• Journal of Periodontal and Implant Science
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• v.49 no.3
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• pp.148-157
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• 2019

Purpose: This study aimed to evaluate periodontal and pulpal healing in replanted rat teeth, preserved under different storage conditions, with or without root conditioning using doxycycline. Methods: A total of 40 maxillary first molars extracted from 20 Sprague-Dawley rats were stored for different durations under different conditions (5 minutes in dry storage and 60 minutes in Hank's balanced salt solution [HBSS]) and subsequently replanted. The rats were divided into 2 groups based on the use of root surface treatment: the doxycycline group (root surface treated with doxycycline) and the control group (no doxycycline treatment). Eight weeks after replantation, the animals were sacrificed, and the teeth were evaluated using micro-computed tomography (micro-CT) and histomorphometric analysis. Results: In the micro-CT analysis, the doxycycline group showed the same rate of occurrence of periapical radiolucency as was observed in the control group, but a lower degree of root resorption in teeth replanted after 60 minutes of storage in HBSS (P<0.05). In the histomorphometric analysis, the doxycycline group exhibited no improvement in either pulpal or periodontal healing of the replanted tooth after 5 minutes of dry storage, but showed a lower grade of surface root resorption ($1.37{\pm}0.77$) and inflammatory resorption in the teeth stored for 60 minutes in HBSS ($1.33{\pm}0.71$). Conclusions: In conclusion, doxycycline improved the periodontal healing of replanted teeth stored for 60 minutes in HBSS, whereas doxycycline did not improve periodontal healing of replanted tooth after 5 minutes of dry storage. Within the limits of this study, doxycycline showed more favorable periodontal healing despite delayed replantation.

• Journal of the korean academy of Pediatric Dentistry
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• v.24 no.1
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• pp.41-57
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• 1997

The present study investigated the effects of hyperbaric oxygen therapy on periodontal wound healing of replanted rat tooth. 80 rats (Sprague-Dawley strain) weighting $130{\pm}5gm$ were selected and divided into experimental and control group, each group consisting of 40 rats. Rats were administered 0.4% ${\beta}$-aminoproprionitrile for 5 days to achieve gentle tooth extraction. The maxillary first molars were extracted under anesthesia with pentobarbital, washed in sterile distilled water, treated with bacterial collagenase to remove collagen fibers on the root surfaces. After washing in water overnight, the mesial root surface were demineralized by application of citric acid, washed, dried and stored at $4^{\circ}C$. Immediately after tooth extraction and bleeding control, the treated molars extracted previously from other rats were replanted. The experimental group was exposed to hyperbaric oxygen at 2.5 atm. for 2 hrs. a day during experimental period. Eight animals of each group were sacrificed 1, 3, 6, 8, 10 days after reimplantation of teeth by intracardiac perfusion with 4% paraformaldehyde. The replanted molars and surrounding tissues were cut, demineralized, dehydrated and embedded in paraffin. Sections were stained with azan, toluidine blue and hematoxylin. Some other sections were stained by means of immunostaining achieved by the avidinbiotin complex method. The results as follows; 1. Experimental group showed fast healing of gingival epithelium. 2. Macrophage and newly formed blood vessels appeared early in the gingival connective tissue of experimental group. 3. Experimental group showed fast, abundant fibroblast proliferation and regularity of collagen fiber. 4. In both group, collagen was distributed along the collagen fiber. The distribution was strong and regular in the experimental group. 5. In the regenerated periodontal ligament of experimental group, fibers showed regular arrangement and invaded root surface fast.

• Restorative Dentistry and Endodontics
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• v.45 no.3
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• pp.29.1-29.9
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• 2020

This study describes the clinical steps taken in the treatment of a patient who had an avulsed right upper central incisor that presented with incomplete root development and chronic apical periodontitis. A 7-year-old boy was referred from a private dentist to a dental office specializing in endodontics. The tooth had remained in a dry environment for 20 minutes, and tooth replantation was performed at an emergency appointment. After clinical and radiographic examinations, root canal decontamination was performed, followed by several changes in intracanal calcium hydroxide medication. Blood clot formation was attempted, but bleeding within the root canal was insufficient; therefore, we opted for an intracanal medication change to stimulate mineralized tissue formation in the apical region. Root obturation was performed 45 days after the last change of intracanal medication, and clinical, radiographic, and tomographic follow-up examinations were performed at 3, 6, 18, and 40 months after the endodontic intervention. The increase in thickness and length of the root structure and the absence of root resorption were verified through follow-up examinations. Therefore, it was concluded that the procedures used were successful for tooth replantation.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.26 no.1
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• pp.73-79
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• 2000

A material of 48 patients with 60 avulsed and replanted permanent teeth were followed retrospectively in the period of 1996. 1 to 1998. 12 (mean observation period=1year 7months). The age of the patients at the time of replantation ranged from 9 to 63 years (mean=24 years). Clinical records of patients were reviewed to obtain valid data concerning the extent of injury and treatment provided. Pulpal and periodontal healing states were examined with periapical x-rays and clinical examination procedures (i.e. percussion test and mobility test) at their recall visit. Root ankylosis was found in fifty-two teeth(87%) and root resorption in twenty-four(40%). Only two of the replanted teeth(3%) showed partial regeneration of the periodontal ligament. Six teeth(10%) resulted in tooth loss, but the remaining fifty-four were clinically well functioning. Most of teeth have mild marginal bone loss accompanied by gingival retraction without pathological periodontal pockets. The incidence of root resorption was much higher in younger age group. However, it was not affected by the interval between avulsion and replantation, the condition of supporting tissues, the degree of root formation and the type of splinting, indicating that multiple factors involved in determining the prognosis of replanted teeth. Based on these findings, avulsed teeth in unfavorable conditions (i.e. long extra-alveolar periods, etc.) should be preserved if possible.

• Restorative Dentistry and Endodontics
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• v.44 no.3
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• pp.32.1-32.13
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• 2019

Calcium hydroxide (CH) is the gold-standard intracanal dressing for teeth subjected to traumatic avulsion. A common complication after the replantation of avulsed teeth is root resorption (RR). The current review was conducted to compare the effect of CH with that of other intracanal medications and filling materials on inflammatory RR and replacement RR (ankylosis) in replanted teeth. The PubMed and Scopus databases were searched through June 2018 using specific keywords related to the title of the present article. The materials that were compared to CH were in 2 categories: 1) mineral trioxide aggregate (MTA) and endodontic sealers as permanent filling materials for single-visit treatment, and 2) Ledermix, bisphosphonates, acetazolamide, indomethacin, gallium nitrate, and enamel matrix-derived protein (Emdogain) as intracanal medicaments for multiple-visit management of avulsed teeth prior to the final obturation. MTA can be used as a single-visit root filling material; however, there are limited data on its efficacy due to a lack of clinical trials. Ledermix and acetazolamide were comparable to CH in reducing RR. Emdogain seems to be an interesting material, but the data supporting its use as an intracanal medication remain very limited. The conclusions drawn in this study were limited by the insufficiency of clinical trials.

• Restorative Dentistry and Endodontics
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• v.40 no.3
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• pp.236-240
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• 2015

Traumatic dental injury can result in avulsion of anterior teeth. In young patients, it is a challenge to the dental professional because after replantation, late complications such as ankylosis require tooth extraction. Although prosthetic and orthodontic treatment, and implant placement have been described as the options for intervention, autogenous tooth transplantation could be an effective procedure in growing patients if there is a suitable donor tooth available. This case presents the treatment of a patient who suffered a traumatic injury at 9 years old with avulsion of tooth 21, which had been replanted, and intrusion of tooth 11. Both teeth ankylosed; thus they were removed and autotransplantation of premolars was carried out. After transplantation, the tooth underwent root canal treatment because of pulpal necrosis. Orthodontic treatment began 3 months after transplantation and during 7 years' follow-up the aesthetics and function were maintained without signs of resorption.

• Journal of the korean academy of Pediatric Dentistry
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• v.23 no.4
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• pp.968-974
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• 1996

Intra-alveolar transverse crown & root fx. provokes many problems in treatment. Conventionally, extraction of the injured tooth and its prosthodontic restoration has been the treatment of choice. Though orthodontic extrusion could be an alternative treatment, there would be a situation it's inadequate to apply. Loss of natural tooth would be a psychological damage to the patient, of course. This report describes a replantation method of tooth in case of intra-alveolar transverse crown & root fracture. The fractured tooth was extracted, rotated, then replanted. Fixation and esthetic restoration was done. And then endodontic treatment was followed. Continuing follow-up of its function and endodontic status is required.

• Restorative Dentistry and Endodontics
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• v.24 no.2
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• pp.426-429
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• 1999

When the tooth avulsion occur in accidents the drying damage to the periodontal ligament has extremely detrimental effects on healing. Pulp necrosis always occurs after an avulsion injury, but revascularization can only take place in teeth with immature apexes. Therefore complications after avulsion injuries are common, and treatment must be carried out in a timely and correct fashion to prevent or limit these complications. Every effort should be made to replant the tooth within the first 15 to 20 minutes. If doubt exists that the tooth can be replanted adequately, the tooth should quickly be stored in an appropriate medium until the patient can get to the dental office for replantation. A complication of inflammatory root resorption is occurred by bacterial infection of periodontal ligament and dental pulp. Therefore aseptic endodontic treatment must be carried out in a timely and systemic antibiotics given at the time of replantation and before endodontic treatment are effective in preventing bacterial invasion. Further studies are needed to establish the clinical importance of preparation of the socket and root.

• Journal of the korean academy of Pediatric Dentistry
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• v.26 no.1
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• pp.96-102
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• 1999

Tooth avusion implies total displacement of teeth out of its socket. Its frequency range from 0.5 to 16% of traumatic injuries. Replantation procedure is used for the treatment of avulsed tooth. However, its major complications are pulp necrosis, inflammatory root resorption and replacement root resorption. This paper describes 10 years and 2 months old male patient whose both maxillary central incisors were avulsed due to fall-down with slightly underdeveloped root apices. Teeth were replanted 2 hours after accident. Right central incisor's pulp tissues were extirpated and filled with $Vitapex^{(R)}$(calcium hydroxide) at 3-4 weeks after replantation, but left central incisor was filled at 8-9 weeks. Right central incisor showed little inflammatory resorption in apical portion, whereas left central incisor showed severe root resorption. During 18 months' follow-up period, left central incisor showed slightly ankylosis while right central incisor did not. Based upon the above-mentioned results, the following conclusions can be drawn: 1. Inflammatory resorption could be suppressed by endodontic treatment with calcium hydroxide. 2. When apex formation is doubted in replanted tooth due to avulsion, early endodontic treatment with calcium hydroxide seems to act positively for better prognosis.

• Journal of Periodontal and Implant Science
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• v.44 no.1
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• pp.13-19
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• 2014

Purpose: The purpose of this study was to retrospectively evaluate the survival of periodontally hopeless teeth that were intentionally extracted and replanted after a delay and to compare the radiographic characteristics of the survival group with those of the failure group. Methods: The clinical and radiographic data from patients who underwent delayed intentional replantation between March 2000 and July 2010 were reviewed. Twenty-seven periodontally hopeless teeth were extracted and preserved in medium supplemented with antibiotics for 10-14 days. The teeth were then repositioned in the partially healed extraction socket and followed for 3 to 21 months. The radiographic parameters were analyzed using a paired t test and the cumulative survival rate was analyzed using Kaplan-Meier analysis. Results: Seven replanted teeth failed and the overall cumulative survival rate was 66.4%. In the survival group, the amount of bone loss was reduced from 68.45% to 34.66% three months after replantation. There was radiologic and clinical evidence of ankylosis with 5 teeth. However, no root resorption was found throughout the follow-up period. In the failure group, bone formation occurred from the bottom of the socket. However, a remarkable radiolucent line along the root of a replanted tooth existed. The line lengthened and thickened as time passed. Finally, in each case of failure, the tooth was extracted due to signs of inflammation and increased mobility. Conclusions: Delayed intentional replantation has many advantages compared to immediate intentional replantation and could serve as an alternative treatment for periodontally involved hopeless teeth. However, techniques for maintaining the vitality of periodontal structures on the tooth surface should be developed for improved and predictable results.