Sclerostin and DKK1 Inhibition Preserves and Augments Alveolar Bone Volume and Architecture in Rats with Alveolar Bone Loss. Liu M,Kurimoto P,Zhang J,Niu Q T,Stolina M,Dechow P C,Feng J Q,Hesterman J,Silva M D,Ominsky M S,Richards W G,Ke H,Kostenuik P J Journal of dental research Alveolar bone is a mechanosensitive tissue that provides structural support for teeth. Alveolar bone loss is common with aging, menopause, tooth loss, and periodontitis and can lead to additional tooth loss, reduced denture fixation, and challenges in placing dental implants. The current studies suggest that sclerostin and DKK1, which are established osteocyte-derived inhibitors of bone formation, contribute to alveolar bone loss associated with estrogen ablation and edentulism in rats. Estrogen-deficient ovariectomized rats showed significant mandibular bone loss that was reversed by systemic administration of sclerostin antibody (SAB) alone and in combination with DKK1 antibody (DAB). Osteocytes in the dentate and edentulous rat maxilla expressed Sost (sclerostin) and Dkk1 (DKK1) mRNA, and molar extraction appeared to acutely increase DKK1 expression. In a chronic rat maxillary molar extraction model, systemic SAB administration augmented the volume and height of atrophic alveolar ridges, effects that were enhanced by coadministering DAB. SAB and SAB+DAB also fully reversed bone loss that developed in the opposing mandible as a result of hypo-occlusion. In both treatment studies, alveolar bone augmentation with SAB or SAB+DAB was accompanied by increased bone mass in the postcranial skeleton. Jaw bone biomechanics showed that intact sclerostin-deficient mice exhibited stronger and denser mandibles as compared with wild-type controls. These studies show that sclerostin inhibition, with and without DKK1 coinhibition, augmented alveolar bone volume and architecture in rats with alveolar bone loss. These noninvasive approaches may have utility for the conservative augmentation of alveolar bone. 10.1177/0022034518766874
    Cell migration capability of vascular endothelial growth factor into the root apex of a root canal model in vivo. Matsuura Takashi,Sugimoto Kouji,Kawata-Matsuura Viviane K S,Yanagiguchi Kajiro,Yamada Shizuka,Hayashi Yoshihiko Journal of oral science Once a tooth develops deep caries and the dental pulp tissue is irreversibly infected, the infected dental pulp tissue should be removed, and filling material should be placed in the root canal. Endodontically treated teeth are prone to root fracture or periapical periodontitis; however, dental pulp tissue has the potential to prevent root fracture or periapical periodontitis. Therefore, dental pulp regeneration after pulpectomy may help prolong tooth life. In this study, a new method of dental pulp regeneration was developed. Vascular endothelial growth factor-adsorbed collagen gel was injected into the root canal of a prepared root canal model, placed into the dorsum of a rat, and cultured for 3 weeks. After retrieving the implant, histological analysis was performed. It was found that rat somatic cells were recruited into the root apex of the transplanted root canal model. These findings suggest a new potential technique for engineering dental pulp tissue. 10.2334/josnusd.17-0456
    Evidence for programmed odontoblast process retraction after dentine exposure in the rat incisor. Mahdee A,Eastham J,Whitworth J M,Gillespie J I Archives of oral biology OBJECTIVE:To re-examine the morphology and potential functions of odontoblasts in intact rat incisors and after cavity preparation into dentine. DESIGN:Intact incisors were fixed, decalcified, snap frozen and sectioned (10μm), before staining with rhodamine phalloidin or antibodies for cyto-skeletal proteins: vimentin and actin, ion transporter: NaK-ATPase, and dendritic cell marker: OX6. Samples with cavity were processed similarly and stained for actin and vimentin before comparing the lengths of odontoblast processes (OP) at baseline, 3h and 24h (n=5 for each group). RESULTS:Actin was expressed through the full length of OP, while vimentin immunoreactivity was not uniform, with 4 distinct regions. OP showed morphological complexity with fine branches emanating within different regions of dentine. Novel actin-positive tree-like OP were identified within predentine which reduced in intensity and length toward the incisal portion of the tooth. Specimens with cavities showed time-dependant pulpal retraction of OP. CONCLUSIONS:Differences in structural antibody expression suggest functional variations in OP within different regions of dentine. The role of actin positive OP in predentine is not known, but could be related to dentine deposition, cellular stability or sensing mechanisms. Cavity preparation into dentine was followed by programmed retraction of OP which could be controlled either mechanically by the spatial limitation of the OP within dentinal tubules or structurally by the presence of vimentin, in addition to actin, in the mid-dentine. 10.1016/j.archoralbio.2017.10.001
    Effects of loss of occlusal contact on the expression of matrix metalloproteinase-2, membrane type 1-MMP, tissue inhibitor of the MMP-2, eruption rate, organization and resistance of collagen fibers of the rat incisor periodontal ligament. Omar N F,Gomes J R,Neves J S,Novaes P D Journal of periodontal research BACKGROUND AND OBJECTIVE:This study investigated the effect of occlusal contact loss (induced by tooth shortening), on matrix metalloproteinase (MMP)-2, membrane type 1-MMP (MT1-MMP) and tissue inhibitor of the MMP-2 (TIMP-2) expressions in the periodontal ligament of the rat incisor, as well as eruption rate, resistance and collagen organization. MATERIAL AND METHODS:Male Wistar rats were distributed into a control group, denominated normofunctional group, whose lower teeth underwent a normal eruption process; and a hypofunctional group, whose lower left incisor teeth were shortened every 2 days during 14 days. Parameters were evaluated on the first, seventh and 14th days and the eruption rate was determined according to the size of the incisor during the eruption process. MMP-2 activity was determined by zymography and the expressions of the MT1-MMP and TIMP-2 proteins were quantitated by western blot. Collagen protein organization, as indicated by the birefringence of the periodontal ligament, was analyzed under polarized light and the periodontal ligament's resistance was determined from the load necessary to inject the incisor into its alveolar space, before extraction. RESULTS:Loss of occlusal contact, in rats submitted to hypofunctional eruption, increased MMP-2 activity and eruption rate, but decreased MT1-MMP and TIMP-2 expression and disrupted collagen organization in the periodontal ligament, consequently reducing periodontal ligament resistance. CONCLUSION:We conclude that, after incisor eruption, occlusal contact may be an important factor for regulating the remodeling and the physiological resistance of the periodontal ligament against the continuous eruption process observed in rat incisors. 10.1111/jre.12484
    A Comparative Assessment of Implant Site Viability in Humans and Rats. Chen C-H,Pei X,Tulu U S,Aghvami M,Chen C-T,Gaudillière D,Arioka M,Maghazeh Moghim M,Bahat O,Kolinski M,Crosby T R,Felderhoff A,Brunski J B,Helms J A Journal of dental research Our long-term objective is to devise methods to improve osteotomy site preparation and, in doing so, facilitate implant osseointegration. As a first step in this process, we developed a standardized oral osteotomy model in ovariectomized rats. There were 2 unique features to this model: first, the rats exhibited an osteopenic phenotype, reminiscent of the bone health that has been reported for the average dental implant patient population. Second, osteotomies were produced in healed tooth extraction sites and therefore represented the placement of most implants in patients. Commercially available drills were then used to produce osteotomies in a patient cohort and in the rat model. Molecular, cellular, and histologic analyses demonstrated a close alignment between the responses of human and rodent alveolar bone to osteotomy site preparation. Most notably in both patients and rats, all drilling tools created a zone of dead and dying osteocytes around the osteotomy. In rat tissues, which could be collected at multiple time points after osteotomy, the fate of the dead alveolar bone was followed. Over the course of a week, osteoclast activity was responsible for resorbing the necrotic bone, which in turn stimulated the deposition of a new bone matrix by osteoblasts. Collectively, these analyses support the use of an ovariectomy surgery rat model to gain insights into the response of human bone to osteotomy site preparation. The data also suggest that reducing the zone of osteocyte death will improve osteotomy site viability, leading to faster new bone formation around implants. 10.1177/0022034517742631
    Effects of corticopuncture (CP) and low-level laser therapy (LLLT) on the rate of tooth movement and root resorption in rats using micro-CT evaluation. Suzuki Selly Sayuri,Garcez Aguinaldo Silva,Reese Patricia Oblitas,Suzuki Hideo,Ribeiro Martha Simões,Moon Won Lasers in medical science The aim of this study was to compare the rate of tooth displacement, quantity of root resorption, and alveolar bone changes in five groups: corticopuncture (CP), low-level laser therapy (LLLT), CP combined with LLLT (CP + LLLT), control (C), and negative control (NC). A total of 60 half-maxilla from 30 male Wistar rats (10 weeks old) were divided randomly into five groups: three (CP, LLLT, and CP + LLLT) test groups with different stimulation for accelerated-tooth-movement (ATM), one control (C) group, and one negative control (NC) group with no tooth movement. Nickel-titanium coil springs with 50 g of force were tied from the upper left and right first molars to micro-implants placed behind the maxillary incisors. For the CP and CP + LLLT groups, two perforations in the palate and one mesially to the molars were performed. For the LLLT and CP + LLLT groups, GaAlAs diode laser was applied every other day for 14 days (810 nm, 100 mW, 15 s). The tooth displacements were measured directly from the rat's mouth and indirectly from microcomputer (micro-CT) tomographic images. Bone responses at the tension and compression sites and root resorption were analyzed from micro-CT images. The resulting alveolar bone responses were evaluated by measuring bone mineral density (BMD), bone volume fraction (BV/TV), and trabecular thickness (TbTh). Root resorption crater volumes were measured on both compression and tension sides of mesial and distal buccal roots. The tooth displacement in the CP + LLLT group was the greatest when measured clinically, followed by the CP, LLLT, and control groups (C and NC), respectively (p <0.05). The tooth movements measured from micro-CT images showed statistically higher displacement in the CP and CP + LLLT groups compared to the LLLT and control groups. The BMD, BV/TV, and TbTh values were lower at the compression side and higher at the tension side for all three test groups compared to the control group. The root resorption crater volume of the distal buccal root was higher in the control group, followed by CP, LLLT, and CP + LLLT, mostly at the compression site. Combining corticopuncture and low-level laser therapy (CP + LLLT) produced more tooth displacement and less root resorption at the compression side. The combined technique also promoted higher alveolar bone formation at the tension side. 10.1007/s10103-017-2421-5
    Invasive Cervical Resorption: Clinical Management in the Anterior Zone. Espona José,Roig Elena,Durán-Sindreu Fernando,Abella Francesc,Machado Manoel,Roig Miguel Journal of endodontics According to the high number of articles published on invasive cervical resorption (ICR), this pathology, as commonly believed, is a more frequent form of cervical resorption. ICR is often misdiagnosed as internal resorption or caries, which leads to inappropriate treatment and even unnecessary tooth loss. Despite a correct diagnosis, the treatment of this type of hyperplastic invasive external resorption poses a challenge for the clinician. The Heithersay classification and the use of cone-beam computed tomographic imaging have increased our knowledge of the pathology and helped improve its prognosis. Nevertheless, there is no standard protocol for the treatment of this type of lesion. This article proposes a treatment protocol for ICR based on the pattern and location of resorption. Three treatment approaches (internal access, external access, and intentional replantation) are presented through 3 clinical cases. 10.1016/j.joen.2018.07.020
    Expression of inflammatory cytokines and MMPs on replanted teeth at different extra-alveolar time: an ex vivo and in vivo study. Ahn Hyo Jung,Nam Ok Hyung,Lee Hyo-Seol,Kim Eun-Cheol,Cohenca Nestor,Choi Sung Chul International journal of paediatric dentistry BACKGROUND:Immediately after the avulsed tooth is replanted, a complex inflammatory response ensues. As part of the periodontium healing process, the extracellular matrix macromolecules are essential to create the cellular environment required during healing and morphogenesis. AIM:This study was designed to evaluate the correlation between different extra-alveolar dry times and inflammatory cytokines and matrix metalloproteinases (MMPs) as part of the periodontal ligament (PDL) gene expression. DESIGN:The first phase of the study aimed testing human PDL cells ex vivo. Extracted teeth were dried for 15 and 30 min. The PDL cells were extracted and analyzed by qRT-PCR. The second phase was performed in vivo, and 36 Sprague Dawley rat first maxillary molars were extracted and replanted after 15, 30, and 60 min extra-alveolar time. We tested the levels of inflammatory cytokines and MMPS in periodontal tissue at 3, 7, and 28 days after tooth replantation. The replanted area was dissected, grounded, and analyzed by RT-PCR. RESULTS:Expressions of IL-1β, IL-6, TNF-α, and MMP-3 and MMP-9 were significantly higher in the replanted teeth. Extended dry time had a direct correlation with induction of pro-inflammatory cytokine and MMPs in PDL cells. CONCLUSION:Our study showed that pro-inflammatory cytokines were more significantly expressed in the tissues surrounding the replanted teeth. Future research must be undertaken to additionally confirm the release of these cytokines and be focused on the inhibition of these cytokines to reduce inflammation of replanted teeth. 10.1111/ipd.12211
    Expression of Inflammatory Cytokines and Chemokines in Replanted Permanent Teeth with External Root Resorption. Bastos Juliana Vilela,Silva Tarcilia A,Colosimo Enrico A,Côrtes Maria Ilma S,Ferreira Daniela Augusta B,Goulart Eugenio Marcos A,Gomez Ricardo S,Dutra Walderez O Journal of endodontics INTRODUCTION:The progressive forms of inflammatory external root resorption (IERR) and replacement external root resorption (RERR) are serious complications and the main causes of tooth loss after replantation. This study aimed to investigate the expression pattern of inflammatory molecules in extracted human teeth presenting with external root resorption (ERR) after replantation. METHODS:Root fragments from 22 teeth showing IERR and 20 teeth with RERR were triturated using a homogenizer to extract inflammatory molecules. Interleukin-1β (IL-1β), IL-1Ra, transforming growth factor beta, IL-8/CXCL8, CCL2, CCL3, and CCL5 were measured using double-ligand enzyme-linked immunosorbent assay, and IL-2, IL-4, IL-6, IL-10, tumor necrosis factor alpha, interferon gamma, and IL-17A detection was performed using the multiplex Th1/Th2/Th17 Cytometric Bead Array kit (BD Biosciences, San Jose, CA). Cytokine and chemokine concentrations were compared in the RERR and IERR groups corrected by patients' age at the moment of extraction, survival time after replantation, and index of ERR, adopting a generalized estimation equation model. RESULTS:The IERR group showed higher levels of tumor necrosis factor alpha than the RERR group, even after correction for the index of ERR (P < .05). IL-1Ra levels were higher in the IERR group for moderate cases but higher in the RERR group for severe cases (P < .05). IL-4 concentration became higher with the increase of patients' age in the RERR group but did not vary in the IERR group (P < .05). CCL2 levels decreased with the increase of the patients' age at the moment of extraction irrespective of the type or index of ERR (P < .05). CONCLUSIONS:The present results showed differences in the immunologic profile of IERR and RERR that may be relevant to understanding the biological mechanisms underlying ERR. 10.1016/j.joen.2016.10.018
    Long-term retention of avulsed maxillary permanent incisors replanted after prolonged non-physiological storage. Krug Ralf,Kremeier Karin,Krastl Gabriel Dental traumatology : official publication of International Association for Dental Traumatology Ankylosis and external replacement resorption (ERR) are two typical biological responses to delayed replantation of avulsed teeth in cases where adequate root canal treatment is performed. The patient's growth stage affects the progression of root resorption and the long-term outcome of the affected teeth. This case report describes the long-term outcome of an 18.5-year-old patient following an accident in which both of his maxillary central incisors were avulsed and replanted after four hours of non-physiological storage. ERR and ankylosis of teeth 11 and 21 were detected clinically and radiographically during the second year of follow-up. Sixteen years after replantation, replacement resorption was progressing very slowly, enabling functional tooth retention with favorable esthetics. Young adults, with delayed replantation of avulsed teeth, may benefit from tooth retention with slow ERR. 10.1111/edt.12445
    Age and timing of pulp extirpation as major factors associated with inflammatory root resorption in replanted permanent teeth. Bastos Juliana Vilela,Ilma de Souza Côrtes Maria,Andrade Goulart Eugenio Marcos,Colosimo Enrico Antonio,Gomez Ricardo Santiago,Dutra Walderez Ornelas Journal of endodontics INTRODUCTION:External root resorption (ERR) is a serious complication after replantation, and its progressive inflammatory and replacement forms are significant causes of tooth loss. This retrospective study aimed to evaluate the factors related to the occurrence of inflammatory ERR (IERR) and replacement ERR (RERR) shortly after permanent tooth replantation in patients treated at the Dental Trauma Clinic at the School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil. METHODS:Case records and radiographs of 165 patients were evaluated for the presence, type, and extension of ERR and its association with age and factors related to the management and acute treatment of the avulsed tooth by using the logistic regression model. RESULTS:The patient's age at the moment of trauma had a marked effect on the ERR prevalence and extension. The patients older than 16 years at the moment of trauma had less chance of developing IERR and RERR (77% and 87%, respectively) before the pulp extirpation, regardless of the extension of the resorption. The patients older than 11 years of age at the moment of trauma showed the lowest indices of IERR (P = .02). Each day that elapsed between the replantation and the pulp extirpation increased the risk of developing IERR and RERR by 1.2% and 1.1%, respectively, and also raised the risk of severe IERR by 0.5% per day. CONCLUSIONS:The risk of mature teeth developing severe IERR before the onset of endodontic therapy was directly affected by the timing of the pulpectomy and was inversely proportional to age. Systemic antibiotic therapy use had no effect on the occurrence and severity of IERR in mature teeth. The occurrence of RERR before the onset of endodontic treatment stimulates further investigations of the early human host response to trauma and subsequent infection. 10.1016/j.joen.2013.10.009
    The effects of three modified Hank's balanced salt solutions on root resorption of late replanted teeth: A pilot study. Qian Hanyu,Ding Yunpeng,Wu Yangou,Li Shengjiao Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery PURPOSE:The purpose of this study was to evaluate the effects of replanted rats' teeth that had been soaked in one of three modified Hank's balanced salt solutions (HBSSs) before replantation and after extended extra-oral dry time. MATERIALS AND METHODS:Maxillary right incisors were extracted from 55 Wistar rats and kept dry for 30 or 60 min (n = 5 each). Afterwards, the pulp was extirpated and both the papilla and enamel organ were removed with a scalpel. Each group of teeth was soaked in one of three modified HBSSs or HBSS alone. After 30 min of immersion in solutions, the root canals were dried and filled with calcium hydroxide paste, and the teeth were replanted. After 8 weeks, animals were euthanized; then, specimens were processed as 5 μm-thick serial sections for histological examination and morphometric assessments. RESULTS:The percentages of root resorption for the groups were found to be in the following order: HBSS3 (the bFGF group) > the HBSS only group > HBSS2 (the GSH group) > no soaking (the positive control group) > HBSS1 (the ALN group) for 30 min and the positive control group > the HBSS only group > HBSS2 > HBSS3 > HBSS1 for 60 min. The lowest incidence of resorption was observed in immediately replanted teeth (negative control). CONCLUSIONS:The findings of this study suggest that soaking for 30 min in HBSS containing 1 mM alendronate can significantly inhibit root resorption for avulsed teeth that have been dried for 60 min. 10.1016/j.jcms.2018.02.009
    Effect of preameloblast-conditioned medium and CPNE7 on root surfaces in dogs: a histologic and histomorphometric evaluation. Yu Sang-Joun,Lee Yoon Seon,Choung Han-Wool,Park Yeoung-Hyun,Kim Byung-Ock,Park Joo-Cheol Journal of molecular histology Preameloblast-conditioned medium (PACM) has been reported as a potent dentin regenerative material, but its effects as a mixture on periodontal regeneration and the role of CPNE7 in PACM are not known. The purpose of this study is to evaluate the histologic and histomorphometric effects of preameloblast-conditioned medium (PACM) and CPNE7 on periodontal tissue healing in dogs. Seventy-two mandibular premolar roots from ten dogs were extracted and randomly divided into six groups (n = 12 each): (1) positive control group; (2) negative control group; (3) cementum-removed and PACM-treated group; (4) cementum-preserved and PACM-treated group; (5) CPNE7-inactivated PACM-treated group; and (6) recombinant CPNE7-treated group. The extracted roots were replanted into extraction sockets for 4 and 8 weeks and analyzed histologically. Most of the root surfaces in the negative control group showed ankylosis; and those in the experimental groups showed newly formed PDL-like and cementum-like tissues. Histomorphometric analysis of horizontal sections showed that the mean length of the PDL on the roots of the positive controls was similar to those in cementum-removed or -preserved and PACM-treated group at 8 weeks (p = 1.08). Sagittal sections showed that the mean length of the new cementum on the roots in cementum-removed and PACM-treated group was significantly greater than that in CPNE7-inactivated PACM-treated group (p = 0.037). The mean length of the newly formed PDL on the roots in CPNE7- inactivated PACM-treated and rCPNE7-treated groups was significantly greater than that in the negative controls at 8 weeks (p = 0.037, p = 0.036). The use of PACM and CPNE7 in tooth replantation resulted in increased PDL and cementum formation, suggesting the beneficial role of PACM and CPNE7 in periodontal tissue healing. 10.1007/s10735-018-9766-3
    Influence of Atopy in the Outcome of Avulsed and Replanted Teeth during 5 Years of Follow-up. Roskamp Liliane,Silva Neto Ulisses Xavier da,Carneiro Everdan,Fariniuk Luiz Fernando,Westphalen Vania Portela Ditzel Journal of endodontics INTRODUCTION:The goal of replantation after dental avulsion is to maintain the tooth in its socket. Presence of vital periodontal ligament cells on the root surface of the replanted tooth and the immunologic status of the patient are factors that protect against root resorption. It is known that dental constituents play an active role in root resorption by inducing specific and non-specific immune responses; however, little information exists regarding the influence of the acquired immune response on replantation. Therefore, the aim of this study was to evaluate the 5-year outcome of replantation in non-atopic and atopic patients. METHODS:Clinical and radiographic examinations were performed in 62 replanted teeth during a 5-year period. The evaluation of atopy was based on the patients' personal and family histories and skin prick test results. The χ and the Z tests were used to assess the association between atopy and the outcome of the replanted teeth (P < .05). RESULTS:There were significant differences between the 1-year and 5-year outcomes of the replanted teeth (P < .05) and atopic and non-atopic patients who had their teeth extracted because of inflammatory or replacement root resorption after 5 years (P < .05). CONCLUSIONS:Being atopic may offer the advantage of loss of fewer teeth because of replacement resorption, whereas being non-atopic may create an advantage of loss of fewer teeth because of inflammatory root resorption during the first 5 years after trauma. 10.1016/j.joen.2016.09.020
    There is probably high variability in the incidence of root resorption after replantation of avulsed teeth across and within types of teeth and resorption. Brignardello-Petersen Romina Journal of the American Dental Association (1939) 10.1016/j.adaj.2018.08.006
    Histologic and micro-computed tomographic analyses of replanted teeth stored in different kind of media. de Paula Reis Manuella Verdinelli,Moura Camilla Christian Gomes,Soares Priscilla Barbosa Ferreira,Leoni Graziela Bianchi,Souza-Neto Manoel Damião,Barbosa Darceny Zanetta,Soares Carlos José Journal of endodontics INTRODUCTION:Coconut water (CW) and soy milk (SM) have been proposed as storage media for avulsed teeth because of their nutrients that preserve cell viability. The present study investigated the periodontal healing process of dog teeth replanted after storage in CW, SM, and whole milk (WM) using micro-computed tomographic (μCT) and histologic analyses compared with immediate tooth replantation. METHODS:Forty roots of 10 adult beagle dogs were extracted and subjected to the following protocols: immediate replantation after extraction (control), stored in CW with an adjusted pH, and SM and WM for 50 minutes before replantation. The animals were euthanized 28 days postoperatively, and the obtained specimens were scanned using a μCT scanner and subjected to routine processing for histometric analyses under an optical microscope. RESULTS:CW and SM performed similarly to WM; however, SM showed significantly higher ankylosis than the control group. CONCLUSIONS:Additionally, this study showed that the combined use of histologic analysis and μCT is a promising method to better identify tooth resorption and the repair process and to evaluate the total extension of the periodontium. CW as a storage medium is a promising transport media for avulsed teeth. 10.1016/j.joen.2013.09.023
    In vitro evaluation of plants as storage media for avulsed teeth: A systematic review. Resende Kêmelly Karolliny Moreira,Faria Geovanna Pascoal,Longo Daniele Lucca,Martins Lázara Joyce Oliveira,Costa Cláudio Rodrigues Rezende Dental traumatology : official publication of International Association for Dental Traumatology BACKGROUND/AIMS:Dental avulsion is defined as the complete displacement of a tooth from its socket owing to trauma. The treatment outcome depends on storage of the avulsed teeth in media capable of maintaining the viability of periodontal ligament cells, when immediate replantation is not possible. To maintain the viability of periodontal ligament cells, plants can be used as a storage medium because of their pharmacological and phytotherapic properties. The aim of this study was to evaluate the effect of plants on the tissue repair following tooth replantation. METHODS:This systematic review was conducted according to the PRISMA guidelines and included articles collected in the Cochrane, LILACS, PubMed, Science Direct, Scopus and Web of Science databases, plus articles found in the grey literature. The articles were screened for partial reading using the Endnote and Rayyan platform. The methodology of studies was evaluated by using the OHAT and GRADE. RESULTS:In the initial search, 2361 articles were obtained, only 51 articles were submitted to complete reading, and 35 articles were selected for the qualitative analysis. The evaluated plants had a potential effect on cell viability and proliferation. The articles evaluated mainly the action of plants on cells of the periodontal ligament. Propolis, coconut water and Aloe vera were the most common storage medium. CONCLUSION:The methodological limitations persist, and the evaluation of the pharmacological potential of plants on dental tissues still requires more research. 10.1111/edt.12501
    Tooth avulsion with extra oral time in less than 60 minutes: two different therapeutic protocols with 13-year follow-up. Giannetti L,Spinas E,Murri Dello Diago A Journal of biological regulators and homeostatic agents The aim of this study is to assess what needs to be the priority in tooth avulsion: replantation as quickly as possible and deferred endodontic treatment, or replantation and elimination of every irritating stimulus for the periodontal ligament.
    Computerized three-dimensional design for accurate orienting and dimensioning artificial dental socket for tooth autotransplantation. Ashkenazi Malka,Shashua Dafna,Kegen Salo,Nuni Eyal,Duggal Monty,Shuster Amir Quintessence international (Berlin, Germany : 1985) OBJECTIVE:To present an improved, accurate, and efficient method for planning and preparing an artificial socket for autotransplantation, by using a three-dimensional (3D) surgical guide and a replica of the transplanted donor tooth. The guide and the tooth replica were fabricated using a computerized 3D simulation. A case treated with this approach is presented. METHOD AND MATERIALS:Cone beam computed tomography (CBCT) and computerized 3D simulations (Simplant plus registration as stereolithography) were used for planning the optimal artificial socket position and dimensions, within the limitations of the alveolar bone borders and the adjacent teeth roots, and for producing a metal replica of the transplanted tooth. The replica was used to assure the correct socket preparation and orientation before extraction and replantation of the donor premolar. RESULTS:The entire procedure time for autotransplantation of a permanent second premolar to the incisor site without the buccal plate was about 45 minutes. At 15 months' follow up, clinical examination of the transplanted tooth demonstrated both normal mobility and no sensitivity to cold stimulation. A radiographic examination revealed continuous root development and pulp obliteration. The adjacent teeth maintained their vitality with no pathologic signs. CONCLUSION:We present an improved technique for autotransplantation based on computerized 3D simulations and guidance for accurate dimensioning and optimal locating of the artificial socket relative to the alveolar bone borders and the adjacent teeth roots. This technique may significantly simplify the autotransplantation procedure and will probably also increase its success rate and use in young patients, even in cases with absence of a buccal plate. 10.3290/j.qi.a40781
    PDL regeneration via cell homing in delayed replantation of avulsed teeth. Zhu Wenting,Zhang Qian,Zhang Yang,Cen Lian,Wang Jun Journal of translational medicine BACKGROUND:This study was aimed to investigate whether regeneration of periodontal ligament (PDL) like tissue could be promoted by stromal cell-derived factor-1 (SDF1) and bone morphogenetic protein-7 (BMP7) induced cell homing in delayed replantation of avulsed teeth. METHODS:Canine mandibular premolar teeth were first extracted and air-dried for 2 h followed by complete detachment of their PDL tissues. The crown and pulp of the teeth were also removed. Twenty-four roots divided into two groups (n = 12/group) were used for the following in vivo transplantation. The roots of Group A were treated with 17 % EDTA for 24 h to achieve demineralization, and then coated with SDF1 and BMP7 supplemented collagen solution. The roots of Group B were similarly treated except being coated with a pristine collagen solution. The above roots were transplanted in the sockets that formed previously during tooth extraction. At 6 months' post-operation, PDL-like tissue composed of spindle-shaped cells, capillaries and highly organized collagen fibers was observed in the interstitial space between the avulsed root surface and surrounding alveolar bone in Group A. The neo-fibers inserted deeply and perpendicularly into the cementum and adjacent bone. The periodontium-like characteristics of the neo-tissue was confirmed by immunohistochemical staining for collagen I, fibronectin and osteocalcin. RESULTS:A high incidence of PDL re-establishment as 42 % was achieved for samples of Group A. However, no PDL-like tissue was found but root ankylosis and replacement resorption as well as inflammatory resorption was observed in the replanted roots of Group B. CONCLUSIONS:It can be confirmed that avulsed teeth could be successfully rescued even in delayed transplantation to avoid dentoalveolar ankylosis or replacement resorption via the current developed cell homing method. 10.1186/s12967-015-0719-2
    Clinical outcome of intentional replantation with preoperative orthodontic extrusion: a retrospective study. Choi Y H,Bae J H,Kim Y K,Kim H Y,Kim S K,Cho B H International endodontic journal AIM:To evaluate retrospectively the clinical outcomes of intentional replantation (IR) of teeth in terms of tooth survival and periradicular healing and to investigate their prognostic factors. METHODOLOGY:Two hundred and eighty-seven teeth treated by IR were analysed retrospectively. Clinical outcomes between the cases with preoperative orthodontic extrusion for 2-3 week and those without extrusion were analysed. The outcomes of IR were determined by clinical and radiographic evaluation. Tooth survival and periradicular healing estimates were compared using Kaplan-Meier analysis. The contribution of a patient's age and gender, tooth type and location, and preoperative orthodontic extrusion was investigated using the multivariate Cox proportional hazard model. RESULTS:The mean follow-up period was 25.4 ± 9.3 months. The overall success rate of IR was 89.5% based on periradicular healing. The overall survival rate was 95.1%. The survival rates were 91.2% for the teeth extracted without extrusion and 98.1% for those extracted with extrusion. Amongst the variables tested, only the extraction technique with preoperative orthodontic extrusion significantly affected the survival rate (P = 0.016). Other prognostic variables, such as age and gender, tooth type and location, did not affect the survival of intentionally replanted teeth. CONCLUSIONS:Intentional replantation was a viable treatment option for teeth with previously failed nonsurgical root canal treatment, regardless of a patient's age and gender, and tooth type and location. Preoperative orthodontic extrusion for 2-3 weeks reduced root resorption and tooth fracture and can be recommended to enhance the outcome of IR. 10.1111/iej.12268
    Influence of Dentoalveolar Ankylosis on the Biomechanical Response of a Single-rooted Tooth and Surrounding Alveolar Bone: A 3-dimensional Finite Element Analysis. Jang Youngjune,Hong Hyoung-Taek,Chun Heoung-Jae,Roh Byoung-Duck Journal of endodontics INTRODUCTION:Dentoalveolar ankylosis necessarily accompanies the loss of periodontal ligament (PDL), which might alter the biomechanical response of the tooth. The purpose of this study was to investigate the influence of dentoalveolar ankylosis on a single-rooted tooth and the surrounding alveolar bone structures in the biomechanical standpoint. METHODS:A basic model of an intact maxillary central incisor and the surrounding bone structures was chosen for the numeric analysis. From this basic model, 6 different models were further developed by combining 3 types of endodontic status (an intact model, a nonsurgically treated model, and a surgically treated model) and 2 types of periodontal attachment condition (models with or without PDL). For each condition, maximum von Mises stress (σ max) in dentin and bone and maximum tooth displacement (ΔR max) were calculated. RESULTS:In models with dentoalveolar ankylosis, stress was concentrated on the cervical dentin around the cementoenamel junction and the alveolar bone crest, whereas the stress was more evenly distributed along the entire length of the root in models with normal PDL. The models with dentoalveolar ankylosis showed higher stress values in dentin (44.72%-80.56% of σ max increase) and bone (24.23%-80.68% of σ max increase) and lower tooth displacement (59.22%-63.97% of ΔR max decrease) compared with the models with normal PDL. CONCLUSIONS:Dentoalveolar ankylosis exerts significant changes on the biomechanical response of a single-rooted tooth and the surrounding bone structures. The dentoalveolar complex with ankylosis showed characteristic stress concentrations, increased stress values, and decreased tooth displacement compared with that with normal PDL. 10.1016/j.joen.2016.07.018
    Efficacy of flapless intentional replantation with enamel matrix derivative in the treatment of hopeless teeth associated with endodontic-periodontal lesions: A 2-year prospective case series. Saida Hiroyuki,Fukuba Shunsuke,Miron Richard,Shirakata Yoshinori Quintessence international (Berlin, Germany : 1985) OBJECTIVE:In this prospective case series, the effects of flapless intentional replantation (IR) with root surface conditioning with enamel matrix derivative (EMD) was evaluated for the treatment of periodontally-endodontally involved hopeless teeth. METHOD AND MATERIALS:A total of 17 teeth (17 patients, aged 40 to 73) with ≥ 10 mm attachment loss and radiographic bone loss to the apex were included in the study. The affected teeth were atraumatically extracted using a flapless approach, then granulation tissues, calculus, and necrotic cementum on the root surfaces were removed. EMD was applied for 5 minutes to the root surfaces. The teeth were reinserted to the socket without any bone grafts and splinted. RESULTS:After 2 years, clinical healing was uneventful in 16 cases and the radiographs revealed no root resorption or ankylosis. IR with EMD treatment provided statistically significant reduction in probing depth (6.4 ± 2.6 mm), gain in clinical attachment level (5.9 ± 2.5 mm), and gain in radiographic bone level (48.2 ± 26.1%) compared to baseline values (P < .01). CONCLUSION:Within the limitations of the study, flapless IR with EMD treatment appeared to act as an alternative strategy to extraction of severely compromised teeth with endodontic-periodontal lesions beyond the root apex. 10.3290/j.qi.a40782
    Intentional replantation of adhesively reattached vertically fractured maxillary single-rooted teeth. Nizam N,Kaval M E,Gürlek Ö,Atila A,Çalışkan M K International endodontic journal AIM:To evaluate the clinical outcomes of intentionally replanted maxillary single-rooted teeth with vertical root fractures (VRFs) after being repaired extraorally using 4-methacryloxyethyl trimellitate anhydride/methacrylate-tri-n-butyl borane (4-META/MMA-TBB) resin cement. METHODOLOGY:Twenty-one root filled maxillary single-rooted teeth with VRFs were evaluated. After atraumatic extraction, fractured fragments were adhesively cemented. The teeth were then replanted and splinted to the neighbouring teeth for 2 weeks. Plaque index (PI), gingival index (GI), probing depth (PD) and clinical attachment level (CAL) were assessed at baseline, 6 and 12 months, and radiographic evaluations were made using PAI scores at baseline and 12 months. Mobility was evaluated using periotest values (PTV) at baseline, 1, 3, 6 and 12 months. Replanted teeth, contralateral teeth (control teeth) and adjacent teeth were analysed statistically using repeated measures one-way anova, unpaired t-tests and Wilcoxon matched-pairs signed-rank tests. RESULTS:Two teeth were extracted in the first month after surgery. PI, GI, CAL and PD scores of the replanted teeth were significantly lower at 6 month (P < 0.0001 for all) and 12 month (P < 0.0001 for all) postoperatively when compared to baseline, but the values were not significantly different from those of the control and adjacent teeth. PTV of the test teeth increased significantly (P < 0.0001) after the intervention and decreased to baseline levels by month 12. PTVs were significantly higher (P < 0.05) at baseline, 1, 3 and 6 months in the test teeth when compared with the control teeth, but were not significantly different at month 12. PAI scores of teeth with VRF were significantly lower (P < 0.05) at 12 months compared with baseline. CONCLUSIONS:Adhesive cementation and intentional replantation were an effective treatment modality for this group of vertically fractured maxillary single-rooted teeth. The clinical periodontal parameters decrease by month 6, and the mobility returned to the physiological limits of natural teeth 12 months after replantation. 10.1111/iej.12444
    Conditioned medium from human bone marrow stromal cells attenuates initial inflammatory reactions in dental pulp tissue. Al-Sharabi Niyaz,Mustafa Manal,Ueda Minoru,Xue Ying,Mustafa Kamal,Fristad Inge Dental traumatology : official publication of International Association for Dental Traumatology AIM:To evaluate the effect of MSC-conditioned medium (CM) on the secretion of pro- and anti-inflammatory cytokines from dental pulp cells (hDPC) in vitro, and on the gene expression in vivo after replantation of rat molars. MATERIALS AND METHODS:hDPC were cultured in CM for 24 h, and the concentration of interleukin IL-10, IL-4, IL-6, and IL-8, regulated on activation, normal T Cell expressed and secreted (RANTES), and prostaglandin E (PGE ) in the media were measured by multiplex assay and ELISA, respectively. Expression of cyclooxygenase-2 (COX-2) was also examined by Western blot analysis after 24 h. Left and right maxillary first rat molars (n = 20) were elevated for 2 min and then replanted with or without application of CM into the tooth sockets. Levels of IL-1β, IL-10, IL-4, IL-6, and IL-8, and tumor necrosis factor-alpha (TNF-α) mRNA were evaluated by real-time qRT-PCR 3 and 14 days following tooth replantation. RESULTS:The production of IL-8, IL-10, and IL-6, RANTES and PGE by cells cultured in CM was significantly higher than production by cells cultured in standard medium (DMEM). At day 3 following replantation in vivo, the levels of IL-1β and IL-6, and TNF-α mRNA were significantly lower in the CM-treated replanted teeth compared with control teeth. Further, at day 3, the IL-6/IL-10 ratio was significantly lower in the CM-treated replanted teeth compared with control. At day 14 following replantation, no differences in the mRNA ratios were detected between the pulp tissues of replanted and control teeth. CONCLUSIONS:These findings indicated that CM promotes secretion of pro- and anti-inflammatory cytokines from hDPCin vitro and attenuates the initial inflammatory response in the rat dental pulp in vivo following tooth replantation. 10.1111/edt.12277
    Effects of diode laser irradiation and fibroblast growth factor on periodontal healing of replanted teeth after extended extra-oral dry time. Carvalho Erica Dos Santos,Rosa Rogério Hadid,Pereira Flávia de Moura,Anbinder Ana Lia,Mello Isabel,Habitante Sandra Marcia,Raldi Denise Pontes Dental traumatology : official publication of International Association for Dental Traumatology AIM:The search for effective protocols to reduce the incidence of root resorption and allow periodontal ligament repair is still challenging, given the unpredictable outcome of late tooth replantation. The aim of this study was to assess the effects of both high-power diode laser irradiation (DL) and basic fibroblast growth factor (FGF) on the periodontal healing of replanted teeth after extended extra-oral dry time. METHODS:Maxillary incisors of 50 male rats were extracted and assigned to three experimental and two control groups (n = 10). DL: root surfaces treated with DL (810 nm, continuous mode, 1.0 W, 30 s), FGF: topical application of FGF gel to the root surface and in the alveolar wound, DL + FGF: DL and topical application of FGF gel, C+: no treatment after extraction and immediate replantation and C-: no treatment after extraction and replantation after 60 min. In the experimental groups, the specimens were kept dry for 60 min, the pulps were removed and the canals were filled with calcium hydroxide paste prior to tooth replantation. The animals were euthanized after 60 days. The specimens were processed for radiographic, histological and immunohistochemical analyses. RESULTS:The radiographic analysis showed fewer resorptive areas in DL + FGF (P < 0.05). The histological and immunohistochemical analyses showed that the DL group had lower mean values of ankylosis, replacement and inflammatory resorption when compared to C-, not differing statistically from C+. DL + FGF produced significantly more collagen fibers (type I and type III) than C-, not differing from C+ in the case of type I fibers (P < 0.05). CONCLUSIONS:DL, with or without FGF, reduced the occurrence of external root resorption and ankylosis. Periodontal healing was favored and some fiber reinsertion occurred only when FGF was used. 10.1111/edt.12308
    Intentional Replantation with a 2-segment Restoration Method to Treat Severe Palatogingival Grooves in the Maxillary Lateral Incisor: A Report of 3 Cases. Yan Hao,Xu Ning,Wang Hanguo,Yu Qing Journal of endodontics The palatogingival groove is a developmental anomaly that typically starts near the cingulum of the maxillary incisors and extends along the roots at varying lengths and depths. Severe grooves that extend to the root apex often lead to complex combined periodontal-endodontic lesions. There are various therapeutic options available for these cases; however, the prognosis is unfavorable. Here, we report the successful surgical treatment of 3 cases of maxillary lateral incisors with severe palatogingival grooves using intentional replantation with a 2-segment restoration method. The teeth were gently extracted, resulting in minimal damage to the periodontal ligament. Under a dental operating microscope, 3 mm of the root end was resected. The palatogingival groove was removed, and root-end preparation was performed with a #700 fissure bur. The groove cavity was connected with root-end cavity to form a class II cavity. The cavity was then filled using a 2-segment restoration method (ie, dividing the cavity into 2 parts by the cementoenamel junction, the coronal portion was filled with a flowable composite while the radicular portion, including the root-end cavity, was filled with bioceramics). The tooth was then replanted into its alveolar bone and splinted with a flexible splint for 7 days. The sinus tract was closed at the 1-week postoperative visit. During subsequent recalls, the teeth showed almost complete periapical healing. In summary, intentional replantation with a 2-segment restoration method is a viable treatment modality for single-rooted teeth with a severe palatogingival groove that extends to the root apex. 10.1016/j.joen.2019.09.007
    Saving Natural Teeth: Intentional Replantation-Protocol and Case Series. Grzanich Derek,Rizzo Gabriella,Silva Renato Menezes Journal of endodontics INTRODUCTION:Intentional replantation is a reliable and predictable treatment for cases in which nonsurgical endodontic retreatment failed or is impractical and endodontic surgery is hampered because of anatomic limitations. METHODS AND RESULTS:This article presents a protocol for intentional replantation illustrated with some interesting cases. The cases presented here are from patients (average age, 61 years) with no contributing medical history. The cases are molars with previous failed endodontic treatment/retreatment and diagnosed with apical periodontitis. Treatment procedures included atraumatic extractions with minimal manipulations of the periodontal ligament, followed by root-end resection, root-end preparation with ultrasonic tips, root-end fill with bioceramic cement, and rapid tooth replacement into the socket. Granulomatous tissue was gently curetted when applicable. All procedures were performed under the microscope. CONCLUSIONS:Intentional replantation with careful case selection may be considered as a last option for preserving hopeless teeth. Atraumatic extraction by using state-of-the-art equipment, instruments, and materials, minimal extra-alveolar time, and maintaining an aseptic technique are key factors for success. 10.1016/j.joen.2017.08.009
    Intentional Replantation of an Avulsed Immature Permanent Incisor: A Case Report. Maniglia-Ferreira Claudio,de Almeida Gomes Fabio,Vitoriano Marcelo de Morais Journal of endodontics This case report discusses the successful endodontic treatment of an open apex maxillary right permanent central incisor that had been avulsed and incorrectly replanted in a 7-year-old patient. The tooth was carefully re-extracted followed by cleaning of the alveolar socket and immediate replantation. However, pulp necrosis was diagnosed, and regenerative endodontic treatment was performed. The root canal system was disinfected by passive ultrasonic irrigation with 2.5% sodium hypochlorite. At the first visit, the tooth was repositioned and immobilized with an appropriate semirigid splint. After 14 days, the splint was removed, and the diagnosis of pulp necrosis was confirmed by thermal testing. The root canal was emptied, disinfected, and filled with calcium hydroxide paste, which was left in place for 7 days. At the third visit, calcium hydroxide was removed with hand files and passive ultrasonic irrigation, and the canal was filled with a mixture of double antibiotic paste (metronidazole/ciprofloxacin) and zinc oxide. The antibiotic paste was left in place for 30 days. At the final visit, the paste was removed and the periapical area stimulated with a #80 K-file to encourage clot formation within the pulp cavity. A mineral trioxide aggregate paste cervical plug was placed, and the tooth was restored with glass ionomer cement. Clinical and imaging (radiographic and tomographic) follow-up at 3, 6, 12, and 36 months showed endodontic success with continued root formation. 10.1016/j.joen.2017.03.007
    Combined Endodontic Therapy and Intentional Replantation for the Treatment of Palatogingival Groove. Garrido Iván,Abella Francesc,Ordinola-Zapata Ronald,Duran-Sindreu Fernando,Roig Miguel Journal of endodontics A palatogingival groove is an anatomic malformation that predisposes the involved tooth to a severe periodontal defect. When the condition is complicated by pulpal necrosis, affected teeth often present a dilemma in terms of diagnosis and treatment planning. In this report, we describe the case of a patient with a maxillary lateral incisor with a deep palatogingival groove extending to the root apex and severe periodontal destruction (local pocketing). Suggested treatment modalities included curettage of the affected tissues, elimination of the groove by grinding and/or sealing with a variety of filling materials, and surgical procedures. In this case, a combined treatment approach, involving both endodontic therapy and intentional replantation after restoration with a self-etching flowable composite, resulted in periodontal healing and significant healing of the periradicular radiolucency at 12 months. In short, intentional replantation offers a predictable procedure and should be considered a viable treatment modality for the management of palatogingival grooves, especially for single-rooted teeth. 10.1016/j.joen.2015.10.009
    Incidence of Root Resorption after the Replantation of Avulsed Teeth: A Meta-analysis. Souza Beatriz Dulcineia Mendes,Dutra Kamile Leonardi,Kuntze Morgane Marion,Bortoluzzi Eduardo Antunes,Flores-Mir Carlos,Reyes-Carmona Jessie,Felippe Wilson Tadeu,Porporatti André Luís,De Luca Canto Graziela Journal of endodontics INTRODUCTION:An avulsion injury is a serious trauma to pulp and periodontal tissues. After avulsion and replantation, teeth are at risk of infection and root resorption, which may affect treatment outcome and survival rate. Thus, the purpose of this systematic review was to evaluate the incidence of root resorption after the replantation of avulsed teeth. METHODS:Two reviewers searched 7 electronic databases for observational studies involving human subjects that evaluated the incidence of root resorption after tooth avulsion. Risk of bias (RoB) was evaluated using the Meta-Analysis of Statistics Assessment and Review Instrument, and the quality of available evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation tool. RESULTS:Of the 1507 articles, 23 met the inclusion criteria. A meta-analysis was conducted and showed that the incidence of internal root resorption was 1.2% (95% confidence interval [CI], 0.02-5.50). Regarding external root resorption, the incidence of surface root resorption was 13.3% (95% CI, 6.21-22.62), that of inflammatory root resorption was 23.2% (95% CI, 13.94-34.19), and that of replacement root resorption was 51.0% (95% CI, 40.10-62.00). Two studies presented a high RoB, 16 had a moderate RoB, and 11 had a low RoB. The overall level of evidence identified was very low. CONCLUSIONS:The incidence of root resorption after avulsion and replantation in descending order was replacement root resorption > inflammatory root resorption > surface root resorption > internal root resorption. 10.1016/j.joen.2018.03.002
    Clinical Outcomes after Intentional Replantation of Periodontally Involved Teeth. Cho Sin-Yeon,Lee Seung-Jong,Kim Euiseong Journal of endodontics INTRODUCTION:Periodontal involvement has been thought to be a contraindication for intentional replantation. This retrospective study aimed to assess clinical outcomes after intentional replantation of teeth with periodontal involvement and to explore potential predictors of outcomes. METHODS:Teeth with a history of intentional replantation between March 2000 and December 2014 and with 1 or 2 preoperative periodontal pockets ≥6 mm among 6 sites evaluated per tooth were included. A total of 103 teeth were included, and 74 teeth were followed up for more than 6 months. Outcomes were assessed as improved (a decrease in the number and depths of periodontal pockets and the size of periapical radiolucency and no external root resorption or sign/symptoms) or failed. Data were analyzed with Kaplan-Meier survival analysis and a Cox proportional regression model. RESULTS:Cumulative improved rates declined from 89% at 1 year to 68% at 4 years. A Cox proportional regression model identified the patient's age (P = .049; hazard ratio, 2.552) and the number of preoperative periodontal pockets with a depth ≥6 mm (P = .041; hazard ratio, 2.523) as predictors of outcomes in the replantation of periodontally involved teeth. CONCLUSIONS:Periodontal involvement is not an absolute contraindication to intentional replantation. The teeth with 1 preoperative periodontal pocket ≥6 mm and the subjects aged ≤40 years had 2.5 times and 2.6 times lower probability of failure, respectively, than the teeth with 2 pockets and the subjects aged >40 years. Therefore, these factors need to be carefully considered for intentional replantation. 10.1016/j.joen.2016.11.024
    A Systematic Review of the Survival of Teeth Intentionally Replanted with a Modern Technique and Cost-effectiveness Compared with Single-tooth Implants. Mainkar Anshul Journal of endodontics INTRODUCTION:The aim of this study was to investigate the survival rate of teeth intentionally replanted with a modern technique and to compare their cost-effectiveness with that of single-tooth implants. MATERIALS AND METHODS:Four databases were systematically searched for articles that met inclusion criteria published between January 1966 and February 2017. Overall survival rate of intentional replantation was determined through a meta-analysis using a random-effects model. Cost of different procedures was determined from the 2016 American Dental Association Dental Fees Survey. Cost-effectiveness analysis was performed for different treatment modalities. RESULTS:Six studies met the inclusion criteria. Meta-analysis resulted in a survival rate of 89.1% (95% confidence interval, 83.8%-94.4%). Compared with a single-tooth implant, intentional replantation was more cost-effective even when custom post/core and crown are also needed. CONCLUSION:The meta-analysis revealed a high survival rate for intentional replantation. Although the survival rate of implants is higher, intentional replantation is a more cost-effective treatment modality. Intentional replantation should be a treatment option discussed with patients, especially because an implant can still be placed if intentional replantation is unsuccessful. 10.1016/j.joen.2017.08.019
    Successful treatment of vertical root fracture through intentional replantation and root fragment bonding with 4-META/MMA-TBB resin. Okaguchi Morio,Kuo Tienchun,Ho Yi-Ching Journal of the Formosan Medical Association = Taiwan yi zhi BACKGROUND/PURPOSE:Vertical root fracture (VRF) is a complication in endodontically treated teeth. This study aimed to assess the clinical outcomes of treatment of 6 VRF teeth with intentional replantation and root fragment bonding with 4-methacryloxyethyl trimellitate anhydride/methyl methacrylate-tri-n-butyl borane (4-META/MMA-TBB) resin. METHODS:A series of 6 complete VRF teeth (one incisor, one canine, one premolar, and 3 M) were treated through intentional replantation and root fragment bonding with 4-META/MMA-TBB resin. RESULTS:This study included 6 VRF teeth in 6 patients (one man and 5 women; mean age, 44 ± 8 years). All 6 teeth had VRF in the bucco-lingual direction and one tooth had concomitant VRF in the mesio-distal direction. The root thickness was classified as thick in all 6 teeth. Of the 6 VRF teeth, 4 had biting, percussion, or palpation pain, 4 had gingival swelling, 3 had sinus tracts, 3 had discomfort, and one had tooth mobility. Radiographically, 5 of the 6 teeth had periradicular radiolucent lesions, 4 of which exhibited complete regression and one of which exhibited nearly complete regression after root fragment bonding therapy. Because all 6 treated teeth exhibited sound function in the oral cavity after a follow-up period ranging from 33 to 74 (mean, 50 ± 15) months, the clinical outcomes were all considered to be successful. CONCLUSION:For a VRF tooth, in addition to tooth extraction, intentional replantation combined with root fragment bonding with 4-META/MMA-TBB resin is a successful treatment modality that can be used to preserve a complete VRF tooth. 10.1016/j.jfma.2018.08.004
    Intentional Replantation with an Atraumatic Extraction System in Teeth with Extensive Cervical Resorption. Krug Ralf,Soliman Sebastian,Krastl Gabriel Journal of endodontics External cervical resorption (ECR) often renders a tooth nonrestorable, especially if it extends deeply within the dental hard tissue. Intentional replantation is sometimes performed as the last resort to save the tooth but may limit conventional forceps extraction because of the high risk of periodontal ligament cell damage or crown fracture.This case report describes the intentional replantation of an upper central incisor with extensive ECR using an axial, atraumatic extraction system to save the otherwise hopeless tooth. The patient was an asymptomatic 37-year-old man with no contributing medical history. The treatment protocol included atraumatic extraction followed by granulation tissue removal, extraoral root canal treatment, and adhesive restoration of the extensive resorption defect. During extraoral manipulation, the utmost care was taken to prevent root surface drying, contamination with dental adhesive, or heat-induced periodontal ligament damage during curing. Two and a half years after replantation, clinical and radiographic examinations revealed normal healing and no symptoms but a slight reduction of bone level compared with the preoperative level and no signs of root resorption or ankylosis. The successful outcome in this case supports the idea of performing intentional replantation with an atraumatic extraction system to save teeth with extensive cervical root resorption and a high risk of fracture during extraction. 10.1016/j.joen.2019.07.012
    Pulp and Periodontal Regeneration of an Avulsed Permanent Mature Incisor Using Platelet-rich Plasma after Delayed Replantation: A 12-month Clinical Case Study. Priya M Harini,Tambakad Pavan B,Naidu Jaya Journal of endodontics Numerous publications have reported revascularization of necrotic immature permanent teeth, but the regenerative potential of pulp in mature teeth has rarely been considered. Platelet-rich plasma (PRP) meets many requirements of a scaffold for regenerative endodontics. To the best of our knowledge, no clinical study has evaluated PRP for endodontic regeneration in a mature avulsed tooth. The present case evaluated PRP for pulpal regeneration in an avulsed mature incisor (>8 hours extraoral dry time) of an 11-year-old boy after delayed replantation. The canal was disinfected after extraoral access cavity preparation and pulp extirpation. The root apex was enlarged, and the tooth was placed in doxycycline solution for 20 minutes. After tooth replantation and splinting, PRP was injected up to the level of the cementoenamel junction and sealed with glass ionomer cement. The 6-month follow-up revealed evidence of internal and external root resorption with periapical radiolucency and an apparent periodontal ligament space. Access was reopened; slurry of 2 antibiotics (minocycline and metronidazole) was inserted into the canal and sealed. Nine- and 12-month radiographs revealed resolution of periapical radiolucency with no further progression of internal resorption. The tooth showed a positive response to thermal and electric pulp tests. The findings observed in this case warrant further research under controlled conditions to evaluate endodontic and periodontal regeneration in a tooth that would otherwise be expected to have an unfavorable prognosis. 10.1016/j.joen.2015.07.016
    Evaluation of laser phototherapy (λ 780 nm) after dental replantation in rats. de Carvalho Fabíola Bastos,Andrade Aline Silva,Barbosa Artur Felipe Dos Santos,Aguiar Márcio Cajazeira,Cangussu Maria Cristina Teixeira,Pinheiro Antônio Luiz Barbosa,Ramalho Luciana Maria Pedreira Dental traumatology : official publication of International Association for Dental Traumatology BACKGROUND/AIM:Tooth replantation is the treatment of choice in cases of avulsion although the outcomes are variable. The teeth can be lost due to external root resorption. The aim of this study was to histologically assess of the effect of laser phototherapy (λ780 nm) on replanted teeth in rats. MATERIAL AND METHODS:Sixty Wistar Albinus rats had their maxillary right incisors extracted and were then divided into four groups: G1-absence of storage medium; G2-milk as storage medium; G3-milk as storage medium followed by a laser irradiation of the root surfaces and entrance of the alveolus (λ = 780 nm; P = 70 mW; CW; DE = 21 J/cm ); G4-milk as storage medium, laser irradiation as in G3 before replantation. After this procedure, laser irradiation was performed on the buccal and palatal mucosa (8.4 J/cm per session) every 48 h for 15 days. The animals were euthanized 15, 30, and 60 days after replantation. RESULTS:The histological results showed that after 15 days, G4 exhibited intense chronic inflammation with the presence of clastic cells and moderate external inflammatory root resorption (P < 0.05) when compared with G3, in which these outcomes were not observed. At the 30th day, G1, G2, and G4 showed chronic inflammation varying from discrete to moderate, as well as intense external inflammatory root resorption. G3 remained without any inflammation and external inflammatory root resorption up to the 60th day. CONCLUSIONS:The use of laser phototherapy on the root surface and at the entrance of the alveolus prior to replantation had a positive biomodulative effect on alveolar repair after tooth replantation in rats. 10.1111/edt.12289
    Intentional Replantation Techniques: A Critical Review. Becker Bradley D Journal of endodontics INTRODUCTION:Techniques and armamentarium for intentional replantation have varied throughout the years with no universally accepted clinical treatment guidelines. A wide range of success rates has been reported, and accordingly, this treatment method has often been regarded as a treatment of last resort. However, recent studies have shown more consistent success rates as high as 88% to 95%. In light of these new studies, intentional replantation may now be considered a more commonly accepted treatment modality. The purpose of this review was to critically examine reported techniques for intentional replantation. METHODS:A search of the literature on intentional replantation techniques was performed using electronic databases including PubMed, Medline, and Scopus. A total of 3183 articles were generated and screened for relevance based on defined inclusion and exclusion criteria. Subsequently, 27 studies were included for critical review of technique. RESULTS:There has been an evolution in technique for intentional replantation over the decades. CONCLUSIONS:Numerous aspects of the procedure exhibit variations, whereas other aspects exhibit considerable consistency. Few studies reported techniques consistent with modern endodontic surgical principles. 10.1016/j.joen.2017.08.002
    Retention and Healing Outcomes after Intentional Replantation. Cho Sin-Yeon,Lee Yoon,Shin Su-Jung,Kim Euiseong,Jung Il-Young,Friedman Shimon,Lee Seung-Jong Journal of endodontics INTRODUCTION:Intentional replantation is an alternative to tooth extraction and prosthetic replacement when conventional endodontic treatment modalities are unfeasible or contraindicated. This study assessed tooth retention and healing after intentional replantation and explored predictors of these outcomes. METHODS:Data of intentional replantation procedures performed between March 2000 and December 2010 were collected prospectively, excluding teeth with preoperative periodontal and root defects. A cohort of 159 teeth was followed up for 0.5-12 years. Retention and healed status without complications (periapical radiolucency, external root resorption, ankylosis, signs/symptoms, probing ≥6 mm) was recorded and analyzed with Kaplan-Meier survival analysis and Cox proportional hazard regression model (P < .05). RESULTS:Complications leading to extraction occurred in 8 of 159 teeth (5%). Kaplan-Meier survival function suggested 93% cumulative 12-year retention. Cumulative healed rates declined from 91% at 6 months to 77% at 3 years. The healed rate was significantly lower for maxillary teeth without preoperative periapical radiolucency, replanted in more than 15 minutes, and root-end filled with ProRoot MTA. Cox regression identified extraoral time ≤15 minutes as predictor of complication-free healing (P < .04; hazard ratio, 2.767; 95% confidence interval, 1.053-7.272). CONCLUSIONS:This prospective cohort study of contemporary intentional replantation suggested a cumulative 12-year retention rate of 93% and healed rate of 77% after 3 years. Healing occurred 1.7 times more frequently in teeth replanted within 15 minutes. Although most complications occurred within 1 year after replantation, follow-up should extend for at least 3 years to capture late complications. 10.1016/j.joen.2016.03.006
    Survival Rate of Teeth with a C-shaped Canal after Intentional Replantation: A Study of 41 Cases for up to 11 Years. Jang Youngjune,Lee Seung-Jong,Yoon Tai-Cheol,Roh Byoung-Duck,Kim Euiseong Journal of endodontics INTRODUCTION:Teeth with a C-shaped canal have been regarded as a challenge for nonsurgical root canal treatment (RCT) and apical microsurgery because of their anatomic variations and low accessibility. For such teeth, intentional replantation might be a treatment option. The purpose of this study was to investigate the prognostic factors for the clinical outcome of intentionally replanted teeth with a C-shaped canal. METHODS:We retrospectively investigated patients who had undergone intentional tooth replantation at the Department of Conservative Dentistry, Yonsei University Dental Hospital, Seoul, Korea, from June 2002 to November 2015. Consequently, 41 intentionally replanted teeth with C-shaped canals were identified. The cumulative survival rate and related prognostic factors were assessed based on clinical and radiographic examination using survival analysis. RESULTS:The cumulative survival rate of intentionally replanted teeth with a C-shaped canal was 83.4% at 4 years and 73.0% at 11 years postoperatively. Based on Cox proportional hazard regression analysis, extraoral time (≤15 minutes vs >15 minutes) and retrofilling material (ProRoot MTA [Dentsply, Tulsa, OK] vs others) were significantly associated with tooth survival (P < .05). CONCLUSIONS:Extraoral time exceeding 15 minutes and the use of ProRoot MTA as a retrofilling material were significantly associated with a lower survival of intentionally replanted teeth with C-shaped canals. With improved clinical procedures based on an understanding of the prognostic factors, intentional replantation would be a favorable treatment option for treating teeth with a C-shaped canal. 10.1016/j.joen.2016.05.010
    Analysis of the association of clinical factors and IL4 gene polymorphisms with root resorption in avulsed teeth after 1 year of replantation. Roskamp L,Trevilatto P C,Souza C M,Silva Neto U X,Carneiro E,Fariniuk L F,Westphalen V P D International endodontic journal AIM:To investigate the association of clinical variables and polymorphisms (tag SNPs) in the interleukin 4 (IL4) gene, with the prognosis of avulsed and replanted teeth. METHODOLOGY:Ninety-four patients who suffered avulsion and had their teeth replanted and endodontically treated were included. Periapical radiographs were obtained soon after tooth replantation and after 1 year. For genotypic IL4 gene analysis, the DNA from oral mucosa cells was collected, and polymorphisms were investigated by real-time PCR. Univariate and multivariate analyses were performed to verify the association of clinical and genetic variables and the outcome of the replanted teeth (P < 0.05). RESULTS:After multivariate analysis, extra-alveolar time longer than 1 h was significantly associated with external root resorption. No significant association was observed between IL4 gene polymorphisms and root resorption. CONCLUSION:No association between root resorption and IL4 gene polymorphisms was observed. An extra-alveolar time of more than 1 h was associated with a susceptibility for external root resorption. Replanting the tooth in its socket immediately is the most important factor to maintain a healthy root surface. 10.1111/iej.12797
    Effect of fibroblast growth factor on injured periodontal ligament and cementum after tooth replantation in dogs. Yu Sang-Joun,Lee Jung-Seok,Jung Ui-Won,Park Joo-Cheol,Kim Byung-Ock,Choi Seong-Ho Journal of periodontal & implant science PURPOSE:The purpose of this animal study was to perform a histological and histomorphometric analysis in order to elucidate the effect of fibroblast growth factor-2 (FGF-2) on injured periodontal ligament (PDL) and cementum after tooth replantation in dogs. METHODS:The roots of 36 mandibular premolars from six mongrel dogs were used in this study. The roots were randomly divided into three groups: (1) a positive control group (n=12), in which the PDL was retained; (2) a negative control group (n=12), in which the PDL and the cementum between the notches were removed; and (3) an experimental group (n=12), in which the PDL and the cementum between the notches were removed and the roots were soaked in an FGF-2 solution (30 µg/0.1 mL). After treating the root surfaces, the extracted roots were replanted into extraction sockets. The animals were sacrificed four and eight weeks after surgery for histologic and histomorphometric evaluation. RESULTS:At four and eight weeks, normal PDLs covered the roots in the positive control group. In the negative control group, most replanted roots showed signs of replacement resorption. In the experimental group, new PDL-like tissue and cementum-like tissue were observed to partially occupy the region between the root surfaces and the newly formed bone. Histomorphometric analysis showed that the mean length of the newly formed cementum-like tissue on the roots treated with FGF-2 was significantly greater than that of the tissue on the roots in the negative control group (four weeks, P=0.008; eight weeks, P=0.042). However, no significant differences were observed between the roots treated with FGF-2 and the negative control roots with respect to newly formed PDL-like tissue. CONCLUSIONS:The results of this study suggest that use of FGF-2 on injured root surfaces promotes cementogenesis after tooth replacement in dogs. 10.5051/jpis.2015.45.3.111
    Periodontal healing by periodontal ligament fiber with or without cells: A preclinical study of the decellularized periodontal ligament in a tooth replantation model. Lee Jung-Seok,Kim Seul-Ki,Gruber Reinhard,Kim Chang-Sung Journal of periodontology BACKGROUND:The periodontal ligament (PDL) comprises cells embedded in the extracellular matrix (ECM) and is required for periodontal healing upon tooth transplantation. However, the extent to which the ECM contributes to periodontal regeneration remains unknown. This study aimed to evaluate effects of separate PDL matrix without cells on periodontal healing. METHODS:Mandibular premolars extracted from six beagle dogs, were 1) left untreated, 2) decellularized, or 3) surface planed. Cytologic, histologic, scanning electron microscopy, and transmission electron microscopy analyses confirmed that detergents could be used to decellularize the PDL. An additional circumferential osteotomy was performed to replant dental roots into extraction sockets. Radiography and histology were used to evaluate periodontal regeneration 8 weeks later, with the data adjusted for multiple testing. RESULTS:In pristine extraction sites, total root resorption (P = 0.034), recovered PDL space (P = 0.012), and new cementum (P = 0.004) were greater in untreated teeth than in roots that underwent surface planing. There were no significant changes when comparing untreated teeth with teeth having a decellularized PDL (P = 0.081, P = 0.170, and P = 1.000, respectively), and decellularized teeth showed significant increase of new cementum compared to surface planed teeth (P = 0.048). In the defect area, only the recovered PDL space (P = 0.034) was greater in untreated teeth when comparing with denuded roots. CONCLUSION:These results suggest that in addition to untreated PDL, decellularized PDL also partially supports reattachment (particularly cementogenesis) in pristine extraction sites but not in defect areas. 10.1002/JPER.19-0126
    Effects of pre-applied orthodontic force on the regeneration of periodontal tissues in tooth replantation. Park Won-Young,Kim Min Soo,Kim Min-Seok,Oh Min-Hee,Lee Su-Young,Kim Sun-Hun,Cho Jin-Hyoung Korean journal of orthodontics Objective:This study aimed to investigate the effect of pre-applied orthodontic force on the regeneration of periodontal ligament (PDL) tissues and the underlying mechanisms in tooth replantation. Methods:Orthodontic force (50 cN) was applied to the left maxillary first molars of 7-week-old male Sprague-Dawley rats (n = 32); the right maxillary first molars were left untreated to serve as the control group. After 7 days, the first molars on both sides were fully luxated and were immediately replanted in their original sockets. To verify the effects of the pre-applied orthodontic force, we assessed gene expression by using microarray analysis and real-time reverse transcription polymerase chain reaction (RT-PCR), cell proliferation by using proliferating cell nuclear antigen (PCNA) immunofluorescence staining, and morphological changes by using histological analysis. Results:Application of orthodontic force for 7 days led to the proliferation of PDL tissues, as verified on microarray analysis and PCNA staining. Histological analysis after replantation revealed less root resorption, a better arrangement of PDL fibers, and earlier regeneration of periodontal tissues in the experimental group than in the control group. For the key genes involved in periodontal tissue remodeling, including , , , , , , and , quantitative RT-PCR confirmed that messenger RNA levels were higher at 1 or 2 weeks in the experimental group. Conclusions:These results suggest that the application of orthodontic force prior to tooth replantation enhanced the proliferation and activities of PDL cells and may lead to higher success rates with fewer complications. 10.4041/kjod.2019.49.5.299
    Effects of platelet-rich plasma on tooth replantation in dogs: a histologic and histomorphometric analysis. Yang Jun-Mo,Yang Keon-Il,Lee Kyung-Hyun,Choi Seong-Ho,Kim Byung-Ock,Park Joo-Cheol,Yu Sang-Joun Journal of periodontal & implant science Purpose:The purpose of this study was to evaluate the effects of platelet-rich plasma (PRP) on periodontal healing of replanted root surfaces in dogs histologically and histomorphometrically. Methods:A total of 36 roots of mandibular incisors and premolars from 6 mongrel dogs were used. The roots were randomly divided into 3 groups: 1) a positive control group (n=12), in which the periodontal ligament (PDL) and cementum were retained and the roots were soaked in saline; 2) a negative control group (n=12), in which the PDL and cementum were removed and the roots were soaked in saline; and 3) an experimental group (n=12), in which the PDL and cementum were removed and the roots were soaked in PRP. After soaking the root surfaces, the extracted roots were replanted into the extraction sockets. The roots were covered using a coronally repositioned flap. Results:Histologically, irregular-thickness PDL-like and cementum-like tissues were observed in the 4-week experimental group and the positive control group. PDL-like tissue and cementum-like tissue with a more uniform thickness were observed at 8 weeks. In the negative control group, PDL-like tissue and cementum-like tissue were rarely found, and root resorption and ankylosis were observed. In the cross-sectional histomorphometric analysis, the experimental group demonstrated a higher rate of formation of cementum-like tissue and a lower tooth ankylosis rate than the positive and negative control groups at 4 and 8 weeks. Although there was a significant difference in the tooth ankylosis rate and the formation of cementum-like tissue across the 3 groups (<0.05), no statistical significance was observed between any pair of groups (>0.017). Conclusions:Applying PRP to root surfaces during tooth replantation in dogs can reduce tooth ankylosis and increase PDL-like and cementum-like tissue formation. 10.5051/jpis.2018.48.4.224
    Effect of the treatment of root surface-adhered necrotic periodontal ligament with propolis or fluoride in delayed rat tooth replantation. Panzarini Sônia Regina,Nonato Carolina Chieregatto,Gulinelli Jéssica Lemos,Poi Wilson Roberto,Sonoda Celso Koogi,Saito Célia Tomiko Matida Hamata,Marão Heloisa Fonseca Clinical oral investigations OBJECTIVES:The purpose of this study was to evaluate the application of 15 % propolis and 2 % acidulated-phosphate sodium fluoride solutions on the root surface-adhered necrotic cemental periodontal ligament in delayed tooth replantation. MATERIALS AND METHODS:Thirty Wistar rats (Rattus norvegicus, albinus) had their right upper incisor extracted and maintained in dry storage for 60 min. After this period, the dental papilla, enamel organ, and pulp tissue were removed, and the animals were randomly assigned to three groups: group I = immersion in saline for 10 min; group II = immersion in a 2 % acidulated-phosphate sodium fluoride solution for 10 min; and group III = immersion in a 15 % propolis and propylene glycol solution for 10 min. The root canals were filled with a calcium hydroxide paste and the teeth were replanted. RESULTS:Inflammatory resorption, replacement resorption, and ankylosis were observed in all groups without a statistically significant difference (p > 0.05) among them. CONCLUSIONS:Under the tested conditions, the application of fluoride or propolis on root surface-adhered necrotic periodontal ligament did not favor the healing process in delayed tooth replantation. 10.1007/s00784-013-1103-3
    Effect of low-level laser therapy on the healing process after tooth replantation: a histomorphometrical and immunohistochemical analysis. Saito Célia Tomiko Matida Hamata,Gulinelli Jéssica Lemos,Panzarini Sônia Regina,Garcia Valdir Gouveia,Okamoto Roberta,Okamoto Tetuo,Sonoda Celso Koogi,Poi Wilson Roberto Dental traumatology : official publication of International Association for Dental Traumatology Success of tooth replantation is limited because part of the replanted tooth is lost because of progressive root resorption. This study used histomorphometry and immunohistochemistry to evaluate the effect of low-level laser therapy (LLLT) on the healing process of rat teeth replanted after different extra-oral periods, simulating immediate and delayed replantation. Sixty Wistar rats (Rattus norvegicus albinus) had their maxillary right incisors extracted and randomly assigned to six groups (n = 10): C4, C30 and C45, in which the teeth were replanted 4 min (immediate), 30 min (delayed) and 45 min (delayed) after extraction, respectively, and L4, L30 and L45, in which the teeth were replanted after the same extra-alveolar times, but the root surfaces and the alveolar wounds were irradiated with a gallium-aluminum-arsenate (GaAlAs) diode laser before replantation. The animals were sacrificed after 60 days. The anatomic pieces containing the replanted teeth were obtained and processed for either histomorphometrical analysis under optical microscopy or immunohistochemical expression of receptor activator of nuclear factor Kappa-B (RANK), and its ligand (RANKL), osteoprotegerin (OPG) and tartrate-resistant acid phosphatase (TRAP) proteins. Areas of external replacement and inflammatory root resorption were observed in all groups, without statistically significant differences (P > 0.05). Ankylosis was more frequent in L30 than in C30 (P < 0.05). RANKL immunostaining predominated over RANK and OPG immunostaining in both groups with immediate tooth replantation (P < 0.05). For the 45-min extra-alveolar time, however, there was greater evidence of RANK immunostaining compared to RANKL for both control and laser-treated groups (P < 0.05). Positive TRAP immunostaining predominated in L4 and L30 (P < 0.05). In conclusion, under the tested conditions, the treatment of the root surface and the alveolar wound with LLLT did not improve the healing process after immediate and delayed tooth replantation in rats. 10.1111/j.1600-9657.2010.00946.x
    Influence of anti-allergic drugs used systemically on the process of root resorption during delayed tooth replantation: A study in rats. Machado Nathália Evelyn da Silva,Banci Henrique Augusto,da Silva Lucas Deszo,Santinoni Carolina Dos Santos,de Oliveira Danilo Louzada,Ervolino Edilson,Prado Rosana Leal do,Mori Graziela Garrido Dental traumatology : official publication of International Association for Dental Traumatology BACKGROUND/AIM:Anti-allergic drugs can inhibit the hard tissue resorption process, and due to similarities between root resorption and bone mechanisms, it can be inferred that these drugs may also control root resorption. The aim of this study was to analyze the effects of anti-allergic drugs used systemically on the process of root resorption following delayed tooth replantation. MATERIALS AND METHODS:Thirty-two maxillary right incisors of rats were extracted and subsequently replanted. Rats were divided into four groups according to the anti-allergic drug administered: the rats in groups DEX, Q, and MO were treated systemically with dexamethasone phosphate, quercetin, and montelukast, respectively, and no systemic medication was administered to rats in group C. After 60 days, the animals were euthanized, and the specimens were processed for histomorphometric and immunohistochemical analyses. Statistical significance was set at P < .05. RESULTS:There were no significant differences between the groups in terms of inflammatory resorption, replacement resorption, or presence of tartrate-resistant acid phosphatase. In terms of events occurring in the periodontal ligament space, there was a difference between groups Q and MO due to the presence of dental ankylosis and inflammatory connective tissue (P < .05). A difference in inflammatory cells was also observed through CD45 immunolabeling between the DEX and Q groups when compared to the C group (P < .05). CONCLUSION:The systemic administration of anti-allergic drugs did not have an effect on the process of root resorption following delayed tooth replantation. 10.1111/edt.12535
    Bone morphology after delayed tooth replantation - case series. Tsukiboshi Mitsuhiro,Tsukiboshi Taisuke Dental traumatology : official publication of International Association for Dental Traumatology The purpose of this report was to describe the morphological changes in the alveolar bone after delayed replantation of avulsed teeth using three dimensional cone-beam computed tomography in 11 during the time period 2003-2012. The radiographic observations revealed the following: Delayed replantation results in ankylosis-related replacement root resorption; the resorption is delayed or arrested around the cervical area superior to the alveolar crest. The buccal bone is reduced in thickness but not the palatal bone. The buccal bone resorption of the alveolar crest progresses approximately to the root canal space of the ankylosed root. Delayed replantation does not completely maintain the bone volume. The buccal profile of alveolar bone in the maxillary anterior region is depending on teeth with viable periodontal ligament. 10.1111/edt.12111
    Effects of a triple antibiotic solution on pulpal dynamics after intentionally delayed tooth replantation in mice. Quispe-Salcedo Angela,Ida-Yonemochi Hiroko,Ohshima Hayato Journal of endodontics INTRODUCTION:This study analyzed the detailed biological events underlying pulpal dynamics evoked by 3Mix (the mixture of ciprofloxacin, metronidazole, and minocycline) solution after intentionally delayed tooth replantation because 3Mix improves pulpal healing after tooth injuries. METHODS:The maxillary first molars of 3-week-old mice were extracted and immersed in 3Mix solution for 30 minutes in comparison with phosphate buffered saline (PBS) alone. Cell proliferation, apoptosis, and differentiation were assessed in extracted/replanted teeth during days 0-14 using immunohistochemistry, apoptosis assay, and reverse-transcriptase polymerase chain reaction. RESULTS:3Mix solution accelerated odontoblast differentiation in the coronal pulp on day 7 and tertiary dentin formation on day 14, whereas the regenerative process was delayed in the PBS group. Cell proliferation and apoptosis occurred in the pulp of the 3Mix group during days 5-7 and subsequently decreased from days 7-14. On day 5, dentin sialophosphoprotein and nestin were first recovered in the 3Mix group, whereas expression levels for alkaline phosphatase, osteopontin, and osteocalcin increased in the PBS group. The expression levels for octamer-binding factor 3/4A and 3/4B reached the maximum level on day 1 and were sharply decreased on day 3 in both groups. High expression levels of Cd11c were first observed in the 3Mix group on day 1 and later at days 5 and 7. CONCLUSIONS:The results suggest that the application of 3Mix may suppress osteoblast differentiation by the migration of dendritic cells to the injury site and via the activation of stem/progenitor cells, resulting in the acceleration of odontoblastlike cell differentiation. 10.1016/j.joen.2014.05.005
    Delayed tooth replantation following root canal filling with calcium hydroxide and MTA: Histomorphometric study in rats. Esteves Jônatas Caldeira,Marão Heloisa Fonseca,Silva Pedro Ivo Dos Santos,Poi Wilson Roberto,Panzarini Sônia Regina,Aranega Alessandra Marcondes,Ribeiro Eduardo Dias,Sonoda Celso Koogi Archives of oral biology OBJECTIVE:The aim of this study was to perform a histomorphometric evaluation of the repair process in rat teeth replanted after root canals were filled with calcium hydroxide (CH) and mineral trioxide aggregate (MTA). DESIGN:Upper right incisors were extracted from 30 rats divided into three groups (n=10). The teeth were stored dry for 60min, after which the pulp and periodontal ligament (PDL) were removed and immersed in acidulated-phosphate sodium fluoride solution. In Group I, the root canals were filled with saline; in Group II, they were filled with CH; and in Group III, they were filled with CH, and the foramen was sealed with an MTA plug. The teeth were replanted, and the animals were sacrificed after 60 days. The sections with teeth were removed for histological preparation (haematoxylin and eosin, H&E). The characteristics of the PDL, cementum, dentine, and alveolar bone, as well as the occurrence of inflammatory and replacement root resorption and apical sealing, were subjected to histological and morphometric analysis (P<0.05). RESULTS:Group I was the most affected by root resorption (mean=67.05%). In Groups II and III, the resorption averaged 42.2% and 11.7%, respectively. Group III was less affected by inflammatory resorption and presented more areas of apical sealing by mineralized tissue (P<0.05). CONCLUSION:An apical MTA plug improved the repair of the replanted tooth by decreasing surface resorption and repairing mineralized tissue in the periapical region. 10.1016/j.archoralbio.2015.02.002
    An experimental model for studies on delayed tooth replantation and ankylosis in rabbits. Maslamani Manal,Almusawi Ala,Joseph Bobby,Gabato Severino,Andersson Lars Dental traumatology : official publication of International Association for Dental Traumatology AIM:To develop an experimental in vivo model to study dentoalveolar ankylosis and osseous replacement resorption after delayed replantation. MATERIALS AND METHODS:The maxillary right incisors of eight rabbits were extracted and replanted, while the maxillary left incisors served as controls. A special technique for extraction was used, luxating the incisor laterally prior to extraction. Extra-oral root canal treatment was performed. In four of the eight replanted teeth, periodontal ligament was removed using gauze. All teeth were replanted after one-hour dry storage. A horizontal line was drilled on the labial enamel surface of the incisors to enable registration of possible subsequent infraposition. The rabbits were sacrificed after 1 week or 4 weeks, respectively. Percussion test of the teeth was carried out and infraposition was registered. Histological processing and evaluation were performed. RESULTS:Percussion sound was normal after 1 week and high in the 4 week group; infraposition was noted in all replanted teeth in the 4-week group. Fusion between the bone and dentin was seen in some areas on the root already after 1 week, but there was little or no osseous replacement. Larger areas of ankylosis were seen in the 4-week group although not significant, but deeper progressive osseous replacement was noted in this group. There was no significant difference in ankylosis with regard to periodontal ligament removal or not. Pulp and periodontal tissues were normal in all control teeth. CONCLUSION:The rabbit tooth model may be useful for experimental in-vivo studies on delayed replantation, subsequent ankylosis, osseous replacement and infraposition. 10.1111/edt.12287
    Effect of bisphosphonates on root resorption after tooth replantation - a systematic review. Najeeb Shariq,Siddiqui Fahad,Khurshid Zohaib,Zohaib Sana,Zafar Muhammad Sohail,Ansari Shazia Akbar Dental traumatology : official publication of International Association for Dental Traumatology BACKGROUND/AIM:Replantation of avulsed teeth may lead to root resorption. Bisphosphonates (BPs), a class of drugs of used to treat resorptive diseases of the bone such as osteoporosis and Paget's disease, have been observed to exert an antiresorptive effect on periodontal bone as well. The antiresorptive properties of BPs could prove them useful in preventing root resorption of replanted avulsed teeth. The aim of this systematic review was to analyze and summarize the currently available literature concerning the use of BPs in preventing root resorption of avulsed teeth. MATERIALS AND METHODS:PubMed/MEDLINE, Google Scholar, ISI Web of Knowledge, and Embase databases were searched using keywords 'bisphosphonate', 'replantation', and 'tooth'. Quality assessment of each study was carried out. In addition, general characteristics and outcomes of each study were summarized. RESULTS:After exclusion of 116 irrelevant articles, 10 animal studies were included in this review. The majority of the studies suggest that surface application of zoledronate or alendronate reduces root resorption of replanted teeth in animal models. Surface treatment with etidronate had no significant effect on root resorption, and intracanal etidronate accelerated resorption. CONCLUSION:Surface application of zoledronate and alendronate reduces root resorption of replanted teeth in animal models. However, the efficacy of intracanal usage of BPs is still debatable. 10.1111/edt.12316
    The effect of cathepsin K inhibitor surface treatment on delayed tooth replantation in dogs. Kwon Youngil,Ko Hyunjung,Kim Soojung,Kim Miri Dental traumatology : official publication of International Association for Dental Traumatology BACKGROUND/AIM:Continuous research efforts have been focusing on promoting healing of delayed replantation of avulsed teeth. The aim of this in vivo study was to assess the effect of cathepsin K inhibitor surface treatment on delayed tooth replantation. MATERIALS AND METHODS:Thirty-four premolar roots of 4 beagle dogs were extracted, and conventional root canal treatment was performed. The canals were filled with gutta-percha and cement. All extracted teeth were air-dried for 1 hour. Teeth were divided into 2 groups according to the root surface treatment prior to replantation: control (n = 13) and cathepsin K inhibitor (n = 21). Treated teeth were replanted in their original sockets and stabilized with a resin-wire splint for 1 week. After 12 weeks, the dogs were euthanized and micro-computed tomography was performed. Tissues were then further processed as resin-embedded specimens stained with hematoxylin and eosin. In each evaluation, data were analyzed using the Mann-Whitney U test (P < .05). RESULTS:In the micro-computed tomography evaluation, inflammation scores of both groups were not statistically different (P > .05). In the histological evaluation, the mean proportions of inflammatory resorption and replacement resorption in the control group were similar to those in the cathepsin K inhibitor group (P > .05). CONCLUSIONS:Cathepsin K inhibitor did not demonstrate significant inhibitory effects on root resorption after delayed replantation in vivo. 10.1111/edt.12397
    Effects of near-infrared LED therapy on experimental tooth replantation in rats. Pigatto Mitihiro Débora,de Paula Ramos Solange,Corazza Montero Janaína,Alves Campos Aline,de Oliveira Toginho Filho Dari,Dezan Garbelini Cassia Cilene Dental traumatology : official publication of International Association for Dental Traumatology BACKGROUND/AIM:Dental avulsion damages periodontal tissues and may induce dentoalveolar ankylosis and root resorption after replantation. The aim of this work was to evaluate the effects of light-emitting diode (LED) therapy after tooth replantation. MATERIAL AND METHODS:The upper right incisors of 36 male Wistar rats were extracted and replanted after 15 min. The control group (Co, n = 18) was submitted to replantation and the LED group (n = 18) was submitted to replantation and LED therapy (940 nm, 4 J cm ) for three consecutive days (0, 24, and 48 h). Six animals from each group were euthanized at 7, 14, and 21 days for histological analysis. The upper left incisors were used as a negative control. Data were compared using the Fisher exact test, considering P < 0.05. RESULTS:After 7 days, the Co (73.3%) and LED (72.2%) groups presented areas of periodontal ligament necrosis. However, periodontal ligament necrosis was more frequent in the LED group at 14 (70%, P < 0.05) and 21 days (43.2%, P < 0.05) in relation to the Co group (33 and 21.6%). Inflammatory cell infiltration was more frequent in the Co group at 7 days (100%) than the LED group (24.4%, P < 0.05), but increased in the LED group after 21 days (83.3%, P < 0.05). Bone necrosis was more frequent in the LED group after 14 (79%, P < 0.05) and 21 days (60%, P < 0.005) than in the Co group (45% and 20%). Bone repair was evident in the Co group at 14 days. All of the replanted teeth had pulp necrosis. CONCLUSION:The results suggest that the application of LED therapy up to 48 h after tooth replantation may delay periodontal ligament repair. 10.1111/edt.12301
    Immediate tooth replantation in rats: effect of systemic antibiotic therapy with amoxicillin and tetracycline. Melo Moriel Evangelista,Silva Cristina Antoniali,de Souza Gomes Weglis Dyanne,da Silva Vanessa Ferreira,Brandini Daniela Atili,Poi Wilson Roberto,Castilho Lithiene Ribeiro,Sonoda Celso Koogi,Panzarini Sônia Regina Clinical oral investigations OBJECTIVES:The aim of this study was to evaluate the influence of systemic administration of antibiotics (amoxicillin and tetracycline) at the different phases of the repair process (7, 15, 30 days) in immediate rat tooth replantation. MATERIALS AND METHODS:Ninety rats had their incisors extracted and stored in saline for 5 min. Next, the teeth were replanted, and the animals were assigned to three groups according to the antibiotic administered by oral gavage: control group, amoxycillin group, and tetracycline group. Euthanasia was performed at 7, 15, and 30 days after replantation. RESULTS:Regardless of the evaluation period, the connective tissue underlying the epithelial attachment and the periodontal ligament showed statistically significant difference relative to the acute inflammatory infiltrate, which was more intense in the control group followed by the tetracycline group. CONCLUSION:These results point to the fact that systemic antibiotic therapy (SAT) in immediate tooth replantation is beneficial to pulpal and periodontal ligament repair and that amoxycillin is an excellent option. CLINICAL RELEVANCE:There is a lack of randomized studies assessing how the use of systemic antibiotics could influence tooth healing after immediate replantation. 10.1007/s00784-015-1534-0
    Delayed tooth replantation in rats: effect of systemic antibiotic therapy with amoxicillin and tetracycline. Gomes Weglis Dyanne de Souza,Silva Cristina Antoniali,Melo Moriel Evangelista,Silva Vanessa Ferreira da,Almeida Melyna Marques de,Pedrini Denise,Poi Wilson Roberto,Sonoda Celso Koogi,Panzarini Sônia Regina Dental traumatology : official publication of International Association for Dental Traumatology Systemic antibiotic therapy (SAT) has usually been recommended after tooth replantation, but its actual value has been questioned. As there are no reports in the literature about its influence on tooth replantation, the aim of this study was to evaluate the influence of systemic administration of antibiotics (amoxicillin and tetracycline) at the different phases of the repair process (7, 15, 30 days) in delayed rat tooth replantation. Ninety Wistar rats (Rattus norvegicus albinus) had their maxillary right incisors extracted and bench-dried for 60 min. The dental papilla, enamel organ, pulp tissue, and root surface-adhered periodontal ligament were removed, and the teeth were replanted. The animals received no antibiotics (n = 30) or were medicated systemically with amoxicillin (n = 30) and tetracycline (n = 30), and were euthanized after 7, 15, and 30 days. Regardless of the evaluation period, the acute inflammatory infiltrate was less intense and root resorption presented smaller extent and depth in the group treated with amoxicillin. The results suggest that SAT has a positive influence on the repair process in delayed tooth replantation and that amoxicillin is an excellent treatment option. 10.1111/edt.12207