Tooth Replantation Research Articles

Alendronate promotes bone formation by inhibiting protein prenylation in osteoblasts in rat tooth replantation model

Bisphosphonates (BPs) are a major class of antiresorptive drug, and their molecular mechanisms of antiresorptive action have been extensively studied. Recent studies have suggested that BPs target bone-forming cells as well as bone-resorbing cells. We previously demonstrated that local application of a nitrogen-containing BP (N-BP), alendronate (ALN), for a short period of time increased bone tissue in a rat tooth replantation model. Here, we investigated cellular mechanisms of bone formation by ALN. Bone histomorphometry confirmed that bone formation was increased by local application of ALN. ALN increased proliferation of bone-forming cells residing on the bone surface, whereas it suppressed the number of tartrate-resistant acid phosphatase (TRAP)-positive osteoclasts in vivo. Moreover, ALN treatment induced more alkaline phosphatase-positive and osteocalcin-positive cells on the bone surface than PBS treatment. In vitro studies revealed that pulse treatment with ALN promoted osteocalcin expression. To track the target cells of N-BPs, we applied fluorescence-labeled ALN (F-ALN) in vivo and in vitro. F-ALN was taken into bone-forming cells both in vivo and in vitro. This intracellular uptake was inhibited by endocytosis inhibitors. Furthermore, the endocytosis inhibitor dansylcadaverine (DC) suppressed ALN-stimulated osteoblastic differentiation in vitro and it suppressed the increase in alkaline phosphatase-positive bone-forming cells and subsequent bone formation in vivo. DC also blocked the inhibition of Rap1A prenylation by ALN in the osteoblastic cells. These data suggest that local application of ALN promotes bone formation by stimulating proliferation and differentiation of bone-forming cells as well as inhibiting osteoclast function. These effects may occur through endocytic incorporation of ALN and subsequent inhibition of protein prenylation.

Storage Media For Avulsed Teeth: A Literature Review

Dental avulsion is the most severe type 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 an exarticulated tooth immediately after avulsion because the extraoral time is a determinant factor for treatment success and for a good prognosis. However, it is not always possible. The success of replantation depends on a number of factors that may contribute to accelerate or minimize the occurrence of root resorption or ankylosis, among which is the type and characteristics of the medium used for temporary storage during the time elapsed between avulsion and replantation. Maintaining the tooth in an adequate wet medium that can preserve, as longer as possible, the vitality of the periodontal ligament cells that remain on root surface is the key to success of replantation. Recent research has led to the development of storage media that produce conditions that closely resemble the original socket environment, with adequate osmolality (cell pressure), pH, nutritional metabolites and glucose, and thus create the best possible conditions for storage. Although these storage media can now be purchased in the form of retail products, the most common scenario is that such a product will not be readily available at the moment of the accident This paper reviews the literature on the different storage media that have been investigated for avulsed teeth based on full-length papers retrieved from PubMed/Medline, Lilacs, BBO and SciELO electronic databases using the key words 'storage medium', 'transportation medium', 'avulsion', 'tooth avulsion', 'replantation', 'tooth replantation', 'milk' and 'propolis'. After application of inclusion and exclusion criteria, 39 papers were selected and critically reviewed with respect to the characteristics, efficacy and ease of access of the storage medium. The review of the literature showed that a wide array of types of wet storage media have been evaluated in laboratory studies and clinical reports, including cell and tissue culture solutions like Hank's Balanced Salt Solution (HBSS); medical/hospital products developed specifically for organ storage purposes, such as Viaspan® and Euro-Collins®; culture media, like Minimum Essential Medium (MEM); saline; natural products like water, saliva, bovine milk and its variations, propolis, green tea, Morus rubra (red mulberry), egg white and coconut water; rehydrating solutions, like Gatorade® and Ricetral, and even contact lens solutions. Based on the literature, it could be stated that, so far, apart from Based on the literature, it could be stated that, so far, apart from solutions designed specifically for storage and culture purposes, regular pasteurized whole milk is the most frequently recommended and with the best prognosis among other solutions that are likely to be available at the scene of an accident, such as water, saline or saliva. Its advantages include its high availability, ready accessibility, physiologically compatible pH and osmolality (fluid pressure) with the root-surface adhered PDL cells, presence of nutrients and growth factors. However, there is not yet a single solution that fulfills all requirements to be considered as the ideal medium for temporary storage of avulsed teeth, and research on this field should carry on.

Effect of the treatment of root surface-adhered necrotic periodontal ligament with propolis or fluoride in delayed rat tooth replantation

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. 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. Inflammatory resorption, replacement resorption, and ankylosis were observed in all groups without a statistically significant difference (p > 0.05) among them. 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.

Treatment Outcomes of Implants Performed After Regenerative Treatment of Absorbed Alveolar Bone Due to the Severe Periodontal Disease and Endoscopic Surgery for Maxillary Sinus Lift Without Bone Grafts

We have developed a regenerative medicine therapy for the alveolar bone and endoscopic surgery for maxillary sinus lift without bone grafts, in patients experiencing severe periodontal disease with significant absorption of the maxillary alveolar bone, in which more than 10 mm of bone thickness in the maxillary bone was attained, with satisfactory results. The objective of this study was to examine the treatment outcomes of implants that were performed after these therapies. The participants were 36 patients with severe periodontal disease, who cannot be cured with any other treatments except the extirpation of all teeth. The 36 patients are all patients who underwent regenerative treatment of the alveolar bone through tooth replantation and transplantation of the iliac cancellous bone (the bone marrow) as well as endoscopic surgery for maxillary sinus lift from May 2003 to July 2007 in our clinic. A total of 120 implants were placed in these patients when the replanted teeth fell out because of root resorption, and the success rate was examined. The success rates of the implants were 16 of 33 (48%) in the group when surveyed less than 2 years after the surgery and 84 of 87 (96.5%) in the group when surveyed more than 2 years after the surgery. A statistically significant difference was found between the 2 groups (Chi-squared test, P < 0.001). It was believed that it takes approximately 2 years for the bones in the maxillary sinus floor, augmented through endoscopic surgery for maxillary sinus lift, to attain the thickness and hardness required for implant placement. Therefore, although the implant treatment should be performed later than 2 years after surgery, chewing is possible during this period, with the replanted teeth that were used for regenerative treatment of the alveolar bone. It is believed that this is an extremely effective treatment method to improve the patients' quality of life.

Host tissue reactions of non-demineralized autogenic and xenogenic dentin blocks implanted in a non-osteogenic environment. An experimental study in rabbits

Dentoalveolar ankylosis with osseous replacement is often seen after replantation of avulsed teeth, and this process may be used for preservation of alveolar crests after trauma. Its exact mechanisms with regard to osteoinductive properties are not yet fully understood and need to be systematically investigated. Dentin can possibly act as a slow-releasing carrier of bone morphogenic proteins (BMP), and this property of dentin has been proposed to be used as an alternative or supplement to bone grafting in the maxillofacial region. We aimed to initially asses host tissue reactions to dentin by implanting dentin blocks of autogenic and xenogenic human origin in rabbit connective tissue of the abdominal wall and femoral muscle. Animals were sacrificed after a period of 3 months, and histological processing, sectioning and examinations were carried out. Bone formation, cell counts and thickness of capsule surrounding the grafts were evaluated. Only minor signs of heterotopic bone formation were seen. There were no significant differences between autografts and xenografts or grafts implanted in connective tissue or muscle with regards to tissue reactions except for a significant difference (P = 0.018) in findings of more local inflammatory cells in relation to grafts placed in connective tissue in the autograft group. We conclude that during the time frame of this study, non-demineralized dentin, whether autogenous or xenogenic did not have the potential to induce bone formation when implanted in non-osteogenic areas such as the abdominal wall and abdominal muscle of rabbits.

Bone-like material growth in a replanted immature central incisor following avulsion.

Avulsion is one of the most complicated types of trauma to the teeth. After replantation of an avulsed immature tooth, numerous pulpo-dentinal responses may occur. This study reports a case of a seven-and-a-half-year-old boy in whom an immature maxillary permanent central incisor was replanted following avulsion due to a fall from a tree, and a bone-like growth was observed in the pulp chamber 6months after the trauma, with a thin radiolucent line on the inner surface of the dentinal walls. The bone-like structure eventually filled the pulp chamber of the tooth. The tooth was followed up 4years after the replantation with no evidence of pathology. This case demonstrates an immature avulsed tooth which did not present positive vital signs, but still maintains the potential of survival, and endodontic intervention may not be required. Instead, follow-up visits are recommended as long as there are no pathologic signs, especially in teeth with questionable prognosis.

Use of a triple antibiotic solution affects the healing process of intentionally delayed replanted teeth in mice

ObjectiveA mixture of ciprofloxacin, metronidazole, and minocycline (3Mix) has been reported to be effective against oral bacteria from carious and endodontic lesions in vitro and in vivo. The objective of this study was to establish an animal model using mice for the application of 3Mix following intentionally delayed tooth replantation and to investigate the effects of 3Mix on the healing process of dental pulp and periodontal tissues. MethodsUpper first molars of ICR mice were extracted, immersed in 3Mix solution at different concentrations for 5–60min with or without the use of a transfer solution (phosphate buffer solution (PBS)), in addition to transfer solution alone, and subsequently repositioned in the sockets. Immunohistochemistry for nestin and Ki-67, histochemistry for TRAP, and TUNEL assay were performed to assess pulpal healing during days 7–21. ResultsIncreased apoptosis was observed in the PBS group at week 1, followed by cell proliferation at week 2, and tertiary dentin and/or bone-like tissue formation at week 3. In contrast, nestin-positive, newly differentiated, odontoblast-like cells began to align along the pulp–dentin border following the appearance of Ki-67- and TUNEL-positive cells during weeks 1–2 in the 3Mix groups, suggesting that pulpal healing was accelerated. Severe root ankylosis was observed exclusively in the 3Mix groups. Rinsing with PBS before replantation partially rescued the viability of the periodontal ligament, but pulpal healing was delayed. ConclusionsThe application of 3Mix promotes pulpal regeneration of intentionally delayed replanted teeth; however, its use may induce severe damage to periodontal tissues.

Replantation of avulsed primary incisors: a critical review of a controversial treatment

Compared with the abundant literature on the replantation of avulsed permanent teeth, the literature on replantation of avulsed primary teeth is significantly more limited. A search of PubMed, using the terms: primary teeth, primary incisors, avulsion, exarticulation, replantation and reposition, and search in the reference list of the relevant articles, revealed 16 case reports of replantation of 31 primary incisors in 24 children. This article is a critical review of the arguments against replantation that have been presented in textbooks, review articles, and clinical guidelines.

Delayed tooth replantation after treatment of necrotic periodontal ligament with citric acid

Objective: to evaluated the effect of treating root-adhered necrotic periodontal ligament (PDL) with citric acid on the healing process in delayed rat tooth replantation. Material and Methods: Forty Wistar rats, assigned to 4 groups (n=10), had their upper right incisor extracted and kept dry on a workbench. For Group I (control), the teeth were replanted after a 5-min extra-alveolar time. For the other groups, replantation was done after 60 min. In Group II, the root canals were filled with a calcium hydroxide-based paste and the teeth were replanted with no root surface treatment. In Group III, the teeth were immersed in citric acid (pH 1) for 3 min, the canals were filled with calcium hydroxide and the teeth were replanted. In Group IV, instead of the immersion, the roots were scrubbed with gauze soaked in citric acid and the teeth were replanted. The animals were sacrificed 60 days postoperatively.Results: Regarding replacement resorption, there was statistically significant difference (p&lt;0.05) between the control group and the other three groups. No statistically significant difference (p&gt;0.05) was found among the groups regarding the areas of inflammatory resorption. There was also a statistically significant difference (p&lt;0.05) between the control group and Group IV regarding ankylosis. The control group showed the least replacement resorption percent means compared to the other groups (p&lt;0.05). The root structure was more affected by replacement resorption and ankylosis in Group IV compared to the Groups II and III, but this difference was not significant statistically (p&gt;0.05). Conclusion: the treatment of root surface-adhered necrotic periodontal ligament with citric acid was not able to prevent the occurrence of ankylosis, root resorption and inflammatory resorption in delayed rat tooth replantation.

Histometric Study of Resorption on Replanted Teeth with Enamel Matrix-derived Protein

Enamel matrix-derived proteins (Emdogain) stimulate the proliferation of periodontal ligament cells, contributing to their regeneration. This study was to perform histometric assessment of root surface resorption in replanted teeth with the use of Emdogain®. Male Wistar rats (Rattus norvegicus), weighing 180 to 200 gm, were anesthetized, subjected to extraction of the upper right incisor tooth, which was then replanted into the alveoli with the following treatment: (a) control group--tooth with root canal filled with calcium hydroxide paste and (b) treated group--tooth with root canal filled with enamel matrix-derived protein. The animals were sacrificed 25 days after tooth replantation. The maxilla was processed to obtain thin sections (6 µ) and stained with hematoxylin and eosin. The resorption volume percentage of each dental element was calculated from the cementoenamel junction to the apex. Quantification of resorption revealed that Emdogaintreated teeth showed a lower percentage of resorption (31.58%) compared to controls (80.48%) (statistically significant values--t-test p-value=0.0431). It was concluded that Emdogain used as root canal filling has properties capable of showing a lower percentage of resorption in replanted teeth.

Expression of OPG, RANK, and RANKL Proteins in Tooth Repair Processes After Immediate and Delayed Tooth

This study evaluated the immunohistochemical expression of OPG, RANK, and RANKL proteins in the repair after immediate and delayed replantation of rat teeth. Fifty-six Wistar rats (Rattus norvegicus albinus) had their maxillary right lateral incisor extracted and then replanted, according to the following conditions: group I (control; n = 8), teeth were not extracted; group II (n = 16), immediate replantation; group III (n = 16), delayed replantation without treatment; and group IV (n = 16), delayed replantation after root surface treatment (periodontal ligament removal and immersion in 2% acidulated-phosphate sodium fluoride) and calcium hydroxide intracanal dressing. Rats in group I were euthanized on the first day of the experiment, while the animals in the other groups were euthanized 10 and 60 days after replantation (n = 8/period). Hematoxylin and eosin-stained sections were obtained for histological analysis. The immunohistochemical analysis revealed expression of OPG and RANKL proteins in all groups and both postreplantation times, except for group II at 60 days. In the experimental groups, RANK expression was observed only at 10 days. In conclusion, there was strong immunostaining for the OPG-RANK-RANKL system at the earlier postreplantation time, suggesting a more effective participation of these proteins at the start of the healing process, as their expression decreased at 60 days.

Intentional tooth replantation for the treatment of endodontic disease

Intentional tooth replantation for the treatment of endodontic disease

The usefulness of an autologous blood clot combined with gelatin for regeneration of periodontal tissue

Several growth factors have been used in tissue regeneration therapy. Here we describe the use of an autologous blood clot combined with gelatin for teeth affected by severe periodontitis and vertical root fracture treated using three oral surgical procedures: periodontal flap surgery, intentional tooth replantation (IR), and tooth autotransplantation. Treatment with a blood clot improved the condition of the periodontal tissue, including reduction of pocket depth. Radiographical images demonstrated no evidence of ankylosis, and revealed the presence of alveolar bone regeneration. Our successful clinical outcome suggests that use of an autologous blood clot combined with gelatin is clinically effective for regeneration of lost periodontal tissue.

Evaluation of the biocompatibility of resin-based root canal sealers in rat periapical tissue

We evaluated the biocompatibility of resin-based root canal sealers (RCSs) in the periapical tissues of rats. Wistar rats underwent tooth replantation for reproducing the response of periapical tissue with RCSs. The resin-based Epipany SE, AH Plus Jet, the eugenol-based sealer (Canals) and a control group were employed. The upper right first molar was extracted and applied with RCSs on apices, and then the tooth was repositioned. Histological evaluation demonstrated that mild inflammation occurred in the periapical tissue with Epiphany and AH Plus Jet sealers on day 7, whereas Canals induced severe-to-moderate inflammation. The statistical analyses demonstrated that the significant differences were observed between Canals and the other groups on day 7 regarding inflammatory response. On day 14, the lesions induced by all sealers were healed and replaced predominantly by fibrous connective tissue. Our results suggest that Epiphany SE and AH Plus Jet are good biocompatible materials.

Regional odontodysplasia: Orthodontic treatment and transplantation of premolars

Regional odontodysplasia is a rare and unique dental anomaly involving both dentitions, but mostly the teeth of 1 quadrant. This report describes the combined surgical and orthodontic treatment of a boy with regional odontodysplasia. The mandibular right central and lateral incisors and the canine (as well as the deciduous predecessors) were affected. In a 2-step procedure, the maxillary right and left second premolars were autotransplanted to the affected area. The extraction sites in the maxilla were closed, and a good functional occlusion was established.

Intentional Replantation of Molar Tooth A Case Report of 14 Years old Girl

A case of extensively decayed of right lower 1st molar tooth with a filling was extracted first and then it was treated by root canal filling outside of the mouth and reinserted into the socket and immobilized by inter-dental wiring in October, 1992. It had been reported in 2006 that the treated tooth was healthy without any complaint of patient. The success of intentional replantation procedure appears to be better in younger age.DOI: http://dx.doi.org/10.3329/cdcj.v9i1.11836 City Dental College Journal Vol.9(1) 2012 32-34

Clinical evaluation of tooth replantation and transplantation of old patients

The purpose of this article is to discuss the effect of aging on the treatment of replantation and transplantation of teeth in old patients. I case of replantation and 2 cases of transplantations in old patients are reported in this article. Patients aged 65 and over are included. They had several problems such as periapical lesion, crack or foot fractures. In those cases, the replantation and transplantation were treatment of choice. White ProRoot MTA was used in apical retrograde filling and perforation repair. After replantation and transplantation of teeth, follow-up visits showed signs of healing in 3 cases. Considerations and indications for replantation and transplantation are not much affected by age. Old patients are aware that replantation and transplantation can be performed comfortably and that age is not a factor in prediction success.

Avulsion and replantation of a primary incisor tooth

Avulsion of a primary tooth is a serious dental trauma, and the guidelines of the International Association of Dental Traumatology and textbooks in paediatric dentistry do not recommend replantation. Such management can result in severe damage to the supporting structures, and together with avulsion itself is commonly associated with developmental disturbances of the permanent tooth. We report the case of replantation in a 9-month-old child with a successful outcome, in a unique situation where conditions were optimal and careful long-term follow up was possible.

Treatment of a crown‐root fracture with intentional replantation – case report with 16‐year follow‐up

To report the intentional replantation of a maxillary central incisor with a crown-root fracture. 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. Intentional replantation may be considered as a treatment option for teeth with crown-root fractures.

A method for the geometric standardization of intraoral radiographs for long‐term follow up of replanted teeth: a case report

The interpretation of the set of radiographs taken during the follow-up period after tooth replantation might pose several difficulties, especially the inability to adequately reproduce the projection geometry of the exposures. This article describes a method for the geometric standardization of intraoral radiographs using a custom-made apparatus comprising a film-holder attached to an occlusal splint for the long-term follow up of dentoalveolar trauma. The method was applied in a patient who suffered an avulsion of the maxillary central incisors and had the teeth replanted after 4 h in saline storage. Endodontic treatment started 7 days after the trauma with changes of a calcium hydroxide intracanal medication every 15 days in the first 2 months and thereafter at 30-day intervals for 8 months. Root canal filling was carried out after this period. The radiographic exposures taken at the follow-up visits were standardized to identify the possible alterations during the repair process, such as root resorptions. A maxillary arch impression was made with alginate, and the model was cast in stone for fabrication of an acetate occlusal splint. The custom-made apparatus used for standardization of the radiographic exposures was fabricated by fixing a Rinn X-C-P film-holder and a 5-mm-long piece of 0.7-mm orthodontic wire to the occlusal splint with autopolymerized acrylic resin. Radiographs were taken at 4-month intervals, starting 10 months after replantation up to 76 months. The images were digitized and analysed using the Digora system. The length of the central incisors was determined to verify the reproduction of the projection geometry of the exposures and the orthodontic wire served to assess accuracy during length estimations in the radiographs. The method described in this article for geometric standardization of intraoral radiographs provided a consistent reproduction of the geometric exposure parameters, being indicated for use in the radiographic follow up of cases of dentoalveolar trauma.