Results after replantation of avulsed permanent teeth. III. Tooth loss and survival analysis

Abstract

Avulsed permanent teeth were replanted following immediate extraoral endodontic treatment by insertion of posts from a retrograde direction. Some teeth were rescued in a physiologic environment (tissue culture medium contained in a tooth rescue box), and in some cases antiresorptive-regenerative therapy (ART) was used. The aim of the study was to identify variables that influence the incidence of tooth loss and the survival of avulsed and replanted permanent incisors. Twenty-eight permanent teeth in 24 patients aged 7-17 years were investigated. In all teeth extraoral endodontic treatment by retrograde insertion of posts was performed. All nine teeth with functional healing (FH) were in situ. Of the 19 teeth with non-FH, seven were removed to allow transplantations. Two teeth were removed due to severe infrapositions. One tooth was lost following a new trauma. No tooth was lost due to acute infections. In descriptive statistics the incidence of tooth loss was significantly related to healing (P = 0.0098, Fisher's exact test), to treatment planning, i.e. consecutive replantation of premolars and primary canines (P = 0.0001, Fisher's exact test) and to immediate physiologic rescue (P = 0.0394). ART was related to tooth loss when tested in teeth with a compromised periodontal ligament (P = 0.0389). No influence could be found for the parameters maturity, age and all other factors. In a regression analysis treatment planning was the only factor left which had a significant influence (P = 0.0002). The estimated mean survival time (Kaplan-Meier analysis) for all teeth was 57.3 months. The survival was significantly reduced (P = 0.0002, log rank test) when consecutive transplantations were intended and performed. No influence could be found for maturity, age and all other factors. The different findings to previous studies can be explained by the prevention of complications related to conventional endodontic treatment approaches. Statistics have to be carefully interpreted due to case preselection which is determined by the treatment guidelines and actual treatment options of the individual treating dentist.

Management of inflammatory root resorption using MTA obturation – a four year follow up

“…time lag between avulsion and replantation -also known as dry time -proper endodontic management and timely follow up. [3][4][5][6] In the present case, there was severe root resorption within three months after the replantation. This could be attributed to the two hour time lag between avulsion and replantation and to the lack of splinting.…”

“…3 Dental traumatic avulsion can have pulpal and/or periodontal sequelae. 4 The pulpal vessels are severed leading to ischaemic infarction of the pulp. The bacterial invasion can further lead to pulpal necrosis.…”

“…In the case of an immature apex with minimal extra-oral time, immediate replantation with no endodontic intervention and long term follow up with vitality testing is recommended. [3][4][5][6] In the case of long extra-oral time, long term placement of calcium hydroxide is advisable to prevent infl ammatory root resorption. [3][4][5][6] Root resorption can be internal and external depending upon the location.…”

“…3,4,6 Conventional methods like immediate replantation with long term calcium hydroxide therapy, 3,5,6 treatment of the root surface with antibiotics, 6 and contemporary methods like the use of enamel matrix protein 7 or bisphosphonates 8 have been used. In the case of an immature apex with minimal extra-oral time, immediate replantation with no endodontic intervention and long term follow up with vitality testing is recommended.…”

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

“…Después de la reimplantación debe aplicarse una férula semirrígida por un período de 7 a 10 días ya que se ha comprobado que una ferulización prolongada podría iniciar un proceso de anquilosis del diente. [34][35][36][37][38][39][40][41][42] Las guías para el manejo de la avulsión de dientes permanentes con ápice cerrado, tiempo extraoral mayor de 60 minutos, mantenidos en un medio seco de transporte, indican: 35,[43][44][45][46] 1. Eliminar el ligamento periodontal necrótico.…”