Surgical Re-entry of an Intentionally Replanted Periodontally Compromised Tooth Treated with Platelet Rich Fibrin (PRF): Hopeless to Hopeful

Abstract

A systemically healthy 23-year-old male patient reported to the Department of Periodontics, College of Dental Sciences, Davangere, Karnataka, India with the chief complaint of pain in his upper front tooth since one week which aggravated on biting. Past dental history revealed a self-fall and trauma to the upper front tooth region, two months back. Clinical examination revealed inflamed gingiva, pus exudation, extrusion, Miller's Grade III mobility, pocket depth of 14mm mesio-, mid-and distolabially; 10mm mesio-and distopalatally in relation to left maxillary central incisor. The tooth was nonresponsive to pulp sensitivity test. Intra-Oral Periapical Radiograph (IOPA) revealed severe bone loss [Table/ Fig-1]. The diagnosis of true combined lesion was established and periodontally hopeless prognosis assigned. Hereafter, the patient was advised to undergo extraction, followed by replacement options such as Removable Partial Denture (RPD), Fixed Partial Denture (FPD) or implants. However, due to financial constraints patient was reluctant for extraction and keen on retaining his natural tooth. Therefore, a treatment plan consisting of intentional replantation with Guided Tissue Regeneration (GTR) was formulated. The success rate of treatment and complications were explained to patient and a written consent was obtained.Case Management: Phase I therapy including scaling, root planning and splinting with wire and composite [Table/ Fig-2] was carried out, no occlusal interferences were noted. This was followed by endodontic treatment involving placement of calcium hydroxide dressing for two weeks followed by obturation with guttapercha. Surgery was scheduled four weeks after completion of endodontic treatment.Replantation procedure: After obtaining adequate anesthesia using Lignocaine hydrochloride 2%, a full thickness mucoperiosteal flap was reflected which revealed periodontal destruction extending beyond the root apex [Table/ Fig-3]. Splint removal was followed by atraumatic tooth extraction. Extracted tooth was root planed with Gracey's curettes for removal of calculus, remaining periodontal ligament and necrotic cementum and was immediately placed in a solution of tetracycline (500 mg of tetracycline dissolved in 20 ml saline) for 5 min.After debridement of the defect site, autologous Platelet Rich Fibrin (PRF) was obtained as follows: Around 5 ml of whole Intentional replantation is generally contraindicated in periodontally compromised teeth however, there are reports suggesting that it can be a successful treatment alternative for periodontally involved hopeless teeth. Currently there is dearth of evidence regarding the success of this therapy, especially evidence for the effectiveness of autologous platelet rich fibrin is lacking. We present a case report of a 23-year-old male patient with periodontally hopeless left maxillary central incisor having bone loss extending beyond root apex. The tooth was gently extracted and replanted utilizing root conditioning and combined regenerative therapy (Xenograft, PRF a...

Tooth intentional replantation from 1964 to 2023: A bibliometric analysis

“…The analysis of research themes showed that IR for periapical diseases gained the most significant attention in publications before 2000, whereas IR for vertical root fractures, 35–39 crown root fractures, 40–43 and periodontic diseases 44–48 gradually became the main theme since 2001. During 2001–2005 and 2010–2015, several materials were used for the management of vertical root fractures with IR, including self‐etching dual‐cure adhesive resin cement, 35,36 calcium‐enriched adhesive resin cement, 49 and 4‐methacryloxyethyl trimellitate anhyride/methacrylate‐tri‐n‐butyl borane (4‐META/MMA‐TBB) resin cement 37–39 .…”

“…Since 2008, an increasing number of studies have evaluated the use of IR for teeth with crown root fractures, 40–43 in some cases with 180‐degree rotation 40,43 . Furthermore, researchers have noted that the use of biomaterials (e.g., leukocyte‐platelet‐rich fibrin) with IR seems to be beneficial for rescuing periodontally hopeless teeth, which might become a future research direction 45,47,50–53 …”

“…The co-occurrence of these 29 keywords was analyzed, and a network structure was constructed. The density visualization map showed that the most frequent keywords were "endodontic disease," "case report," "root canal treatment," and "intentional replantation" (Fig- The analysis of research themes showed that IR for periapical diseases gained the most significant attention in publications before 2000, whereas IR for vertical root fractures, [35][36][37][38][39] crown root fractures, [40][41][42][43] and periodontic diseases [44][45][46][47][48] Note: q1: first quartile of the publication year. q3: third quartile of the publication year.…”

“…40,43 Furthermore, researchers have noted that the use of biomaterials (e.g., leukocyteplatelet-rich fibrin) with IR seems to be beneficial for rescuing periodontally hopeless teeth, which might become a future research direction. 45,47,[50][51][52][53]…”

Replantation in adolescents: a case report

“…The local action of these factors results in cell survival, migration, proliferation and differentiation [14]. Due to these properties, PRF can be used to improve the regeneration of the replanted tooth by applying it directly to the socket or to protect the tooth outside the socket, thanks to the properties that reduce the death of PDL [15].…”