Results after replantation of avulsed permanent teeth. II. Periodontal healing and the role of physiologic storage and antiresorptive‐regenerative therapy

Abstract

The status of the periodontal ligament (PDL) and of the pulp are decisive for the healing of avulsed and replanted teeth. A tooth rescue box was developed and distributed to offer optimal storage conditions for avulsed teeth. The therapy comprised extraoral endodontic treatment and applications of medicaments to enhance periodontal healing. In this long-term clinical study the healing results following avulsion and replantation were investigated. Twenty-eight permanent teeth in 24 patients were evaluated. The extraoral storage media and periods varied considerably. Soon after avulsion six teeth were stored in a cell culture medium (tooth rescue box Dentosafe) for 1-53 h; the PDL was defined as not compromised. Sixteen teeth were stored in a non-physiologic situation temporarily, the PDL was considered as compromised. Six teeth were stored in non-physiologic conditions for longer periods; the condition of the PDL was defined as hopeless. On 14 teeth antiresorptive-regenerative therapy (ART) with the local application of glucocorticoids and enamel matrix derivative and the systemic administration of doxycyclin was used. In all teeth extraoral endodontic treatment by retrograde insertion of posts was performed. The mean observation period was 31.2 months (+/-24.1; 5.1-100.2; median: 23.8). All six teeth rescued physiologically healed with a functional PDL (functional healing, FH) irrespective of the storage period. Of eight teeth with a compromised PDL on which ART was used, three teeth healed with a functional PDL. All other teeth showed replacement resorption, in three teeth additionally infection-related resorption was recorded. The predominant influence on the healing results was the immediate physiologic rescue of avulsed teeth (chi-square, P = 0.0001). The use of ART seemed to support FH (chi-square, P = 0.0547) in teeth with a compromised PDL. No other factors (maturity of roots, crown fractures, gender, age, antibiotics) were related to healing. In a linear regression analysis physiologic storage (P = 0.0013) and ART (P = 0.0421) were related to FH. For a good prognosis avulsed teeth should be stored immediately in a cell-compatible medium. Therefore the tooth rescue box should be distributed at places with higher risks of accidents, in families with children and in emergency facilities. The use of ART might have potential for enhancing the prognosis of teeth with a PDL that is compromised but not in a hopeless condition. Extraoral endodontic treatment reduces infection-related complications; this item was discussed in the first part of the publication.

Tratamiento De Una Reabsorción Externa Inflamatoria Con Trióxido De Mineral Agregado: Reporte De Un Caso

“…Posteriormente, el conducto fue obturado con un apósito de hidróxido de calcio en pasta, Calcifar -P (Eufar ® ) (Figura 2 y 3). [21][22][23][24][25][26][27][28][29][30][31][32][33] Figura 2. Estimación de la longitud de trabajo en 20 mm.…”

Current Developments in Transport Media for Avulsed Teeth: An Update

“…The use of this system is self-explanatory and simple to understand for lay persons. Although effective, this medium is still not easily available in many countries [41].…”

Simple replantation protocol to avoid ankylosis in teeth intended for orthodontic treatment

“…Specifically, it has a direct inhibitory effect on resorption activity of osteoclast cells and collagenase. 5 While tetracycline affects osteoclasts at the site of resorption, drugs are able to affect the recruitment of osteoclasts to the site of injury. Thus the combination of the two types of drugs might have a synergistic effect on the inhibition of root resorption.…”

“…This disruption allows growth of bone across the periodontal ligament and ankylosis (RR). [3][4][5] Inflammatory resorption (IRR) sustained by bacterial infection of necrotic pulp tissue in the replanted tooth can be effectively arrested by pulpectomy followed by Ca(OH)2 root canal filling. However, despite the ability to treat IRR predictably, unfortunately, its arrest promotes RR.…”

“…Pulp necrosis and consecutive infections cause ankylosis (or replacement resorption, RR), 3 and infection-related resorption (IRR, formerly called inflammatory resorption). 4,5 Unfortunately, tooth ankylosis leads to difficulties in orthodontic treatment i.e. retracting the avulsed protruded teeth.…”