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    Maxillary first molar with an O-shaped root morphology: report of a case. Shin Yooseok,Kim Yemi,Roh Byoung-Duck International journal of oral science This case report is to present a maxillary first molar with one O-shaped root, which is an extended C-shaped canal system. Patient with chronic apical periodontitis in maxillary left first molar underwent replantation because of difficulty in negotiating all canals. Periapical radiographs and cone-beam computed tomography (CBCT) were taken. All roots were connected and fused to one root, and all canals seemed to be connected to form an O-shape. The apical 3 mm of the root were resected and retrograde filled with resin-modified glass ionomer. Intentional replantation as an alternative treatment could be considered in a maxillary first molar having an unusual O-shaped root. 10.1038/ijos.2013.68
    Palatal Radicular Groove Morphology of the Maxillary Incisors: A Case Series Report. Tan Xuelian,Zhang Lan,Zhou Wei,Li Yan,Ning Jiali,Chen Xi,Song Dongzhe,Zhou Xuedong,Huang Dingming Journal of endodontics INTRODUCTION:Teeth with a palatal radicular groove are challenging to diagnose, treat, and save. We classified this condition using cone-beam computed tomographic (CBCT) cross-sectional configurations combined with radiographic and morphologic observations during an intentional replantation procedure to identify and analyze the characteristics of palatal radicular grooves comprehensively as a reference for diagnosis, treatment planning, and prognosis evaluation of this condition. METHODS:Eight cases with palatal radicular grooves present in permanent maxillary incisors were investigated by radiography and CBCT imaging before intentional replantation. RESULTS:The palatal radicular grooves were classified into 3 types based on groove depth and cross-sectional shape on CBCT images: type I, with a shallow groove depth, corresponding to a normal, simple, and single root canal; type II, with a medium groove depth, corresponding to a C-shaped canal system; and type III, with a deep groove depth, almost bisecting the root of the tooth, simultaneously present with 2 independent root canals and an apex with normal shape, corresponding to a labial groove connecting with a palatal groove. The extracted teeth and their radiographic images showed corresponding characteristics. CONCLUSIONS:The CBCT cross-sectional images allowed the best visualization of the depth of the grooves and highlighted the difficulties entailed in treating such teeth. Intentional replantation is an effective therapeutic decision for this type of deformity and can provide better prognosis estimation, especially in teeth with type II and III grooves. 10.1016/j.joen.2016.12.025
    Intentional re-plantation of a vertically fractured tooth repaired with an adhesive resin. Unver S,Onay E O,Ungor M International endodontic journal AIM:To present the successful treatment of a vertically fractured tooth by intentional re-plantation after root canal treatment and repair with an adhesive resin. SUMMARY:Vertical root fracture is a challenging problem in respect of diagnosis and management options. In this case, a vertically fractured maxillary premolar was treated by intentional re-plantation after repairing it with 4-Methacryloxyethyl trimellitate anhyride/methacrylate-tri-n-butyl borane (4-META/MMA-TBB) resin cement. At the 36-month follow-up, the tooth was asymptomatic, radiographically sound with reduced deep periodontal pockets and vertical bone loss. KEY LEARNING POINTS:• Intentional replantation after repairing fractured fragments with an adhesive resin extraorally is a treatment option. • Long-term follow-up is necessary to evaluate the outcome of this technique. 10.1111/j.1365-2591.2011.01922.x
    Intentional replantation: a case report. Cotter Michael R,Panzarino John Journal of endodontics Nonsurgical retreatment and surgical endodontics are not always viable solutions to endodontic disease. Access for retreatment may be limited by posts. Surgical endodontics may be limited by anatomical features including bone thickness and nerve and sinus proximity. Anatomical limitations and complex restorations may prevent implant placement. Intentional replantation is considered by many as a procedure of last resort when nonsurgical or surgical endodontics is contra-indicated. The treatment described demonstrates intentional replantation as a procedure to be considered when endodontic procedures or a dental implant are not possible. 10.1016/j.joen.2005.08.004
    Extraoral endodontic treatment, odontotomy and intentional replantation of a double maxillary lateral permanent incisor: case report and 6-year follow-up. Sivolella S,Bressan E,Mirabal V,Stellini E,Berengo M International endodontic journal AIM:To describe combined endodontic, surgical and orthodontic treatment of a maxillary lateral incisor fused with a supernumerary. SUMMARY:Double tooth is a dental irregularity consequent to fusion of two or more teeth or dental gemination. The teeth most commonly involved are deciduous, but in 0.1% of cases permanent teeth are affected, in which case aesthetic, functional and periodontal problems can result. This paper reports a clinical case of a double tooth in the position of the maxillary right lateral permanent incisor. Combined orthodontic, endodontic and surgical treatment (intentional replantation) allowed the tooth to be retained without periodontal compromise and with a positive orthodontic result both immediately and 6 years following intervention. *A conservative approach that addresses periodontal, pulpal and tooth tissues, can result in the retention of a double tooth. *Maintenance of the root and alveolar bone in young adults at least until full skeletal maturation should be the main treatment objective. 10.1111/j.1365-2591.2008.01391.x
    Intentional replantation for the management of maxillary sinusitis. Peñarrocha M,García B,Martí E,Palop M,von Arx T International endodontic journal AIM:To present a case that emphasizes the importance of the use of intentional replantation as a technique to successfully treat a periapical lesion and an odontogenic maxillary sinusitis through the alveolus at the same time. SUMMARY:This case report presents a patient with odontogenic maxillary sinusitis secondary to periapical disease of a maxillary molar that had previously received root canal treatment. The molar was extracted, with drainage and rinsing of the maxillary sinus. The apices were resected extra-orally, the retrograde cavities prepared with ultrasound and retrograde fillings of silver amalgam placed. The tooth was then replanted. After 2 years, the patient was asymptomatic, periapical radiography showed no evidence of root resorption and computed tomography scanning demonstrated the resolution of maxillary sinusitis. KEY LEARNING POINTS:*When root canal treatment or periapical surgery cannot be undertaken or has failed, intentional replantation may be considered. *This alternative treatment may be predictable in certain cases. 10.1111/j.1365-2591.2007.01278.x
    The usefulness of three-dimensional imaging for prognostication in cases of intentional tooth replantation. Kabashima Hiroaki,Mizobe Kunitaka,Sakai Takako,Nakamuta Hiroyoshi,Kurita Kenichi,Terada Yoshihiro Journal of oral science This paper describes the utility of three-dimensional (3D) images obtained with cone beam computed tomography (CBCT) for prediction of successful clinical outcome in two cases of intentional tooth replantation (IR). IR was performed for teeth affected by vertical root fracture and root perforation with local application of blood clot and oxy-tetracycline antibiotic. High-resolution 3D images demonstrated no evidence of ankylosis, but did reveal the presence of alveolar bone regeneration, suggesting a good long-term prognosis. Our observations in these cases suggested that local application of the above two materials might help to induce the regeneration of lost periodontal tissues in IR. 10.2334/josnusd.54.355
    Adhesive tooth fragment reattachment with intentional replantation: 36-month follow-up. Dogan Muharrem Cem,Akgun Erkan Onur,Yoldas Hamdi Oguz Dental traumatology : official publication of International Association for Dental Traumatology Crown-root fracture is one of the most challenging fracture types in dental traumatology literature. Aesthetic and functional rehabilitation is the primary goal of the treatment of crown-root-fractured tooth. For this purpose, reattachment of the fragment to its original position is a good choice. This paper reports a case of an adhesive fragment reattachment of a complicated crown-root fracture with intentional replantation in a 9-year-old girl patient and 36-month follow-up. 10.1111/j.1600-9657.2012.01144.x
    Management of complicated crown-root fractures using intentional replantation: two case reports. Kim Duck-Su,Shin Dong Ryul,Choi Gi-Woon,Park Sang Hyuk,Lee Jin Woo,Kim Sun-Young Dental traumatology : official publication of International Association for Dental Traumatology The management of complicated crown-root fractures is a challenge. Intentional replantation with 180° rotation may be a useful procedure to overcome this problem. In Case 1, a 23-year-old woman with complicated crown-root fractured teeth #11, #21, and #22 was referred for treatment. All fractured teeth were extracted, rotated 180°, and replanted in a slightly extruded position. After 3 months, root canal treatment was completed and the final restorations fabricated. At the 18-month follow up, the patient was asymptomatic, the tooth was functional, and no root resorption was observed radiographically. At the 90-month follow up, slight cervical root resorption of tooth #11 was noted. In Case 2, a 27-year-old woman with a crown-root fractured tooth #21 was referred for treatment. Despite immediate repositioning of the coronal fragment and a 2-week stabilization with a wire splint, the coronal fragment remained separated from the apical tooth segment. The apical segment was extracted, rotated 180°, and replanted in a slightly extruded position. After 1 and 4 weeks, the root canal treatment was completed and the final restoration fabricated, respectively. At the 24-month follow up, the patient was asymptomatic and apical healing was completed. 10.1111/j.1600-9657.2011.01075.x
    Treatment for a complicated crown-root fracture with intentional replantation: a case report with a 3.5-year follow up. Yuan Lin-Tian,Duan Duo-Mo,Tan Ling,Wang Xiao-Jing,Wu Li-An Dental traumatology : official publication of International Association for Dental Traumatology Crown-root fractures are always challenging for pediatric dentists because of their complicated treatments and uncertain prognosis. The purpose of this case report was to describe a severe crown-root fracture successfully treated by multidisciplinary approaches including intentional replantation. After a 3.5-year follow up, the patient felt comfortable and satisfied with her tooth, and the prosthesis was functionally and esthetically acceptable. It is recommended that multidisciplinary treatment with intentional replantation is effective and necessary for similar cases to be conservatively managed. 10.1111/j.1600-9657.2012.01130.x
    Treatment of a crown-root fracture with intentional replantation - case report with 16-year follow-up. Moura L F A D,Lima M D M,Moura M S,Carvalho P V,Cravinhos J C P,Carvalho C M R S International endodontic journal AIM:To report the intentional replantation of a maxillary central incisor with a crown-root fracture. SUMMARY:An 11-year-old girl was referred to a paediatric clinic with an extensive crown-root fracture of the maxillary right central incisor (tooth 11) with pulp exposure. Radiographs revealed that tooth 11 had a periapical radiolucent lesion, which suggested pulpal necrosis. The treatment option chosen was planned extraction and immediate intentional replantation of tooth 11 in a more coronal position. Sixteen years after treatment, tooth 11 was aesthetically and functionally sound, suggesting that the treatment was successful. KEY LEARNING POINT:Intentional replantation may be considered as a treatment option for teeth with crown-root fractures. 10.1111/j.1365-2591.2012.02078.x
    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
    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
    Survival of Intentionally Replanted Teeth and Implant-supported Single Crowns: A Systematic Review. Torabinejad Mahmoud,Dinsbach Nathan A,Turman Michael,Handysides Robert,Bahjri Khaled,White Shane N Journal of endodontics INTRODUCTION:Although nonsurgical initial root canal treatment and retreatment have high success rates, periapical disease can remain. The survival rates of 2 surgical procedures, intentionally replanted (IR) teeth and implant-supported single crowns (ISCs), have yet to be compared. The purpose of this systematic review and meta-analysis was to examine the literature and quantify the survival of IR teeth and compare it with that of ISCs. METHODS:Systematic searches were enriched by citation mining. Weighted survival means and 95% confidence intervals (CI) were estimated using a random-effects model and compared. RESULTS:The quality of the IR and ISC articles was only moderate. Data for ISCs were much more plentiful than for IR teeth. Meta-analysis revealed a weighted mean survival of 88% (95% CI, 81%-94%) for IR teeth. Root resorption was reported with a mean prevalence of 11%. The weighted mean survival of ISCs was 97% (95% CI, 96%-98%). The mean survival of ISCs was significantly higher than that of IR teeth (P < .001). A recent study on IR teeth indicated that orthodontic extrusion before intentional replantation improved survival rates. CONCLUSIONS:A systematic review and meta-analysis found that the mean survival of ISCs was significantly higher than IR teeth. However, treatment decisions must be based on a wide variety of treatment and patient-specific parameters. Intentional replantation may have a role when ISC is not practicable. Studies using contemporary treatment and analytic methods should be used to identify and measure intentional replant prognostic and treatment variables. 10.1016/j.joen.2015.01.004
    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
    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
    Intentional Replantation of Teeth is a Viable and Cost-effective Alternative Treatment to Single-Tooth Implants. Chogle Sami,Chatha Nauman,Bukhari Samah The journal of evidence-based dental practice ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION:A Systematic Review of the Survival of Teeth Intentionally Replanted with a Modern Technique and Cost-effectiveness Compared with Single-tooth Implants. Mainkar A. J Endod 2017:43(12):1963-8. SOURCE OF FUNDING:Information not available. TYPE OF STUDY/DESIGN:Systematic review/meta-analysis. 10.1016/j.jebdp.2018.12.001
    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
    Clinical outcomes after intentional replantation of permanent teeth: A systematic review. Wang Lin,Jiang Hua,Bai Yang,Luo Qiang,Wu Hao,Liu Hongchen Bosnian journal of basic medical sciences This study aimed to systematically assess the outcomes of intentional replantation (IR) of teeth and to determine the survival rate, success rate, and prognostic factors related to the treatment. A search was conducted for all relevant English language articles published from January 2000 to October 2017. The search terms included "intentional replantation" and "teeth" according to the inclusion criteria. The Methodological Index for Non-randomized Studies (MINORS) was used to assess the methodological quality of included studies. Twelve studies were identified as relevant for the systematic review. In total, 896 patients with 905 teeth were examined for intentional teeth replantation. The success rate was greater than 90% in four studies (33.33%) and between 70% and 80% in five studies. At short-term follow-up (<6 months), the survival rate was approximately 90% in four studies. At longer-term follow-up (>36 months), the survival rates of teeth were slightly reduced in four studies, and tended to be stable after 48 months. In conclusion, the long-term success and survival rate of IR are likely dependent upon short extraoral time, reduced pocket depth, type of tooth, type of root-end filling material, and the prevention of atraumatic tooth root damage. 10.17305/bjbms.2019.3937
    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
    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
    Intentional replantation of periodontally involved hopeless teeth: a case series study. Zhang Jiayu,Luo Ning,Miao Di,Ying Xuan,Chen Yue Clinical oral investigations OBJECTIVES:To explore the clinical effect, the healing modes, and the potential influence factors of intentional replantation for periodontally hopeless teeth in combination with regeneration techniques. MATERIALS AND METHODS:Intentional replantation was operated on forty-eight periodontally hopeless teeth from forty-eight patients. The clinical indexes and the X-ray films were recorded during the follow-up period of 18 months. The Wilcoxon signed-rank test or the paired T test was adopted to carry out the statistical analysis. RESULTS:The overall survival rate at the ninth month was 95.8% and declined to 91.7% at the eighteenth month. The improved rate of the mobility was 89.1% at the ninth month and the ankylosis percentage was 77.3% at the eighteenth month. The survival rate and mobility-improved rate of anterior teeth were both better than that of posterior teeth. Probing depth and bone loss decreased while ginginval recession increased (P < 0.05). Smoking had an adverse effect on both mobility improvement and bone gain (P < 0.05). CONCLUSIONS:Intentional replantation for periodontally hopeless teeth could achieve favorable outcomes through a reasonable healing mode of tooth ankylosis. Strict control of infection and smoking could improve the success rate of this procedure. CLINICAL RELEVANCE:To provide additional treatment for allowance of flexible options when patients and dentists are faced with periodontally hopeless teeth. 10.1007/s00784-019-03039-z
    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 to Treat Apical Periodontitis of Maxillary First Molar with Foreign Body Located Outside Apical Foramen Using CBCT: A Case Report. Fujii Rie,Morinaga Kazuki,Asai Tomohiro,Aida Natsuko,Yamada Masashi,Sako Ryo,Furusawa Masahiro The Bulletin of Tokyo Dental College The recent use of cone beam computed tomography (CBCT) in the field of dentistry to obtain 3-dimensional (3D) images has enabled more effective examination and diagnosis in endodontic treatment. Such information has also been reported to be of benefit in surgical endodontic treatment such as intentional replantation. Here, we report a case of intentional replantation with the assistance of CBCT in which a good therapeutic outcome was achieved. The patient was a 30-year-old woman who visited our hospital with the chief complaint of spontaneous pain in the right maxillary first molar. Dental radiographs revealed a radiolucent area in the apical portion of the distal root, and a radiopaque area thought to be a broken shard from a small surgical instrument measuring approximately 1.5 mm in length. The shard was located outside the distal apical foramen. Based on these findings, the diagnosis was acute suppurative apical periodontitis of the right maxillary first molar. Infected root canal therapy was subsequently commenced. The patient's symptoms showed no improvement, however, and the pain persisted. Therefore, dental CBCT was performed to obtain 3D images, which confirmed a radiopaque area thought to be a broken shard from a small surgical instrument located outside the apical foramen of the distal root and facing in a direction that made it impossible to remove from the root canal. Because the patient's symptoms had shown no improvement and a foreign body was observed outside the apical foramen, intentional replantation combined with root resection was performed with informed consent. At a 1-year follow-up visit, progress was good, and there were no reported symptoms or signs. When reaching a diagnosis is difficult based on clinical findings and dental radiographs alone, the 3D images provided by CBCT offer a means of securing a more reliable diagnosis, allowing planning of treatment to be more effective. 10.2209/tdcpublication.2019-0016
    Intentional replantation and Biodentine root reconstruction. A case report with 10-year follow-up. Chaniotis A,Kouimtzis T H International endodontic journal AIM:To describe the innovative use of intentional replantation for Biodentine root reconstruction of a previously treated immature maxillary central incisor with vertically extended crown root fracture and root detachment. SUMMARY:In the present case, the intentional replantation of a failing, previously treated maxillary central incisor with a vertical crown/root fracture in a 12-year-old male patient is reported. The gross extrusion of gutta-percha points beyond the apex and the pre-existing extensive, trauma related, distal cervical dentinal detachment justified the intentional replantation treatment plan as an option for tooth retention. After controlling the infection by oral administration of antibiotics, the immature tooth was extracted atraumatically and kept in gauze embedded with tooth replantation medium. The apical third of the immature fractured tooth was treated with ultrasonics and an MTA plug (MTA Angelus White, Londrina, Brazil). The distal cervical dentinal root defect was reconstructed with Biodentine (Septodont, St. Maur-des-Fosses, France). The tooth was reinserted and stabilized to the adjacent teeth for 2 weeks. The total extraoral time before replantation was 25 min. In the 10 years since the initial trauma (9 years after the intervention) radiographic and clinical evaluation revealed uneventful healing of the periapical lesion, normal mobility and no detectable signs of external replacement resorption. KEY LEARNING POINTS:Intentional replantation may provide a viable treatment alternative in cases of severe complicated crown/ root fractures Biodentine may be useful in the reconstruction of external root defects in crown root fractured traumatic dental injuries. 10.1111/iej.13475
    A long-term treatment outcome of intentional replantation in Taiwanese population. Wu Shao-Ying,Chen Gin Journal of the Formosan Medical Association = Taiwan yi zhi BACKGROUND/PURPOSE:Intentional replantation was a conventional treatment option in surgical endodontics but usually be seen as a last resort. Therefore, the purpose of this study was to evaluate the long-term treatment outcome of intentional replantation in Taiwanese population, including the survival rates and the related prognostic factors. METHODS:Subjects included 215 teeth from 199 patients who had received intentional replantation in a Taiwan medical center. Patients at age under 20 years and those follow-up periods less than 6 months were excluded. The replanted teeth were followed up for a period of 6 months-120 months. Post-treatment assessments, including tooth survival and functional status, were evaluated using both clinical and radiographic examinations. RESULTS:Kaplan-Meier survival analysis revealed the overall tooth survival rate at 4 years was 82.8%. In bivariate analysis, both root-end filling material and enamel matrix derivative (EMD) applications were found to be significant (P < 0.05). The multivariate analysis revealed that age and the presence of a sinus tract or abscess might be the predictors of treatment outcome in intentional replantation. CONCLUSION:Intentional replantation, operated with improved modern technique, is a reliable and viable treatment with a high long-term survival rate (82.8%). If replanted teeth are diagnosed as acute or chronic apical abscess at the pre-operative examination, the risk of failure is measured 2.7 times higher than those diagnosed with other conditions. Application of EMD on the root surface of a replanted tooth may promote the formation and regeneration of periodontal apparatus, therefore increasing the functioning rate and improving the treatment outcome. 10.1016/j.jfma.2020.05.017
    Clinical procedures and outcome of surgical extrusion, intentional replantation and tooth autotransplantation - a narrative review. Plotino G,Abella Sans F,Duggal M S,Grande N M,Krastl G,Nagendrababu V,Gambarini G International endodontic journal Surgical extrusion is defined as the procedure in which the remaining tooth structure is repositioned at a more coronal/supragingival position in the same socket in which the tooth was located originally. Intentional replantation is defined as the deliberate extraction of a tooth and after evaluation of root surfaces, endodontic manipulation and repair, placement of the tooth back into its original position. Tooth autotransplantation is defined as the transplantation of an unerupted or erupted tooth in the same individual, from one site to another extraction site or a new surgically prepared socket. The advent of titanium implant rehabilitation has reduced the use of these treatments in day-by-day clinical practice; however, the re-emerging trend to conserve and preserve natural sound tissues has led to a rediscovery of these treatments. All three distinct surgical methods are closely related, as they act to treat teeth that cannot be predictably treated using other more conventional procedures in endodontics, periodontics and restorative dentistry. Furthermore, these procedures share the same treatment approach and include the atraumatic extraction of a tooth, visual inspection of the tooth/root and its subsequent replantation. The clinical procedures for surgical extrusion, intentional replantation and tooth autotransplantation treatment have undergone several changes in recent years, and currently, there are no clear clinical treatment protocols/guidelines available. The clinician should be aware of the outcome of these treatments. Hence, the aim of this narrative review is to provide the background, clinical procedures and outcomes of surgical extrusion, intentional replantation and tooth autotransplantation. 10.1111/iej.13396