Discoloration of teeth after avulsion and replantation: results from a multicenter randomized controlled trial

Introduction: There is evidence to suggest that Ledermix, placed as an intervisit root canal dressing, might improve periodontal healing after replantation of avulsed teeth. As a part of a multicenter randomized controlled trial, we aimed to compare the effect of 2 root canal medicaments, Ledermix and Ultracal XS, on the discoloration of replanted teeth. Methods: Discoloration was investigated by using 3 methods: patient satisfaction with the color of replanted teeth, clinical photographs taken at baseline and 12-month reviews, and estimation of color change by using CIELAB scores for baseline and 12-month photographs. Results: Twenty-two patients (27 teeth) were recruited. Ten patients (12 teeth) Were randomized to the Ledermix group and 12 patients (15 teeth) to the Ultracal XS group. At 12 months, 8 patients were concerned with the discoloration of their teeth. Seven came from the Ledermix group and 1 from the Ultracal XS group. This difference was significant (Fisher exact test, P = .009). Standardized photographs were taken for the patients recruited at one center only (17 patients). There was significant discoloration of teeth from baseline with Ledermix, causing a darkening and gray-brown discoloration (mean change from baseline to 12 months, L(star) = -5.1, a(star) = 0.3, b(star) = -1.2, and, Delta E = 8.1) and Ultracal XS, causing a yellowing and lightening of teeth (L(star) = 1.9, a(star) = 0.3, b(star) = 3.3, and Delta E = 5.4). There was a significant difference for the L(star) and b(star) variables (independent t test) between the 2 groups. Conclusions: Both root canal medicaments cause discoloration, with Ledermix proving less acceptable to patients.