Extra-oral Time Research Articles

Guided Osteotomy and Guided Autotransplantation for Treatment of Severely Impacted Teeth: A Proof-of-Concept Report

IntroductionThe aim was to present a novel surgical technique using virtually preplanned 3-dimensional (3D)-printed templates for guided osteotomies. These were to ensure atraumatic uncovering of a severely impacted donor tooth including guided drilling of the recipient alveolus followed by a secure autotransplantation procedure. MethodsThis report presents an autotransplantation procedure of a 14-year-old patient with a severely impacted second premolar and extensive contact to the roots of the adjacent teeth and the inferior alveolar nerve. Autotransplantation of the impacted premolar was virtually performed using modified methods from guided implant surgery in order to prefabricate 3D-printed templates with the aid of a fully digital workflow. ResultsSatisfactory treatment could be achieved using surgical templates for guided osteotomies of the surgical access, guided drilling of the recipient site, and occlusal reference template ensuring autotransplantation in the appropriate 3D location of the graft. An atraumatic approach could be ensured with an extraoral time of 46 seconds by 1 fitting attempt; no injuries or altered sensation of the inferior alveolar nerve were present. A vital natural tooth could be observed. ConclusionsThis innovative technique uses for the first time a fully implemented digital workflow for guided osteotomies, guided drilling, and guided autotransplantation of a severely impacted tooth. 3D-printed templates could ensure a guided atraumatic approach and facilitate highly complex treatments by virtually implementing recommended guidelines in future autotransplantations.

The use of 3D additive manufacturing technology in autogenous dental transplantation

BackgroundIn medicine and dentistry, 3D technology allows the virtual planning and printing of surgical replicas of anatomical structures that can facilitate certain transplant procedures. In dentistry, 3D technology is useful in autogenous tooth transplantation.Case presentationWe present a clinical case of an ectopic mandibular second premolar, describing the preoperative planning with dental replicas and the autotransplantation surgery. 3D prints of the surgical replica of the tooth to be transplanted was made using an Objet30 Prime® Printer, PolyJet. Clinical controls performed at 3, 6 and 12 months indicated the satisfactory evolution of the transplanted tooth.Conclusion3D additive manufacturing technology allows the preparation of a new recipient socket with the aid of a surgical replica of the tooth to be transplanted, thus minimizing handling and extraoral time.

Replantation of two avulsed teeth after 1 h of storage in adverse extraoral dry conditions: A thought-provoking outcome after a 15-month follow-up

This article reports a clinical case of an 8-year-old boy who sustained avulsion of the maxillary right central incisor and the maxillary left lateral incisor. The avulsed teeth were kept in adverse extraoral dry conditions for 1 h from the moment of trauma until their replantation.The prognosis of tooth replantation is dependent on multiple factors such as methods of teeth storage in vitro, endodontic intervention, extra-oral time, and type of retention employed. The main reasons for root resorption in this case may be the extra-oral time, the initial replantation, or the delayed endodontic treatment.

Autotransplantation of third molars with completely formed roots to replace compromised molars with the computer-aided rapid prototyping.

To describe a method to fabricate donor tooth replica to assist surgeons in preparation of recipient socket during tooth autotransplantation. A total of 28 compromised molars in 27 patients were transplanted with third molars using computer-aided rapid prototyping (CARP) technique. Surgery time and extra-alveolar time were documented. Postoperatively, the distance between cervix of transplanted tooth and the alveolar wall was measured. The degree of postoperative pain experienced was assessed with visual analog scale at day 1, 3, and 7. From 28 clinical cases, the average extra-alveolar time and surgery time were 2.5 minutes (±1.3) and 44 minutes (±6.8), respectively. Postoperatively, the average distance between cervix of transplanted tooth and the alveolar wall was 0.87 mm (±0.15) at the mesial-cervix, 0.95 mm (±0.17) at the distal-cervix, 0.88 mm (±0.18) at the buccal-cervix, and 0.95 mm (±0.13) at the lingual-cervix. The value of visual analog scale score significantly decreased from day 1 to day 3. CARP is a reliable technique for fabrication of tooth like surgical replicas in conventional autotransplantation. CARP technique minimized extra-oral time, reduced iatrogenic damage, and consequently increased the survival rate of tooth autotransplantation.

Beyond Endodontic MicroSurgery 2: Transplantation

This review aimed to report the outcome of contemporary transplantation of mature and immature teeth and its correlation with various procedural factors. The success rate of immature tooth transplantation was around 90% with successful revascularization. The teeth with root development stage of 3 or 4 show the most favorable outcome, which are the teeth with almost full root formation and open apical foramina. Mature teeth have a lower prognosis than immature teeth after transplantation and patients over 45 years old and extraoral time over 15 min caused significantly more failures. Transplantation of mature donor teeth and immature donor teeth can be a good alternative to other prosthetic methods and best performed by the endodontist, if the indications are there. This is true, especially for young adults, who lost their permanent tooth due to fracture or severe caries, both physically and psychologically.

Autotransplantation of mature impacted tooth to a fresh molar socket using a 3D replica and guided bone regeneration: two years retrospective case series

BackgroundThe aim of this study was to evaluate the clinical outcome of autotransplantation of mature third molars to fresh molar extraction sockets using 3D replicas.MethodsTen patients underwent teeth autotransplantation with or without GBR. We observed the mobility, percussion, radiography examination, the probing depth and the masticatory function of the transplanted teeth during 2 years following up, which were transplanted into fresh molar sockets by using 3D replicas, and GBR when it is necessary.ResultsThe average extra-oral time of donor tooth had been shortened to 1.65 min when used the 3D replica. Some probing depth of the transplanted tooth were deeper than 3 mm at 4 or 5 weeks temporarily. And one patient felt slight sensitive when chewing with soft food at 4 weeks, then disappeared. The clinical examination of the autotransplantation teeth during 1 year follow-up showed no sign of failure.ConclusionsThe tooth autotransplantation using 3D replica with or without GBR is an effective method which can reduce the extra-oral time of the donor teeth and may result in less failure.

Natural Product as the Storage medium for an avulsed tooth – A Systematic Review

Dental avulsion is considered as one of the most severe types of traumatic tooth injuries because it causes damage to several structures and results in the complete displacement of the tooth from its socket in the alveolar bone. The ideal situation is to replant the tooth immediately after avulsion because the extra oral time is an important determinant for the success of the treatment and for a good prognosis. The aim of this systematic review was to identify the recommended natural storage m to store and transport avulsed tooth based on the survival capacity of periodontal ligament cells.This paper reviews the different storage media that have been evaluated for avulsed teeth based on full-length research papers retrieved from PubMed/Medline, Lilacs, BBO and SciELO electronic databases using the key words ‘storage medium’, ‘avulsion’, ‘tooth avulsion’, ‘replantation’, ‘tooth replantation’, ‘milk’ and ‘propolis’. Based on the application of inclusion and exclusion criteria, About 14 papers have been selected and critically reviewed with respect to the characteristics, efficacy and ease of access of the storage media. The review of this study shows and includes a wide array of wet storage media that have been evaluated in laboratory-based studies on PDL cells found on adult permanent teeth. Among the natural products other than milk, propolis, coconut water, green tea extract, egg white, green tea extract, Alovera gel, pomegranate juice, salvia officinalis followed by dragon blood sap (Croton Lechleri) were recommended based on the cell viability and its longevity. In an emergency, it is important for dentists to consider the circumstances of the accident, the location and suggest an appropriate transport media.

Clinical outcomes after intentional replantation of permanent teeth: A systematic review.

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.

Intentional replantation of endodontically treated second premolar with chronic apical abscess

A case of 51-year-old female reported with pain of failed root canal treatment of the mandibular right second premolar. Periapical lesion, mobility, and deep periodontal pocket were detected during examination. Intentional replantation was discussed with the patient. The tooth was atraumatically extracted followed by root end resection and retrograde cavity preparation and filling with MTA. Curettage in conjunction with irrigation of the alveolus was considered to eliminate the inflammatory tissue. The tooth was replanted back into its socket and splinted to the adjacent tooth. The total extraoral treatment time was ≤15 min. One- and three-month follow-up revealed no clinical symptoms and progressive periapical healing. After 2 years and 7 months, complete periapical healing was evident. The success rate of intentional replantation is very promising when the procedural techniques are applied properly.

Knowledge and attitude of emergency physician about the emergency management of tooth avulsion

BackgroundThe aim of the study was to evaluate the knowledge of ER physicians with different specialties, experience and hospital sectors for the management of avulsed teeth in the emergency rooms of eight major hospitals in Jeddah, Saudi Arabia. It also covers their attitude towards receiving further education on tooth avulsion management.MethodsA cross-sectional survey was conducted at the emergency rooms of eight hospitals in Jeddah from August to December 2015. A self-administered questionnaire consisting of 31 multiple choice questions assessing both knowledge and attitude was distributed to 150 physicians who were working in the ER departments.ResultsResponse rate was 81.33%. Data revealed that 45.9% of the respondents did not have prior knowledge about avulsion. Physicians working in military hospitals had better knowledge about the ER management of avulsion cases than physicians of public hospitals. 80.3% of participants showed willingness to replant the tooth, however, 65.3% would not do it by themselves. 42.6% of the physicians did not know the importance of extra-oral time. Milk was selected as the best transport media for avulsed tooth by 31.1% of the participants. Regarding physicians’ attitude, 95.1% showed interest in receiving information about the subject.ConclusionThis study revealed that the majority of ER physicians lack the knowledge needed to manage avulsions cases. Hence, educational programs are necessary for ER physicians to provide proper management for those cases.

Evaluating the effectiveness of rehydrating solutions in preserving periodontal ligament cells vitality: An in vitro study

Background and Purpose of the Study: Two of the most critical factors affecting the prognosis of an avulsed tooth after replantation are extraoral dry time and the storage medium in which the tooth was placed before treatment could be rendered. The ability of a storage medium to support cell viability of the periodontal ligament (PDL) can be an important factor in the prognosis, and thus, the aim of this study was to evaluate the efficacy of commonly available storage media. Materials and Methods: Cultured PDL cells of sixty freshly extracted human teeth were randomly divided into four groups of 15 each, Group I: Electral solution, Group II: Ringer's lactate, Group III: Oral rehydration salt liquid (ORS-L), and Group IV: Coconut water. Samples in each group were further divided into three subgroups depending on the time duration they were placed in the storage medium, i.e., 1, 4, and 8 h. Further these samples were subjected to Collagenase assay, the cells were stained with trypan blue and viable PDL cells were counted under light microscope. Results: Statistical analysis showed that Group II demonstrated significantly (P Conclusion: Ringer's lactate maintained highest PDL cell viability followed by coconut water, electoral solution, and ORS-L at various time intervals. More studies with large samples are required to prove the efficacy of Ringer's lactate as viable storage media.

Intentional Replantation with 180° Rotation of a Crown-Root Fracture as a Last Expedient: A Case Report

The treatment of complicated crown-root fractures of tooth is often compromised by a fracture apical to the gingival margin and/or bone. This makes isolation difficult and compromises the adhesive union which is critical for a successful treatment. In the present case, the fracture line extended from cervical third of labial surface to cervical third of palatal surface sub gingivally which made the case a complicated crown root fracture. The reattachment of fragments would bring the vulnerable joint in the primary stress bearing area and in the subgingival region. Hence the tooth was removed traumatically with the help of periotome and intentional replantation was done which facilitated the attachment of fragments extra orally. Fragments reattachment was reinforced with the intraradicular fiber post and glass ionomer cement. Then the tooth was rotated 1800 to bring the subgingival fracture line to the labial surface where the occlusal load is less. As the amount of extra oral time is a critical factor in the success of reimplantation, the procedure was completed in 20 minutes. The teeth were stabilized with semi rigid splint for 6 weeks. Later full veneer crown was cemented on the tooth. The patient was followed up with clinical examination for mobility test, gingival sulcus depth and radiographic analysis to analyze the integrity of root, the alveolar cortex and the periodontal space for 12 months. The treatment is successful so far and has rendered satisfaction to both the clinician and patient.

Reimplantation of Accidentally Avulsed Permanent Maxillary Anterior Teeth in a 10-Year-Old Girl

Accidental tooth avulsion is a grievous injury and common among the children. Management of avulsed tooth within alveolar socket by reimplantation becomes a challenge for the clinician due to extraoral time and media of transportation. Although the long-term prognosis of reimplantation is poor, the time during which the tooth remain within the arch will guide the development of alveolar bone completely. Moreover, reimplantation will maintain anatomical, functional and esthetic rehabilitation of the patient. In this case report, we present a case of accidental avulsion where teeth were gently rinsed of any debris and placed in normal saline during the examination and preparation of the reimplantation sockets. The teeth were then reimplanted, functionally splinted followed by endodontical treatment. After 12 months follow-up the periodontal space was healed perfectly without any resorption or ankylosis.J Enam Med Col 2017; 7(3): 165-169

Autotransplantation of Mandibular Third Molar with Buccal Cortical Plate to Replace Vertically Fractured Mandibular Second Molar: A Novel Technique

Tooth replacement often leads to inadequate vertical volume in the recipient site bone when a tooth has been extracted because of a vertical root fracture (VRF). This case report presents the autotransplantation of a mandibular third molar (tooth #32) with the attached buccal cortical plate to replace a mandibular second molar (tooth #31) diagnosed with a VRF. After extraction of tooth #31, the recipient socket was prepared based on the size measured in advance with cone-beam computed tomographic imaging. The precise and calculated osteotomy of the cortical bone of tooth #32 allowed for the exact placement of the donor tooth in the position of tooth #31. The total extraoral time was only 25 minutes. The block was fixed to the recipient socket with an osteosynthesis screw and splinted with a double resin wire for 8 weeks. At the 6-month follow-up, the screw was removed, and the stability of the tooth and the regeneration obtained throughout the vestibular area were confirmed. At the 2-year follow-up, the transplanted tooth was asymptomatic and maintained a normal bone level. Advantages of autotransplantation over dental implants include maintenance of proprioception, possible orthodontic movements, and a relatively low cost. This case report demonstrates that an autotransplantation of a third molar attached to its buccal cortical plate is a viable option to replace teeth with a VRF.

Delayed replantation of avulsed tooth with 4½ days extraoral time with 18 months follow up

Avulsion or exarticulation is one of the most severe injuries of the tooth, frequently encountered in young children and the maxillary anterior teeth. Immediate transplantation of the avulsed tooth is the suggested treatment that results in a favorable prognosis, although this may not be possible every time. Here, we present a case report of an 8-year-old girl who sustained an avulsion injury of the maxillary left central incisor with 4½ days extraoral time. Treatment guidelines for avulsed immature permanent teeth with prolonged extraoral dry time were followed. Portland cement was used for obturation of the root canal. The clinical and radiographic findings after 18 months revealed minimal inflammatory root resorption and ankylosis of the replanted tooth, whereas clinically, the tooth was asymptomatic and maintained the aesthetics of the child, suggesting the importance of replantation, although there was prolonged extraoral dry time.

Survival Rate of Teeth with a C-shaped Canal after Intentional Replantation: A Study of 41 Cases for up to 11 Years

IntroductionTeeth 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. MethodsWe 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. ResultsThe 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). ConclusionsExtraoral 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.

Retention and Healing Outcomes after Intentional Replantation

IntroductionIntentional 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. MethodsData 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). ResultsComplications 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). ConclusionsThis 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.

Prognostic Factors for Clinical Outcomes in Autotransplantation of Teeth with Complete Root Formation: Survival Analysis for up to 12 Years

IntroductionTooth autotransplantation is a treatment option that has the potential to restore masticatory function and esthetics to edentulous spaces resulting from extracted teeth. The purpose of this study was to investigate the prognostic factors and clinical outcomes for autotransplanted teeth with complete root formation. MethodsPatients who had received tooth autotransplantation in the Department of Conservative Dentistry, Yonsei University Dental Hospital, Seoul, Korea, from July 2001 to August 2010 were electronically searched, and a total of 105 cases of autotransplanted teeth met the inclusion criteria. Tooth survival, inflammatory root resorption (IRR), ankylosis, and related prognostic factors were assessed by using the survival analysis that was based on clinical and radiographic examination. ResultsThe cumulative tooth survival rate was 68.2% at 12 years after the tooth autotransplantation. According to the Cox proportional hazard regression analysis, patient age, donor position, and extraoral time were significantly associated with tooth survival (P < .05). Donor extraction type was significantly associated with IRR (P < .05), and transplantation timing and initial stability were significantly associated with ankylosis (P < .05) ConclusionsPatients less than 45 years of age, maxillary donor teeth, and an extraoral time of less than 15 minutes were associated with significantly higher tooth survival. Surgical extraction of the donor tooth was associated with a significantly higher incidence of IRR. Immediate transplantation after the extraction of the recipient site's tooth and low initial stability were associated with a significantly lower incidence of ankylosis

Multidisciplinary approach in the immediate replantation of a maxillary central incisor - A six and a half year follow-up

AbstractThis report proposes a discussion of the various peculiarities of a tooth 21 replantation in a 9-year-old patient and describes different treatment facets and a 6-year follow-up of the case. The splint was maintained for a 3-month period. After a 1½ year therapy with calcium hydroxide to control inflammatory resorption, the final canal obturation was performed 18 months after trauma with mineral trioxide aggregate. Two years after replantation, the orthodontic treatment had been initiated and 5 years after avulsion, whitening of tooth 21 was also done. Clinical and radiographic follow-up at regular intervals revealed that the treated tooth was still functional, showing normal mobility, resorption stabilization, and normal appearance of the bone tissue and lamina dura, testifying the treatment has been so far successful. The possibility of submitting avulsed teeth to other dental treatments once, there is close professional monitoring by controlling the risks and benefits of each therapy, as well as the patient′s cooperation, extra-oral time, and storage media for transport to the dentist among other details is emphasized.

Delayed replantation of avulsed teeth: two case reports.

This case report presents two cases of delayed replantation of avulsed maxillary central incisors after an extended dry extra-alveolar period. Eight-year-old boy and 10-year-old boy presented with avulsed maxillary central incisors due to trauma occurring 27 and 7 hours earlier, respectively. Treatment guidelines for avulsed mature/immature permanent teeth with prolonged extra-oral time were carried out for the teeth and the extra-oral endodontic treatment was completed. After having been repositioned, the teeth were stabilized for 4 weeks and prophylactic antibiotic was prescribed. Clinical and radiographic controls were done after 18 months for Case I and 12 months for Case II. During the follow-up periods the teeth reported in these cases have remained in a stable, functional position but revealed clinical initial replacement resorption and ankylosis.