From a clinical perspective, since avulsions occur infrequently, the average practitioner will not instinctively know how best to treat each rare case that heshe encounters. Replantation of a tooth with an out of socket drytime 60 minutes is futile because the periodontal ligament pdl cells are no longer viable. In reality, intentional replantation is highly predictable and should be considered before condemning select teeth as having a hopeless prognosis 1, 2. Although most of the authors revealed periodontal involvement as a contraindication for replantation, there are some studies with successful results with periodontally involved teeth. Intentional replantation ir is a concept that has been known for over a thousand years, it is defined by grossman 1966 as an atraumatic extraction of a tooth and its reinsertion into its. This article describes the management of a 12year old male with four avulsed anterior maxillary permanent teeth. The success of replantation of an avulsed tooth is dependent upon using calcium hydroxide as a treatment root canal filling completion of endodontic therapy before replantation length of time between avulsion and replantation immersing the tooth in fluoride solution before replantation. Intentional replantation is defined by grossman as the removal of a tooth and its almost immediate replacement, with the object of obturating the canals apically while the tooth is out of the socket. Thornton, dmd, ma t he literature has few articles on primary anterior teeth replantation and splinting. Intentional replantation ir is a surgical procedure that has often been regarded as the last treatment option 1. Tooth avulsion, which is characterized by complete dislodgement of the tooth from its alveolus, accounts for 0. Management of avulsed permanent teeth with closed apex tooth immediately replanted at accident site verify normal position of the replanted tooth both clinically and radiographically follow the same treatment guideline for extra oral dry time teeth. Extraalveolar dry time and the storage media used to transport the tooth are critical factors for successful and longterm outcomes. This strategy can be particularly helpful in lower second molars where proximity to the mandibular nerve and thickness of the buccal bone make endodontic surgery difficult.
Intentional replantation is defined as the extraction of the tooth and its reinsertion int o the socket after sealing the resected root end with a rootend filling material 6. Intentional replantation of endodontically treated tooth. From this point of view, intentional replantation may be an alternative choice for some of these cases 4,5. Intentional replantation is a recognized endodontic procedure in cases in which root canal and surgical endodontic treatments are not recommended. A total of 18 cases 90% were successful over a mean followup period of 15. Intentional replantation involves the purposeful removal of a tooth and its reinsertation into the socket after proper endodontic management and repair. The use of mta or other slower setting materials is not advised as the blood can dissolve before set. Once the tooth and mouth are clean an attempt can be made to replant in its. Laboratory of research in oral healh and maxillo facial rehabilitation lr12es11, faculty of dental medicine, university of monastir, monastir, tunisia. Replantation of an avulsed incisor after prolonged dry. Intentional replantation of endodontically treated tooth a case report saeed kazi m.
Abstract pediatric dentists who treat a significant number of children under 4 years of. Intentional replantation saves a tooth and preserves. The tooth 62 was replanted in place and splinted with soft stainlesssteel wire and light cure resin figure 4. Delayed tooth replantation after traumatic avulsion resulting. Teeth are replanted to prevent permanent loss of the tooth, and to restore the landscape of the mouth so that the patient can eat and speak normally. Infection can cause the tooth root to rapidly dissolve months to a year. Intentional replantation of periodontally involved and. Delayed intentional replantation has many advantages compared to immediate intentional replantation and could serve as an alternative treatment for periodontally involved hopeless teeth. Tooth replantation list of high impact articles ppts. A replantation will have a lower success rate if the tooth is already compromised periodontally and missing the interseptal bone. Replantation in dentistry certified fixed orthodontic courses by indian dental academy 1. Intentional replantation is a treatment option when more conventional forms of treatment either fail or are impossible.
The therapy comprised extraoral endodontic treatment and applications of medicaments to enhance periodontal healing. A tooth replantation procedure involves the teeth, gums, and mouth. Treatment guidelines for avulsed matureimmature permanent teeth with prolonged extraoral time were. Indications for intentional replantation intentional replantation is the intentional removal of a tooth and replantion into the socket following endodontic manipulation. At an 18month recall the tooth was clinically sound with no radiographic evidence of inflammatory or replacement root resorption. Dec 05, 2012 a replantation will have a lower success rate if the tooth is already compromised periodontally and missing the interseptal bone. Abuhussein muhamad1, watted nezar2, and abdulgani azzaldeen3. A radiograph revealed infection surrounding this tooth and a large post in the distal canal. The success of replantation of an avulsed tooth is. Tooth replantation is the reinsertion and splinting of a tooth that has been avulsed of its socket.
Indications for replantation and recommended techniques. Although complications like ankylosis or root resorption may be unavoidable, delayed replantation of avulsed tooth may be a good alternative to prosthesis implant or fixed partial denture till the growth is completed due to preservation of the alveolar bone and psychological benefit to the patient. The indications for intentional replantation include failed previous nonsurgical endodontics, an apicoectomy procedure is unfavorable because of anatomical factors e. Orthodontics will use occasionally to replace missing anterior central tooth. Management of avulsed permanent teeth with closed apex tooth immediately replanted at accident site verify normal position of the replanted tooth both clinically and radiographically follow the same treatment guideline for extra oral dry time of the replantation step. Intentional replantation ir is a concept that has been known for over a thousand years, it is defined by grossman 1966 as an atraumatic extraction of a tooth and its reinsertion into its socket immediately after endodontic treatment and apical repair is done extraorally. Avulsion and replantation of primary teeth a feasible option. Intentional replantation of an endodontically treated. Tooth avulsion in the young permanent dentition is a frequent finding, and its prognosis depends on the treatment of the avulsed tooth before replantation, the extraalveolar time, the storage medium, and the patients general health.
May 29, 2009 saving the natural tooth with intentional replantation intentional replantation is the intentional removal extraction and replantation of a tooth. Continued development of a tooth root separate from the body of the tooth was not observed. Although not frequently used, intentional replantation is a treatment option that dentists should consider. Results after replantation of avulsed permanent teeth. This article presents an intentional replantation of a periodontally involved hopeless mandibular molar tooth with 3 years of results. Conclusion it appears that the authors of textbooks are correct to discourage replantation of primary incisors based on the low level of evidence to support the procedure and on the riskbenefit assessment of the outcomes. A tooth rescue box was developed and distributed to offer optimal storage conditions for avulsed teeth.
In evaluating 45 cases of intentional replantation, 36 were considered successful, evidencing no root resorption. Glossary of endodontic terms defines intentional replantation as insertion of a tooth into its alveolus after the tooth has been extracted for the purpose of performing treatment, such as root. Few authors suggest the use of scaler, curette, pumice prophylaxis, diamond bur, sand paper disk. While publications, including in vivo and in vitro studies, on the various aspects of replantation of avulsed permanent teeth are abundant, the replantation of primary incisors has received only scant and super. Continued root formation after delayed replantation of an. The avulsed permanent tooth should be gently but well rinsed with saline, with care taken not to damage the surface of the root which may have living periodontal fiber and cells. It is considered by many as a procedure of last resort. Replantation of a tooth with an out of socket drytime 60 minutes is futile because. It is less popular than implant and endodontic retreatment. Intentional replantation of periodontally compromised. Teeth with fused roots are good candidates for extraction. Pdf intentional replantation is a recognized endodontic procedure in cases in which root canal and surgical endodontic treatments are not.
Replantation of an avulsed incisor after prolonged dry storage. Case report successful replantation and splinting of a maxillary segment fracture in the primary dentition j. Delayed replantation of avulsed tooth with 15hours extra. Sep, 2016 intentional replantation tooth when to use it.
Conventional and surgical endodontic therapy is accepted as foreseen clinical procedures that save teeth with pulpal disease which would. Prospects for tooth survival and the incidence of pulpal necrosis, root resorption and ankylosis are unknown. Saving the natural tooth with intentional replantation. However, in cases where a dental implant, nonsurgical retreatment or surgical treatment is not possible, intentional replantation may be a viable treatment option. Replantation as the name implies is the process in which a tooth, normally the front tooth, is reinserted into the bone after its loss or displacement by accidental means.
It can be concluded that intentional replantation with careful case selection can have a high success rate over 2 years. Intentional replantation is an alternative to tooth extraction and prosthetic replacement when conventional endodontic treatment modalities are unfeasible or contraindicated. Intentional replantation ir is a surgical procedure that has often been regarded as the last treatment option. Purpose teeth are replanted to prevent permanent loss of the tooth, and to restore the landscape of the mouth so that the patient can eat and speak normally.
Intentional replantation of a periodontally involved. Options included either accessing or removing the crown and retreating the tooth. Intentional replantation in a maxillary molar with. Tooth replantation is the best treatment option for tooth avulsion in the permanent dentition. Reports in the literature on avulsion and replantation pri. Case report successful replantation and splinting of a. Tooth avulsion in the permanent dentition constitutes a dental emergency. Options included either accessing or removing the crown and retreating the tooth, apical root surgery, extraction or intentional replantation.
Delayed tooth replantation after root surface treatment. Intentional replantation of an endodontically treated tooth. That means that if it is put back in it will have to be extracted sooner or later. Intentional replantation of periodontally compromised hopeless tooth. Delayed tooth replantation after traumatic avulsion. Yaqoob1, summan dost1, sana siddiqui2 1pg trainee mcps periodontology, federal government services hospital, pakistan 2pg trainee mds operative dentistry, pakistan institute of medical sciences. Endodontics may use as an alternative to retreatment or endodontic microsurgery. Journal of dental sciences replantation of avulsed permanent anterior teeth. Intentional replantation is a recognized endodontic procedure in cases in which root canal and surgical endodontic treatments are not. Conventional and surgical endodontic therapy are established as predictable clinical procedures that save teeth with pulpal disease. Tooth replantation is the reinsertion and splinting of a tooth that has been avulsed knocked or torn out of its socket. It is generally well accepted that the best procedure for treating an avulsed tooth is its replantation, which can yield, at least temporarily, the reestablishment of esthetics and function 2. Multidisciplinary approach in the immediate replantation.
Intentional replantation is the intentional removal extraction and replantation of a tooth. A technique to consider in rare cases when conventional surgery is impossible. Intentional replantation is a procedure by which the tooth is gently extracted, the apicoectomy and retrofilling procedure are performed extraorally, and the tooth is replanted in the alveolar socket. The success of replantation of an avulsed tooth is dependent upon using calcium hydroxide as a treatment root canal filling. There are few reports in the literature of this technique proving successful for indefinite periods of time. Replantation in dentistry indian dental academy leader in continuing dental education 2. Intentional replantation of a periodontally involved hopeless. Why is the tooth replantation surgical procedure performed. Delayed tooth replantation after traumatic avulsion resulting in complete root resorption kallel ines, douki nabiha department of dental medicine, sahloul hospital, sousse, faculty of dentistry. Success with this treatment is dependent upon atraumatic extraction, minimal manipulation of the periodontal ligament, rapid replacement into the socket, and minimizing. Selfreplantation of an avulsed tooth in torsoversion. Dental avulsion is a real dental emergency in which prompt management within 2040 minutes of injury affects the prognosis of the tooth. The recommended technique to extract a tooth treatment planned for replantation is to grab the tooth with forceps on enamel or the crown, at or coronal to the cej, and gently luxate buccally and linguallypalatally, as well as slight rotational forces, in order to create an acute inflammatory response in the pdl space, resulting in increased mobility until the tooth can be extracted atraumatically.
Delayed intentional replantation of periodontally hopeless. The tooth must be extractable without fracturing any of the root structure. Intentional replantation saves a tooth and preserves natural. The tooth was finally extracted in the thirtythird month after intentional replantation. Replantation in dentistry certified fixed orthodontic. This technique can be useful for teeth that cannot be treated with traditional endodontic surgery. Three keys point should be keep in mind to ensure the success. Tooth replantation procedure, pain, complications, adults. The replanted tooth, because of its previous bone loss, would not serve as a suitable abutment for the partial denture. Intentional replantation is considered when the conventional forms of treatment options either fail or become impossible. What is replantation, tooth replantation, avulsed tooth.
The end result may be a tooth hopelessly compromised due to a poor crownroot ratio fig 2. Mar 21, 20 replantation in dentistry certified fixed orthodontic courses by indian dental academy 1. Success with this treatment is dependent upon atraumatic extraction, minimal manipulation of the periodontal ligament, rapid replacement into the socket, and minimizing occlusal forces following replantation. Prioritising replantation of avulsed and grossly mobile luxated teeth nearing avulsion is associated with best possible long term prognosis and restoration of the landscape of the mouth.
Kratchman in 1997 11 suggested holding the extracted tooth in dental forceps while performing the rootend procedures. Intentional replantation is a procedure in which an intentional tooth extraction is performed followed by reinsertion of the extracted tooth. A 6yearold girl sustained an avulsion injury to her upper left central permanent incisor. Delayed replantation after prolonged dry storage rao a. In this longterm clinical study the healing results following avulsion and replantation were investigated. Eightyearold boy and 10yearold boy presented with avulsed maxillary central incisors due to trauma occurring 27 and 7 hours earlier, respectively. Although intentional replantation is usually contraindicated in teeth with moderatetosevere periodontal involvement, there are studies presenting successful results with periodontally involved teeth. This decade has shown a rising interest in ir with biomaterials in several dental disciplines, including rootend biomaterials, and periodontal regenerators 2, 3. The percentage of success of tooth replantation has been observed to be low, ranging from 4 to 50%. Replantation of the avulsed tooth restores aesthetics and occlusal function shortly after the injury.
Intentional replantation of endodontically treated tooth medwin. Finally, in each case of failure, the tooth was extracted due to signs of inflammation and increased mobility. This case report presents two cases of delayed replantation of avulsed maxillary central incisors after an extended dry extraalveolar period. Mar 16, 2010 intentional replantation is the intentional removal of a tooth and replantion into the socket following endodontic manipulation. Delayed intentional replantation has many advantages compared to immediate intentional replantation and could serve as an. Periodontal healing and the role of physiologic storage and antiresorptiveregenerative therapy. Indications and case series of intentional replantation of teeth. The present report describes management of an immature avulsed lower central incisor 90 minutes after the accident. Greater than 15 minutes has a negative impact on the success rate of endodontic intentional replantation of a tooth. From a clinical perspective, since avulsions occur infrequently, the average practitioner will not instinctively know how best to. Historically, intentional replantation was deemed a treatment modality with limited success and a plan z treatment consideration. Intentional replantation is a procedure which involves the purposeful removal of a tooth and its reinsertion into the socket almost immediately after sealing the apical foramina.
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