Survival Rate of Teeth after Replantation of permanent incisors in Relation to defined Parameters: An Interventional Study
Abstract
Treatment of severely traumatized teeth is known to be a challenge in oral surgery. In particular, severe tooth trauma in children is difficult to treat, mainly because of damage to the periodontal ligament, unphysiologic storage of the tooth and the growing jaw of these patients.
In this present clinical study, teeth with severe trauma were treated using an extra-oral endodontic method. Auto-alloplastic replantation involves using a titanium post as endodontic filling prior to replantation. Aim of this study was to determine survival rate of such replanted permanent teeth in relation to defined parameters that may influence survival. In this study, 44 patients with 58 replanted teeth were evaluated.
Out of 58 teeth, 28 were avulsed and 30 teeth were dislocated; 24 teeth healed with a functional periodontal ligament (functional healing), 8 teeth healed with ankylosis and a further 8 showed replacement resorption. Infection-related resorptions were present in 2 teeth, which were removed after two months. Other 16 cases could not be assessed. 5-year survival rate according to Kaplan-Meier analysis was 83.9% and estimated time of survival was 88.5 months. Avulsion and storage had no significant effect on tooth loss (p=0.178). Mature teeth had a significantly higher 5-year survival rate (92.2%) than immature teeth (72.4%, p = 0.041, log rank test).
It can be concluded that auto-alloplastic replantation is a reliable method in dental trauma treatment. This method is suitable with a high rate of success for avulsed or severely traumatized teeth.
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Introduction
Currently, avulsed permanent teeth can be replanted with an acceptable outcome. Survival of periodontal ligament is important for a successful replantation: formation of a physiological periodontal ligament after replantation and the preservation of cells of root surface is vital. 1 Andreasen and Hjorting-Hansen described resorption of roots after replantation as a possible reaction of periodontal ligament. 2,3 On the basis of radiological and histological studies in humans, healing process is classified into three categories: surface resorption, replacement resorption and infection-related resorption and surface resorption with functional recovery.
Periodontal healing depends on storage of injured tooth, endodontic treatment, management of replantation, splinting and immune response of body. Avulsed and replanted teeth can be lost within first two months or survive for many years. 3,4 In children, loss of permanent teeth has serious long-term consequences. A prosthetic conventional bridge or a dental implant is not indicated because of continuing growth of jaw.
Conclusion
Present study suggest that treatment using auto-alloplastic replantation is a reliable method with a good long-term outcome. It yielded higher survival rates than conventional treatment. Extraoral endodontic preparation of avulsed teeth did not result in further damage to periodontal ligament due to prolonged extra-oral time. With regard to root status, immature teeth healed better than they did in other studies. Auto-alloplastic replanted teeth can function successfully until adolescence.
Influencing factors, such as storage of avulsed teeth or comparison between conventional and autoalloplastic treatment, need to be studied with a larger number of patients. A multi-center study may be a promising enterprise.