Replantation of 400 avulsed permanent incisors. 4. Factors related to periodontal ligament healing

Abstract

400 avulsed and replanted permanent teeth were examined for periodontal ligament (PDL) healing, using standardized radiographic and clinical examination procedures (i.e. percussion test and mobility test). The effect of various clinical factors was examined, such as age and sex of the patient, type of tooth replanted, presence of crown fracture or bone fracture, stage of root development (including apical diameter and length of the pulp), type and length of extra-alveolar storage, clinical contamination of the root surface, type of root surface cleansing procedure, type and length of splinting period and antibiotic therapy. Surface resorption was generally diagnosed after 12 months; while inflammatory resorption and replacement resorption (ankylosis) were usually observed after 1 month and 1-2 months respectively. Most resorptive processes were diagnosed within the first 2-3 years. However, although rarely, even after 5 and 10 years new resorptive processes could be diagnosed. A univariate statistical analysis of 272 teeth revealed 9 factors significantly related to PDL healing. A subsequent multivariate analysis revealed that the following 4 factors had the strongest impact upon PDL healing, in descending order of significance: Stage of root development; length of the dry extra-alveolar storage period; immediate replantation and length of the wet period (saliva or saline storage). Nonphysiological storage, such as homemade saline and sterilizing solutions (chloramine and alcohol) always led to root resorption. Storage in tap water for more than 20 minutes usually led to root resorption. The common denominator for all these factors related to PDL healing appears to be survival of the PDL cells along the root surface. Based on these findings, immediate replantation is recommended irrespective of stage of root development.

A preliminary study of effects of low-intensity pulsed ultrasound (LIPUS) irradiation on dentoalveolar ankylosis

“…Certain studies have reported good prognoses after tooth transplantation, with recent success rates exceeding 90% (7,16). However, other studies have demonstrated failure of approximately 23% of transplanted teeth, most commonly because of dentoalveolar ankylosis (4)(5)(6)(7)(8). Therefore, we aimed to investigate whether LIPUS could regenerate PDL and prevent dentoalveolar ankylosis after autotransplantation.…”

“…However, autotransplantation is more advantageous than prostheses such as dentures or implant placement in terms of success and periodontal sensation in the alveolar bone; this type of transplantation induces formation of new supporting tissue, continued root formation, eruption, and maintenance of occlusal contact with opposing teeth (1)(2)(3). Use of transplantation is increasing, and its clinical success rates are improving as well (4)(5)(6)(7)(8). Sugai et al reported a success rate of approximately 90% for autotransplantation; however, in the other 10% of cases, the prognosis was poor, and one-third of these cases experienced postoperative dentoalveolar ankylosis (7).…”

Tooth replantation: an update

“…A recent evidencebased appraisal of the literature indicates that splint type and duration were not generally a significant variable in relation to healing outcomes [24]. Although, ankylosis and replacement resorption may be observed with a long-term splinting, significant improvements outcomes with short-term spliting have not been shown [25][26][27]. Now it's recommended that the tooth be splinted for up to two weeks contrary to six weeks as before [24].…”

Delayed Replantation of Avulsed Incisor with Prolonged Extraoral Dry Storage

“…2 Clinical reports have indicated that the prognosis is best for teeth replanted within 5 minutes of avulsion. [3][4][5][6] Most often replantation is not done immediately, because of injury circumstances. Extended non-physiological storage of avulsed teeth before replantation results in necrosis of the PDL and consequent healing by replacement root resorption.…”