyl tetrazolium bromide (MTT) assay was used to investigate the effect of scaffolds, SDF-1 and bFGF on BMSCs proliferation. RT-PCR and Western blot were used to evaluate gene and protein expression. Beagle dogs were used to establish an animal model of tooth reimplantation and to investigate the effects of scaffolds, BMSCs, SDF-1 and bFGF on periodontal ligament regeneration. X-ray images and micro computed tomography (micro CT) were used to assess morphological changes in replanted teeth and surrounding alveolar bone. H&E staining and Masson's staining were also performed. BMSCs from Beagle dogs growth on scaffolds consisted of dense structured collagens. SDF-1 and bFGF effectively promoted the differentiation of BMSCs into fibroblasts, periodontal membrane reconstruction, and cell proliferation in vitro. SDF-1 and bFGF also stimulated the expression of type I collagen (Col I), type III collagen (Col III), CXC family chemokine receptor 4 (CXCR4), and S100 calcium binding protein A4 (S100A4), and decreased the expression of alkaline phosphatase (ALP). In our experimental Beagle dog model of tooth extraction and replantation, application of SDF-1 and bFGF significantly elevated periodontal membrane reconstruction and thus supported the survival of replanted teeth. In conclusion, the findings from the present study demonstrated that SDF-1 and bFGF enhance the process of periodontal ligament reconstruction, and provide a basis and reference for the use of stem cell tissue engineering in promoting periodontal membrane regeneration., (© 2019 The Author(s).)

Objective: The main purpose of the present systematic review was to evaluate the efficacy of enamel matrix derivative Emdogain in healing of replanted teeth in humans., Materials and Methods: This review conducted in adherence to PRISMA standards and was registered in PROSPERO with registration number CRD42017062736. We graded the methodological quality of the studies by means of Cochrane's tool of risk of bias in non-randomized studies - of interventions (ROBINS-I)., Results: In total, 65 studies were identified for screening, and five studies were eligible. The uneventful healing of replanted teeth was varied from 20% to 75%. Two controlled trials found Emdogain treatment significantly reduced resorption of replanted teeth and improved the healing of periodontal ligament compared with controls. Two studies showed high recurrent resorption in Emdogain treated teeth., Conclusions: To conclude, the number of publications that met all inclusion criteria were limited and did not allow for drawing evidence for Emdogain being effective in supporting healing of replanted teeth.

Background/purpose: Vertical root fracture (VRF) is a complication in endodontically treated teeth. This study aimed to assess the clinical outcomes of treatment of 6 VRF teeth with intentional replantation and root fragment bonding with 4-methacryloxyethyl trimellitate anhydride/methyl methacrylate-tri-n-butyl borane (4-META/MMA-TBB) resin., Methods: A series of 6 complete VRF teeth (one incisor, one canine, one premolar, and 3 M) were treated through intentional replantation and root fragment bonding with 4-META/MMA-TBB resin., Results: This study included 6 VRF teeth in 6 patients (one man and 5 women; mean age, 44 ± 8 years). All 6 teeth had VRF in the bucco-lingual direction and one tooth had concomitant VRF in the mesio-distal direction. The root thickness was classified as thick in all 6 teeth. Of the 6 VRF teeth, 4 had biting, percussion, or palpation pain, 4 had gingival swelling, 3 had sinus tracts, 3 had discomfort, and one had tooth mobility. Radiographically, 5 of the 6 teeth had periradicular radiolucent lesions, 4 of which exhibited complete regression and one of which exhibited nearly complete regression after root fragment bonding therapy. Because all 6 treated teeth exhibited sound function in the oral cavity after a follow-up period ranging from 33 to 74 (mean, 50 ± 15) months, the clinical outcomes were all considered to be successful., Conclusion: For a VRF tooth, in addition to tooth extraction, intentional replantation combined with root fragment bonding with 4-META/MMA-TBB resin is a successful treatment modality that can be used to preserve a complete VRF tooth., (Copyright © 2018. Published by Elsevier B.V.)

Background: Traumatic dental injuries are common. One of the most severe injuries is when a permanent tooth is knocked completely out of the mouth (avulsed). In most circumstances the tooth should be replanted as quickly as possible. There is uncertainty on which interventions will maximise the survival and repair of the replanted tooth. This is an update of a Cochrane Review first published in 2010., Objectives: To compare the effects of a range of interventions for managing traumatised permanent front teeth with avulsion injuries., Search Methods: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 8 March 2018), Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 2) in the Cochrane Library (searched 8 March 2018), MEDLINE Ovid (1946 to 8 March 2018), and Embase Ovid (1980 to 8 March 2018). The US National Institutes of Health Ongoing Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases., Selection Criteria: We considered randomised and quasi-randomised controlled trials that included a minimum follow-up period of 12 months, for interventions for avulsed and replanted permanent front teeth., Data Collection and Analysis: Two review authors independently selected studies, extracted data and assessed the risk of bias. Authors were contacted where further information about their study was required., Main Results: Four studies, involving a total of 183 participants and 257 teeth were identified. Each of the interventions aimed to reduce infection or alter the inflammatory response or both at the time of or shortly after the tooth or teeth were replanted. Each study assessed a different intervention and therefore it was not appropriate or possible to numerically synthesise the data. All evidence was rated as being of very low quality due to problems with risk of bias and imprecision of results. This means that we are very uncertain about all of the results presented in this review.One study at high risk of bias with 69 participants (138 teeth) compared a 20-minute soak with gentamycin sulphate for both groups prior to replantation with the experimental group receiving daily hyperbaric oxygen for 80 minutes for the first 10 days. There was some evidence of a benefit for the hyperbaric oxygen group in respect of periodontal healing, tooth survival, and pulpal healing.One study at unclear risk of bias with 22 participants (27 teeth) compared the use of two root canal medicaments, Ledermix and Ultracal. There was insufficient evidence of a difference for periodontal healing or tooth survival. This was the only study to formally report adverse events with none identified. Study authors reported that Ledermix caused a greater level of patient dissatisfaction with the colour of avulsed and replanted teeth.A third study at high risk of bias with 19 participants compared extra- or intra-oral endodontics for avulsed teeth which were stored dry for longer than 60 minutes before replantation. There was insufficient evidence of a difference in periodontal healing.The fourth study at high risk of bias with 73 participants compared a 10-minute soak in either thymosin alpha 1 or saline before replantation followed by daily gingival injections with these same medicaments for the first 7 days. There was some evidence of a benefit for thymosin alpha 1 with respect to periodontal healing and tooth survival., Authors' Conclusions: Based on the results of the included studies, there is insufficient evidence to support or refute the effectiveness of different interventions for avulsed and replanted permanent front teeth. The overall quality of existing evidence was very low, and therefore great caution should be exercised when generalising the results of the included trials. There is urgent need for further well-designed randomised controlled trials.

The purpose of this study was to analyze various characteristics and classification of C-shaped root canals and evaluate the causes of endodontic failure of C-shaped root canals by examining the resected root surface with an endodontic microscope and a scanning electron microscope (SEM). Forty-two teeth with C-shaped root canals were included in this study and had undergone intentional replantation surgery. Before surgery, periapical radiography and cone-beam computed tomography were taken. The root canal configuration was analyzed and classified according to Melton's classification at coronal and apical level. After injection of 1 : 100,000 epinephrine with 2% lidocaine, the tooth was carefully extracted. After the root-end resection, the resected root surface was examined using an operating microscope and SEM. Mandibular second molars were most frequently involved teeth (90.4%). The most frequently observed root canal configurations were C1 at the coronal level (45.2%) and C3 at the apical 3 mm level (45.2%). The most common cause of failure for a C-shaped root canal treatment was a leaky canal (45.2%), followed by an isthmus (23.8%), missing canal, overfilling, and iatrogenic problems. In conclusion, C-shaped root canals were most frequently found in mandibular second molars. The most common cause of failure was a leaky canal and isthmus.

Effective management of external cervical resorption (ECR) depends on accurate assessment of the true nature and accessibility of ECR; this has been discussed in part 1 of this 2 part article. This aim of this article was firstly, to review the literature in relation to the management of ECR and secondly, based on the available evidence, describe different strategies for the management of ECR. In cases where ECR is supracrestal, superficial and with limited circumferential spread, a surgical repair without root canal treatment is the preferred approach. With more extensive ECR lesions, vital pulp therapy or root canal treatment may also be indicated. Internal repair is indicated where there is limited resorptive damage to the external aspect of the tooth and/or where an external (surgical) approach is not possible due to the inaccessible nature of subcrestal ECR. In these cases, root canal treatment will also need to be carried out. Intentional reimplantation is indicated in cases where a surgical or internal approach is not practical. An atraumatic extraction technique and short extraoral period followed by 2-week splinting are important prognostic factors. Periodic reviews may be indicated in cases where active management is not pragmatic. Finally, extraction of the affected tooth may be the only option in untreatable cases where there are aesthetic, functional and/or symptomatic issues., (© 2018 International Endodontic Journal. Published by John Wiley & Sons Ltd.)

Background/aim: The extra-alveolar dry period and storage medium in which a tooth is kept prior to replantation remain critical factors affecting the survival and repair potential of the periodontal ligament in avulsed teeth. When replantation is not immediate, replacement root resorption (RRR) is the most common complication. The aim of this histological study was to evaluate the effect of immediate controlled-orthodontic forces in periodontal healing of replanted teeth in a canine model., Material and Methods: Sixty maxillary and mandibular premolar roots were endodontically treated in vivo and subsequently hemisected and extracted. Roots were replanted after an extraoral dry time of 20 minutes and randomly assigned to two experimental groups: Group 1: root was stabilized with a flexible and passive bracket/stainless steel wire splint for 2 weeks; Group 2: root was stabilized with a flexible bracket/NiTi wire splint activated with orthodontic elastics for 2 weeks. After 4 months, the dogs were euthanized, and all specimens were processed for histology and microscopically evaluated., Results: The mean percentage of RRR for Group 2 was 3.17 compared with 12.13 in Group 1. Eighty-three percent of specimens from Group 2 exhibited similar healing to the negative control group, compared to 60.5% of the specimens from Group 1. No statistical difference was found in periodontal healing between experimental groups., Conclusion: Immediate application of mild and controlled orthodontic forces was not detrimental to the periodontal healing of teeth replanted after 20 minutes extraoral dry time, although no significant improvement on periodontal healing was observed., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Autotransplantation is considered a standard procedure with a poorer prognosis for mature than for immature teeth. In this case report, the root tip of an almost fully developed tooth was resected during autotransplantation to fit into a deficient recipient site. As a positive side effect, the apical foramen was enlarged, with potential improvement of the probability of revascularization. Clinical and radiologic follow-up examinations up to 18 months indicated revascularization and uneventful periodontal regeneration and thus successful autotransplantation. This case supports the hypothesis that intraoperative apicoectomy can improve the prognosis for revascularization of mature autotransplanted teeth. Further prospective controlled clinical studies are needed to confirm this innovative surgical approach., (Copyright © 2018 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Tooth avulsion in children and adolescents demands emergency treatment to increase the chances of successful reimplantation. The treatment prognosis depends on intrinsic and extrinsic factors, such as the extra-alveolar time until reimplantation, storage medium, handling, and periodontal ligament condition of the avulsed tooth as well as the patient's general health. This case report describes the treatment of an 11-year-old boy who suffered an avulsion of the maxillary right central incisor followed by delayed reimplantation after the tooth was stored in a dry medium for 6 days. Although the tooth was kept in extremely unfavorable conditions, tooth reimplantation was attempted because the patient was young and it was desirable to avoid psychological trauma as well as esthetic and functional problems. The treatment performed followed the guidelines of the International Association of Dental Traumatology for an avulsed tooth with a closed apex and extraoral dry time exceeding 60 minutes. At a 1-year follow-up appointment, the tooth exhibited clinical function, no mobility or pain symptoms, and mild signs of ankylosis. A radiographic image showed resorption by substitution. Although the long-term prognosis is uncertain, this treatment approach was advantageous for the patient because it maintained esthetics, function, and alveolar bone height., Competing Interests: Disclaimer: The authors report no conflicts of interest pertaining to any of the products or companies discussed in this article.

Intentional tooth replantation is the last resort for saving natural teeth in treatment of the endodontic diseases. In order to promote the utilization, standardize the operation and improve the success rate of this treatment, this review suggests the indication, discusses the key points of the surgical procedure, proposes the path of the diagnosis and the treatment protocol of the intentional replantation.