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Background: A continuous obstacle that has limited access to and implementation of finger replantation surgery is timeliness, as ischemia time is traditionally considered a crucial factor for success. However, claims that the vitality of amputated fingers decreases after 6 h of warm ischemia and 12 h of cold ischemia are mostly based on theoretical considerations. Methods: Here we present a case of multi-digit revascularization after 72 h of warm ischemia using the microsurgical arteriovenous bypass technique. Results: In the reported case, revascularization was performed after a long ischemic period and showed good recovery of motor and sensory function. Conclusions: We identified significant limitations in the literature supporting time limits of ischemia and recent evidence demonstrating the feasibility of delayed finger replantation. The current treatment approach for amputation injuries often requires transfers or nighttime emergency procedures, increasing costs and limiting the national availability of finger replantation. Changes to finger replantation protocols based on evidence could expand access to this service and improve the quality of care. [ABSTRACT FROM AUTHOR]

Background/Aim: Tooth avulsion and delayed replantation may cause inflammatory responses and root resorption of the tooth. The aim of this study is to investigate the effect of a doxycycline-loaded nitric oxide-releasing nanomatrix (DN) gel on the delayed replantation of avulsed rat teeth, with a focus on assessing the gel's potential to promote regeneration and inhibit complications associated with the replantation process. Materials and Methods: Twenty-four right maxillary first molars from male Sprague-Dawley rats were atraumatically extracted using sterile extraction forceps. The molars were dried for 1 h at room temperature (approximately 23 °C) and divided into four groups according to the root conditioning methods after extra-alveolar 60-min drying: Group 1, no root conditioning treatment prior to replantation; Group 2, soaking in 2% NaF solution for 5 min before replantation; Group 3, 5-min soaking in NO gel and injection of the gel into the alveolar socket; Group 4, 5-min soaking in DN gel and injection of the gel into the alveolar socket before replantation. The animals were euthanized four weeks after the operation and the specimens were evaluated histologically. Results: The use of NO gel alone showed better anti-inflammatory and periodontal effects than the control group, but it did not show a significant effect compared to the group using NaF. When using NO gel loaded with doxycycline, it showed a significant anti-inflammatory effect compared to the control group and showed a similar inhibitory effect to the group using NaF. Conclusions: Within the limits of this study, in delayed replantation situations, the control of inflammatory resorption and replacement resorption is an important factor for achieving a better prognosis of replanted teeth. Root surface treatment with DN gel decreased root resorption after delayed replantation. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Replantation should be attempted in any case of avulsion, be it immediate or delayed. Retention of the replanted tooth helps in preservation of adjacent alveolar bone. Despite the occurrence of replacement resorption, the tooth can stay healthy and functional in the arch for a longer duration. [ABSTRACT FROM AUTHOR]

Key Clinical Message Replantation should be attempted in any case of avulsion, be it immediate or delayed. Retention of the replanted tooth helps in preservation of adjacent alveolar bone. Despite the occurrence of replacement resorption, the tooth can stay healthy and functional in the arch for a longer duration.

Background/Aim: Tooth avulsion and delayed replantation may cause inflammatory responses and root resorption of the tooth. The aim of this study is to investigate the effect of a doxycycline-loaded nitric oxide-releasing nanomatrix (DN) gel on the delayed replantation of avulsed rat teeth, with a focus on assessing the gel’s potential to promote regeneration and inhibit complications associated with the replantation process. Materials and Methods: Twenty-four right maxillary first molars from male Sprague-Dawley rats were atraumatically extracted using sterile extraction forceps. The molars were dried for 1 h at room temperature (approximately 23 °C) and divided into four groups according to the root conditioning methods after extra-alveolar 60-min drying: Group 1, no root conditioning treatment prior to replantation; Group 2, soaking in 2% NaF solution for 5 min before replantation; Group 3, 5-min soaking in NO gel and injection of the gel into the alveolar socket; Group 4, 5-min soaking in DN gel and injection of the gel into the alveolar socket before replantation. The animals were euthanized four weeks after the operation and the specimens were evaluated histologically. Results: The use of NO gel alone showed better anti-inflammatory and periodontal effects than the control group, but it did not show a significant effect compared to the group using NaF. When using NO gel loaded with doxycycline, it showed a significant anti-inflammatory effect compared to the control group and showed a similar inhibitory effect to the group using NaF. Conclusions: Within the limits of this study, in delayed replantation situations, the control of inflammatory resorption and replacement resorption is an important factor for achieving a better prognosis of replanted teeth. Root surface treatment with DN gel decreased root resorption after delayed replantation.

This case report describes the treatment of avulsion and intrusion trauma of the upper left incisors in a 21-year-old female patient. The avulsed tooth was stored in dry conditions for 48 h since the accident happened. Teeth were treated according to the trauma protocol recommended for avulsed and intruded teeth. During the 1-year follow-up period, absence of mobility, root resorption, or any symptoms were observed in the clinical and radiological examination. [ABSTRACT FROM AUTHOR]

Copyright of Turkiye Klinikleri Journal of Dental Sciences is the property of Turkiye Klinikleri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background/Aims: Tooth avulsion is the most severe traumatic tooth injury. Immediate replantation after avulsion provides the highest success rate, whereas delayed replantation with dehydration for >1 h always results in ankylosis, replacement resorption, and eventual tooth loss. The aim of this study was to investigate the geomorphologic change of ultrastructure on tooth root surfaces due to dehydration. Material and Methods: Twenty‐four sound human premolars and fully developed third molars without periodontitis were selected for the experiment. Roots were separated into 6–7 pieces with an intact root surface area (3 × 3 mm2) and then divided into the following groups: fresh group, prolonged dehydration groups (air drying for 1, 2, 4, 12, or 24 h), and dehydrated teeth (air drying for 2 h) treated with acid (Tris‐HCl buffer or citric acid buffer). More than six pieces of root from each group were subjected to scanning electron microscopy (SEM) observation. Captured images were exported to ImageJ software to quantitatively analyze the areas covered with fibers. Statistical significance was determined by comparing the means of the different groups using t‐testing or one‐way analysis of variance followed by post hoc testing. Results: Fibrous "vegetation" covering the cementum was observed on the fresh root surface by SEM. This was destroyed by dehydration (>1 h), resulting in a root surface resembling the "Gobi Desert." The difference was statistically significant (p <.001). Root surface deteriorated by dehydration could be recovered by the re‐use of the fibers embedded in the cementum as acid demineralization of the outer layer of cementum exposed the embedded fibers to simulate the geomorphology of fresh root surface. Conclusions: Dehydrated teeth had deteriorated geomorphology of the root surface, which could be reversed by the re‐use of the fibers embedded in the cementum using citric acid. Direct evidence from SEM gives new insights into the replantation of dehydrated avulsed teeth. [ABSTRACT FROM AUTHOR]

Introduction: Dental avulsion is a severe injury in which the tooth is totally displaced out of its alveolar socket. Replantation of avulsed teeth is a standard procedure. The success of the treatment of traumatized teeth revolves around the status of periodontium since it is a vital structure. Furthermore, other factors, including extra-alveolar time period, choice of storage media, and contamination of the avulsed tooth, can determine the success of replantation. Delay in the replantation of avulsed incisors increases the risk of dentoalveolar ankylosis and replacement root resorption. Case Presentation: This case report presented a 9-year-old girl with tooth avulsion subjected to a 3-year follow-up after the replantation of avulsed maxillary central incisors kept in dry conditions for seven days. The avulsed mature permanent teeth were managed through the application of treatment guidelines with prolonged extra-oral time. The avulsed teeth were replanted and splinted for four weeks. The canals of both teeth were filled with calcium hydroxide and replaced by mineral trioxide aggregate after six months. Two months after replantation, there were signs of external root resorption in tooth 21. Conclusions: In the third year of follow-up, both teeth were infraoccluded, although they had an acceptable level of functionality and appearance. These ankylosed incisors can be managed successfully with the decoronation technique in the future. [ABSTRACT FROM AUTHOR]

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

Objective: To investigate the effects of Er:YAG laser on the attachment of human periodontal ligament fibroblasts (hPDLFs) to denuded root surfaces simulating delayed replantation cases. Background data: Dental avulsion is one of the most severe dental traumas, which is often treated with replantation. In delayed replantation scenarios, poor prognosis, including root resorption, usually occurs due to poor root surface conditioning and nonviable hPDLF attachment. Methods: Thirty-six root fragments (5 x 5 x 2mm) were obtained from periodontium tissue-free premolar root surfaces. Specimens were randomly and equally assigned to the following: Group A, untreated control; Group B, 25 J/cm2 and 10 Hz of Er:YAG laser irradiation; and Group C, 50 J/cm² and 10Hz of Er:YAG laser irradiation. Some specimens in each group were then prepared for surface topography visualization under SEM, others were subjected to coculture with hPDLF suspension, and cell adhesion was further evaluated by SEM. Results: Group A presented homogenous smooth root surface, with fewer and round-shaped cells attached; Group B and C exhibited rather rough and irregular morphologies, and spindle-shaped fibroblasts were firmly attached by numerous lamellipodia and extensions. After a 3-day coculture, the number of fibroblasts attached in Group A was significantly lower compared with the other two laser-treated groups (p = 0.008 < 0.05). No significant alterations were observed between the two laser groups (p = 0.135 > 0.05). Conclusions: Er:YAG laser-treated root surfaces are compatible for the attachment of PDLFs, which suggests that Er:YAG laser irradiation may be used as a promising strategy for root surface conditioning in delayed replantation cases. [ABSTRACT FROM AUTHOR]

Avulsion of permanent teeth constitutes a dental emergency and accounts for 1%–16% of all traumatic dental injuries. It occurs frequently among 7–14 years age group, whereas maxillary central incisors are the most commonly effected. Esthetics and occlusion function can be restored with replantation of an avulsed tooth. The purpose of this article is to describe a management of an 11-year-old male child with avulsed permanent maxillary central incisor which was replanted subsequently 48 h after root surface treatment with triple antibiotic paste. Follow-up visits showed signs of “replacement resorption.”

Avulsion or exarticulation is one of the most severe injuries of the tooth, frequently encountered in young children and the maxillary anterior teeth. Immediate transplantation of the avulsed tooth is the suggested treatment that results in a favorable prognosis, although this may not be possible every time. Here, we present a case report of an 8-year-old girl who sustained an avulsion injury of the maxillary left central incisor with 4½ days extraoral time. Treatment guidelines for avulsed immature permanent teeth with prolonged extraoral dry time were followed. Portland cement was used for obturation of the root canal. The clinical and radiographic findings after 18 months revealed minimal inflammatory root resorption and ankylosis of the replanted tooth, whereas clinically, the tooth was asymptomatic and maintained the aesthetics of the child, suggesting the importance of replantation, although there was prolonged extraoral dry time.

Ankylosis and external replacement resorption (ERR) are two typical biological responses to delayed replantation of avulsed teeth in cases where adequate root canal treatment is performed. The patient's growth stage affects the progression of root resorption and the long-term outcome of the affected teeth. This case report describes the long-term outcome of an 18.5-year-old patient following an accident in which both of his maxillary central incisors were avulsed and replanted after four hours of non-physiological storage. ERR and ankylosis of teeth 11 and 21 were detected clinically and radiographically during the second year of follow-up. Sixteen years after replantation, replacement resorption was progressing very slowly, enabling functional tooth retention with favorable esthetics. Young adults, with delayed replantation of avulsed teeth, may benefit from tooth retention with slow ERR. [ABSTRACT FROM AUTHOR]

Avulsion is the complete displacement of tooth out of its socket. It is the gravest form of dental traumatic injury which accounts for 0.5-3% of the total dental traumatic injuries of the permanent teeth and most commonly involves the maxillary central incisors. The treatment is immediate tooth replantation or if that is not possible then storing tooth in an appropriate storage medium and attending dental clinic at the earliest. The present case report describes the replantation of maxillary left central incisor tooth that was avulsed. The tooth was out of the socket for 22 hours without any storage medium. Tooth was replanted after the removal of non-viable periodontal tissues; splinting was done for 4 weeks and endodontic treatment was initiated after 7 days. The tooth was stable and functional with mild discoloration and ankyloses at four years follow up, which is considered a desirable treatment outcome after delayed replantation. [ABSTRACT FROM AUTHOR]

Background/aim: Delayed (dry storage > 60 minutes) replantation results in ankylosis and replacement resorption. It has been suggested to remove the non-viable periodontal ligament before replantation to possibly reduce the rate of replacement resorption. However there has been no study on the rate of replacement resorption after such measures. The aim of this study was to investigate if there was any difference in the rate of replacement resorption by either removing the periodontal ligament (PDL) with gauze or not removing PDL in teeth subjected to delayed replantation followed by healing for 2 or 6 weeks.Materials and Methods: Maxillary central incisors were extracted in 8 rabbits. In the right central incisors, the necrotic PDL was removed by dry gauze over the root surface. In the left eight extracted teeth PDL was left on the root surface. All extracted teeth were left to dry for 60 minutes. Extra-oral root canal treatment was performed before replantation. The rabbits were sacrificed after 2 weeks and 6 weeks respectively. Histologic processing and evaluation was done.Results: In the 2 weeks group, all teeth showed ankylosis. The cementum was intact, and fusion of the bone and root was generally seen without resorption of the root, whereas in the 6 weeks group regardless of whether PDL had been kept or not, ankylosis and osseous replacement of the dentin was seen. There was no evidence of inflammatory infiltrate in the sections examined.Conclusion: Removal of PDL prior to delayed replantation may result in some initial protection of the cementum during the first few weeks. However, over longer times there seems to be neither protection of the dentin from ankylosis and osseous replacement, nor any influence on the rate of replacement resorption. [ABSTRACT FROM AUTHOR]

Background/aim: Continuous research efforts have been focusing on promoting healing of delayed replantation of avulsed teeth. The aim of this in vivo study was to assess the effect of cathepsin K inhibitor surface treatment on delayed tooth replantation.Materials and Methods: Thirty-four premolar roots of 4 beagle dogs were extracted, and conventional root canal treatment was performed. The canals were filled with gutta-percha and cement. All extracted teeth were air-dried for 1 hour. Teeth were divided into 2 groups according to the root surface treatment prior to replantation: control (n = 13) and cathepsin K inhibitor (n = 21). Treated teeth were replanted in their original sockets and stabilized with a resin-wire splint for 1 week. After 12 weeks, the dogs were euthanized and micro-computed tomography was performed. Tissues were then further processed as resin-embedded specimens stained with hematoxylin and eosin. In each evaluation, data were analyzed using the Mann-Whitney U test (P < .05).Results: In the micro-computed tomography evaluation, inflammation scores of both groups were not statistically different (P > .05). In the histological evaluation, the mean proportions of inflammatory resorption and replacement resorption in the control group were similar to those in the cathepsin K inhibitor group (P > .05).Conclusions: Cathepsin K inhibitor did not demonstrate significant inhibitory effects on root resorption after delayed replantation in vivo. [ABSTRACT FROM AUTHOR]

Background: Traumatic tooth avulsion requires an urgent intervention to replant the tooth. Prolonged post-injury dry extra-oral conditions worsen the prognosis and increase the risk of root resorption. Fluoride has the potential to delay replacement resorption. Calcium silicate cements (CSC) are used to seal the root canal system and to stimulate periapical regeneration in immature open apex teeth (apexification). This report suggests the application of a novel fast-setting CSC with fluoride for apexification in an attempt to hinder root resorption.Case report: A delayed replantation of an avulsed open apex permanent central incisor after 75 h of storage in a dry condition in a 6-year-old girl. Standard treatment guidelines for avulsed immature permanent teeth were followed. After tooth replantation a novel fast-setting, CSC containing fluoride was used for apexification.Follow-up: The radiographic and clinical evaluations over a period of 3 years demonstrated periodontal bone healing without root resorption, mobility, and ankylosis and an acceptable periapical tissue tolerance to the novel CSC. However, a longer follow-up period is needed.Conclusions: Delayed replantation of the avulsed open apex permanent incisor after 75 h of storage under dry conditions and apexification with a novel fast-setting CSC showed a successful outcome after 3 years. Novel CSC with fluoride demonstrated an acceptable biocompatibility and tissue tolerance. [ABSTRACT FROM AUTHOR]

Copyright of West China Journal of Stomatology is the property of Sichuan University, West China College of Stomatology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Avulsion or exarticulation is one of the most severe injuries of the tooth, frequently encountered in young children and the maxillary anterior teeth. Immediate transplantation of the avulsed tooth is the suggested treatment that results in a favorable prognosis, although this may not be possible every time. Here, we present a case report of an 8-year-old girl who sustained an avulsion injury of the maxillary left central incisor with 4 1/2 days extraoral time. Treatment guidelines for avulsed immature permanent teeth with prolonged extraoral dry time were followed. Portland cement was used for obturation of the root canal. The clinical and radiographic findings after 18 months revealed minimal inflammatory root resorption and ankylosis of the replanted tooth, whereas clinically, the tooth was asymptomatic and maintained the aesthetics of the child, suggesting the importance of replantation, although there was prolonged extraoral dry time. [ABSTRACT FROM AUTHOR]

Avulsion of permanent teeth is most serious of all dental injuries and accounts for 1-16% of all traumatic injuries, of which maxillary incisors are most commonly involved. However, in this report a rare case of isolated avulsed immature premolar has been described. The patient had reported more than 3 hours after the trauma with a tooth stored in dry condition and soil contamination. The prognosis depends on measures taken at the place of accident or the time immediately after avulsion. Replantation is the treatment of choice, but cannot always be performed immediately. An appropriate emergency management and treatment plan is important for good prognosis. In this report stepwise management of an avulsed immature maxillary premolar with extended period of dry storage has been described followed up for a period of 2 yrs.

Travmatik yaralanma sonrasında dişin alveoler soketten tamamen çıkmasına avulsiyon, travma sonucu total olarak alveoler soketten çıkmışolan dişin tekrar yerine yerleştirilmesine replantasyon adı verilmektedir. Ön grup dişlerin travmatik

Aim: To develop an experimental in vivo model to study dentoalveolar ankylosis and osseous replacement resorption after delayed replantation.Materials and Methods: The maxillary right incisors of eight rabbits were extracted and replanted, while the maxillary left incisors served as controls. A special technique for extraction was used, luxating the incisor laterally prior to extraction. Extra-oral root canal treatment was performed. In four of the eight replanted teeth, periodontal ligament was removed using gauze. All teeth were replanted after one-hour dry storage. A horizontal line was drilled on the labial enamel surface of the incisors to enable registration of possible subsequent infraposition. The rabbits were sacrificed after 1 week or 4 weeks, respectively. Percussion test of the teeth was carried out and infraposition was registered. Histological processing and evaluation were performed.Results: Percussion sound was normal after 1 week and high in the 4 week group; infraposition was noted in all replanted teeth in the 4-week group. Fusion between the bone and dentin was seen in some areas on the root already after 1 week, but there was little or no osseous replacement. Larger areas of ankylosis were seen in the 4-week group although not significant, but deeper progressive osseous replacement was noted in this group. There was no significant difference in ankylosis with regard to periodontal ligament removal or not. Pulp and periodontal tissues were normal in all control teeth.Conclusion: The rabbit tooth model may be useful for experimental in-vivo studies on delayed replantation, subsequent ankylosis, osseous replacement and infraposition. [ABSTRACT FROM AUTHOR]

Numerous publications have reported revascularization of necrotic immature permanent teeth, but the regenerative potential of pulp in mature teeth has rarely been considered. Platelet-rich plasma (PRP) meets many requirements of a scaffold for regenerative endodontics. To the best of our knowledge, no clinical study has evaluated PRP for endodontic regeneration in a mature avulsed tooth. The present case evaluated PRP for pulpal regeneration in an avulsed mature incisor (>8 hours extraoral dry time) of an 11-year-old boy after delayed replantation. The canal was disinfected after extraoral access cavity preparation and pulp extirpation. The root apex was enlarged, and the tooth was placed in doxycycline solution for 20 minutes. After tooth replantation and splinting, PRP was injected up to the level of the cementoenamel junction and sealed with glass ionomer cement. The 6-month follow-up revealed evidence of internal and external root resorption with periapical radiolucency and an apparent periodontal ligament space. Access was reopened; slurry of 2 antibiotics (minocycline and metronidazole) was inserted into the canal and sealed. Nine- and 12-month radiographs revealed resolution of periapical radiolucency with no further progression of internal resorption. The tooth showed a positive response to thermal and electric pulp tests. The findings observed in this case warrant further research under controlled conditions to evaluate endodontic and periodontal regeneration in a tooth that would otherwise be expected to have an unfavorable prognosis. [ABSTRACT FROM AUTHOR]

Dental injuries are very common and their extent has been classified by Ellis. Avulsion of tooth is a grievous injury and ranges from 1-16% among the traumatic injuries, of which maxillary anterior are commonest. Reimplantation of avulsed teeth is a standard procedure. However, it has certain limitations. Most often their management is very challenging. In this case report we are presenting the management of maxillary incisors by replantation after 36 hrs in a 12 year old girl.

Replantation refers to the insertion and temporary fixation of completely or partially avulsed teeth resulting from traumatic injury. Replantation of an avulsed tooth depends on certain clinical conditions like physiological status of periodontal ligament, the stage of root development and the length of extra-oral time. Depending on the patient's age, retention of the permanent incisor can maintain the aesthetic appearance, occlusal function and alveolar ridge height. Though the risk of progressive replacement resorption and subsequent tooth loss is high after a long dry storage, replantation provides an aesthetically acceptable permanent prosthesis at a later age. This article presents management of a case with two avulsed permanent incisors that were stored in a physiological solution for ten hours. [ABSTRACT FROM AUTHOR]

Avulsion of permanent teeth is most serious of all dental injuries and accounts for 1-16% of all traumatic injuries, of which maxillary incisors are most commonly involved. However, in this report a rare case of isolated avulsed immature premolar has been described. The patient had reported more than 3 hours after the trauma with a tooth stored in dry condition and soil contamination. The prognosis depends on measures taken at the place of accident or the time immediately after avulsion. Replantation is the treatment of choice, but cannot always be performed immediately. An appropriate emergency management and treatment plan is important for good prognosis. In this report stepwise management of an avulsed immature maxillary premolar with extended period of dry storage has been described followed up for a period of 2 yrs. [ABSTRACT FROM AUTHOR]

A 15-year-old boy lost his maxillary right and left central incisor teeth in a bicycle accident. He was referred to our clinic 1 week after the injury. The crown-root integrities of both the teeth were not damaged. Although the teeth were stored under dry conditions for 1 week, reimplantation of the teeth was planned to retain the teeth in the mouth for as long a period as possible because of the patient's age. Following the debridement and sterilization of root surfaces in 2.5% NaOCl, root canals were prepared and filled with calcium hydroxide. Then, about 2 mm of the apexes were resected to ensure that the roots easily seated in the alveolar socket and the prepared cavities in root ends were obturated with the amalgam. The teeth were placed into their respective sockets and splinted temporarily. The root canal therapy was completed 5 weeks later. Ankylosis was observed radiographically after 10 months. The patient is now 23 years old and he is still able to use both the central incisors functionally. However, there is a pink appearance on the cervical buccal surface of left central incisor because of progressive replacement resorption. In this case, the new treatment plan is to perform a permanent restoration with dental implants following the extraction of both teeth. Even though the long-term prognosis is uncertain, this treatment technique has provided an advantage for the patient in his adolescent period by maintaining the height of alveolar bone and making the provision of an aesthetically acceptable permanent restoration at a later age possible. [ABSTRACT FROM AUTHOR]

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.

Objective: To investigate the effects of Er:YAG laser on the attachment of human periodontal ligament fibroblasts (hPDLFs) to denuded root surfaces simulating delayed replantation cases. Background data: Dental avulsion is one of the most severe dental traumas, which is often treated with replantation. In delayed replantation scenarios, poor prognosis, including root resorption, usually occurs due to poor root surface conditioning and nonviable hPDLF attachment. Methods: Thirty-six root fragments (5 × 5 × 2 mm) were obtained from periodontium tissue-free premolar root surfaces. Specimens were randomly and equally assigned to the following: Group A, untreated control; Group B, 25 J/cm 2 and 10 Hz of Er:YAG laser irradiation; and Group C, 50 J/cm 2 and 10 Hz of Er:YAG laser irradiation. Some specimens in each group were then prepared for surface topography visualization under SEM, others were subjected to coculture with hPDLF suspension, and cell adhesion was further evaluated by SEM. Results: Group A presented homogenous smooth root surface, with fewer and round-shaped cells attached; Group B and C exhibited rather rough and irregular morphologies, and spindle-shaped fibroblasts were firmly attached by numerous lamellipodia and extensions. After a 3-day coculture, the number of fibroblasts attached in Group A was significantly lower compared with the other two laser-treated groups ( p  = 0.008 < 0.05). No significant alterations were observed between the two laser groups ( p  = 0.135 > 0.05). Conclusions: Er:YAG laser-treated root surfaces are compatible for the attachment of PDLFs, which suggests that Er:YAG laser irradiation may be used as a promising strategy for root surface conditioning in delayed replantation cases.

Background/aim: Continuous research efforts have been focusing on promoting healing of delayed replantation of avulsed teeth. The aim of this in vivo study was to assess the effect of cathepsin K inhibitor surface treatment on delayed tooth replantation., Materials and Methods: Thirty-four premolar roots of 4 beagle dogs were extracted, and conventional root canal treatment was performed. The canals were filled with gutta-percha and cement. All extracted teeth were air-dried for 1 hour. Teeth were divided into 2 groups according to the root surface treatment prior to replantation: control (n = 13) and cathepsin K inhibitor (n = 21). Treated teeth were replanted in their original sockets and stabilized with a resin-wire splint for 1 week. After 12 weeks, the dogs were euthanized and micro-computed tomography was performed. Tissues were then further processed as resin-embedded specimens stained with hematoxylin and eosin. In each evaluation, data were analyzed using the Mann-Whitney U test (P < .05)., Results: In the micro-computed tomography evaluation, inflammation scores of both groups were not statistically different (P > .05). In the histological evaluation, the mean proportions of inflammatory resorption and replacement resorption in the control group were similar to those in the cathepsin K inhibitor group (P > .05)., Conclusions: Cathepsin K inhibitor did not demonstrate significant inhibitory effects on root resorption after delayed replantation in vivo., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Replacement resorption is the most frequent complication after delayed replantation of avulsed teeth. The resorption can interfere with the development of the alveolar ridge and lead to tilt of the adjacent teeth in growing patients. However, there is no means of arresting or reversing the process. Recently decoronation is recommended by International Assocaition of Dental Traumatology as the optimal choice to manage it. This paper demonstrates the procedure and effectiveness of the decoronation by literature review and a case report with 4-year follow-up.

Background: Avulsion is one of the most serious injuries of the tooth which is most commonly seen in young children and occurs in the upper front teeth. Immediate transplantation of the avulsed tooth is recommended treatment and results in good prognosis although this may not be always possible., Case Report: The present case highlights the 3-year follow-up of delayed replantation (after 15h) of maxillary central incisor which was avulsed due to trauma. The complications seen in the present case were ankylosis and inflammatory resorption, but clinically the tooth was asymptomatic and maintains the esthetics of the individual signifying the importance of delayed replantation even after prolonged extra-oral time., Clinical Implications and Conclusion: Although complications like ankylosis or root resorption may be unavoidable, delayed replantation of avulsed tooth may be a good alternative to prosthesis (implant or fixed partial denture) till the growth is completed due to preservation of the alveolar bone and psychological benefit to the patient. Also efforts should be made to educate and update children, teachers and parents regarding management of avulsed tooth at accident site and also the dentists regarding its management in dental office., (Copyright © 2014. Published by Elsevier B.V.)