Tooth replantation

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Tooth replantation is a form of restorative dentistry in which an avulsed or luxated tooth is reinserted [1] and secured into its socket through a combination of dental procedures. The purposes of tooth replantation is to resolve tooth loss and preserve the natural landscape of the teeth. [1] [2] Whilst variations of the procedure exist including, Allotransplantation , where a tooth is transferred from one individual to another individual of the same species. [3] It is a largely defunct practice due to the improvements made within the field of dentistry and due to the risks and complications involved including the transmission of diseases such as syphilis, [4] histocompatibility, [5] as well as the low success rate of the procedure, has resulted in its practice being largely abandoned. Autotransplantation , otherwise known as intentional replantation in dentistry, is defined as the surgical movement of a tooth from one site on an individual to another location in the same individual. [6] [7] [8] While rare, modern dentistry uses replantation as a form of proactive care to prevent future complications and protect the natural dentition [9] in cases where root canal and surgical endodontic treatments are problematic. In the modern context, tooth replantation most often refers to reattachment of an avulsed or luxated permanent tooth into its original socket.

Contents

History

One of the first recorded surgeries with details on tooth replantation was made by Ambroise Paré in 1962. [10] However, earlier dental interventions of this nature documented in the 11th century ad were made by Abulcasis, [11] who described replantation and use of ligatures to splint the replanted tooth. The earliest instances of tooth replantation, however, can be  traced back to ancient Egypt, where slaves were forced to give their teeth to the pharaoh. Tooth replantation saw further usage within the 17th and 18th century Europe, becoming popular nearing the end of the 18th century most often in the form of allotransplantation. In many cases, older wealthy patients whose teeth had decayed often paid poor people to have their teeth removed to be replanted in their own mouths. [12] Another instance of a similar situation occurred during the Napoleonic wars, where soldiers were forced to donate their teeth to the officers who had lost theirs in battle. In 1685, Charles Allen wrote of tooth transplantation in the first English dental textbook, The Operator for the Teeth, and encouraged the replantation of teeth from animals as he considered it to be “inhumane” to source them from people. In 1890, Scheff J. Die highlighted the role of the periodontal ligament in long term prognosis of replanted teeth. In 1955, Hammer H. highlighted the importance of leaving an intact PDL on intentionally replanted teeth. In 1974, Cvek M, Hollender L and Nord CE showed that the removal of the dental pulp following replantation was required to prevent root resorption and also demonstrated that storage of knocked out teeth in saline could improve the success of replanted teeth. [13]

Procedure

Dental avulsions are a dental emergency and replantations are generally performed by either dentists, endodontists, or oral surgeons.

Diagnosis

A graphical representation of the periodontal fibres found in the tooth Periodontium.svg
A graphical representation of the periodontal fibres found in the tooth

Prior to implantation the suitability of the avulsed tooth and the gum must be assessed to determine the correct procedure for tooth implantation.

Process

Prior to the beginning of the procedure, a local anaesthetic should be administered to both the palatal & lingual tissues to numb the surrounding area and minimise discomfort. Gentle irrigation with a saline solution should be performed on the tooth to remove blood clots and possible contaminants from the tooth. Following preparation, any injury to the gum is treated before the tooth is reinserted into the socket and kept stable through the use of splints to adjacent teeth. [14]

Aftercare

The patient may be given mild pain killers such as paracetamol for the pain. Antibiotics may also be prescribed to prevent infection. The patient should avoid rinsing the mouth, spitting, contact sports, or smoking for the first 24 hours after surgery and should limit food to a soft diet for the next few days. Following surgery, subsequent check ups may be required to evaluate the success of the procedure.

Complications and risk

Pulp necrosis

Root resorption

A leakage of toxins from the infected pulp through dentinal tubules will start a chain reaction that stimulates osteoclasts to resorb, not only from the cementum and dentin, but also alveolar bone. This starts an aggressive resorption process that can lead to loss of most of the root structure in a few months.

Tooth discolouration

Following any type of trauma to a tooth, there is a possibility for the tooth to discolour. When teeth are damaged or injured in any way, as internal bleeding occurs in the pulp chamber, blood gets into the dentinal nerves and gets trapped into the pulp, staining the dentin. Post trauma, a tooth can discolour and turn black or grey within a few days and if the injury is mild the tooth may return to its original status. However, a severely traumatised tooth may darken gradually with each passing day indicating poor functioning of the dentinal nerves. The tooth ultimately loses its vitality within a few months or a year and will require nerve treatment. [15]

Replacement osseous resorption "Ankylosis"

Replacement osseous resorption otherwise known as "Ankylosis" of replanted teeth occurs when the root has been stripped of its periodontal membrane, when osteoclasts originating from the surrounding alveolar bone and subsequently osteoblasts, reach the root surface after crossing the damaged periodontal ligament (PDL) and precementum [16] allowing for the joining of the cementum and the bone. [17] Over a number of years, the adjacent bony socket will remodel the tooth, replacing the root with bone, leaving the tooth with no root. Once the root is replaced the visible part of the tooth, the crown, will eventually give way and be lost. [18]

Contraindications

Primary teeth

The replantation of primary teeth is uniformly cautioned against as primary teeth are in young patients whose facial development is usually incomplete and do not usually have long enough roots for successful replantation. [19] Due to the risks and poor prognosis replanting a primary tooth is cautioned also due to the possible harms it may pose on future permanent teeth. [14] [16]

Storage medium

To delay and minimise the death of tooth root cells the avulsed tooth must be stored in a suitable medium. [20] [21] Storage in improper mediums can cause further damage to the cells in the tooth, thereby decreasing the chance of successful replantations and increasing potential risks. When considering potential suitable mediums, factors such as fluid pressure and osmolarity need to be taken into account to maintain normal cell metabolism for extended periods of time. Some suitable storage mediums that suit these criteria include Hank's Balanced Salt Solution and whole milk. [22]

Time frame

Delayed replantation has a poor long term prognosis due to the death of the periodontal ligament, [14] increasing the likelihood of complications such as ankylosis, infection and pulp necrosis. Avulsed teeth should be replanted within the hour to increase the likelihood of a successful tooth replantation. [23]

Cell damage

Damage to the cells must be minimised during the handling and transportation of the avulsed tooth. Contact should be avoided with the root of the teeth and attempts to cleaning through the use of either soaps, chemicals or toothpaste must not occur. [20] Too much damage occur to the periodontal membrane or fibrolasts, tooth reimplantation may become unviable due to the complications that it presents due to ankylosis and root resorption.

Related Research Articles

<span class="mw-page-title-main">Human tooth</span> Calcified whitish structure in humans mouths used to break down food

Human teeth function to mechanically break down items of food by cutting and crushing them in preparation for swallowing and digesting. As such, they are considered part of the human digestive system. Humans have four types of teeth: incisors, canines, premolars, and molars, which each have a specific function. The incisors cut the food, the canines tear the food and the molars and premolars crush the food. The roots of teeth are embedded in the maxilla or the mandible and are covered by gums. Teeth are made of multiple tissues of varying density and hardness.

<span class="mw-page-title-main">Endodontics</span> Field of dentistry which studies the interior tissue (pulp) of teeth

Endodontics is the dental specialty concerned with the study and treatment of the dental pulp.

<span class="mw-page-title-main">Cementoenamel junction</span> Region on a tooths surface where cementum and enamel join

In dental anatomy, the cementoenamel junction (CEJ) is the location where the enamel, which covers the anatomical crown of a tooth, and the cementum, which covers the anatomical root of a tooth, meet. Informally it is known as the neck of the tooth. The border created by these two dental tissues has much significance as it is usually the location where the gingiva (gums) attaches to a healthy tooth by fibers called the gingival fibers.

<span class="mw-page-title-main">Periodontal fiber</span> Group of specialized connective tissue fibers

The periodontal ligament, commonly abbreviated as the PDL, are a group of specialized connective tissue fibers that essentially attach a tooth to the alveolar bone within which they sit. It inserts into root cementum on one side and onto alveolar bone on the other.

<span class="mw-page-title-main">Dental follicle</span> Anatomical entity

The dental follicle, also known as dental sac, is made up of mesenchymal cells and fibres surrounding the enamel organ and dental papilla of a developing tooth. It is a vascular fibrous sac containing the developing tooth and its odontogenic organ. The dental follicle (DF) differentiates into the periodontal ligament. In addition, it may be the precursor of other cells of the periodontium, including osteoblasts, cementoblasts and fibroblasts. They develop into the alveolar bone, the cementum with Sharpey's fibers and the periodontal ligament fibers respectively. Similar to dental papilla, the dental follicle provides nutrition to the enamel organ and dental papilla and also have an extremely rich blood supply.

Dens invaginatus (DI), also known as tooth within a tooth, is a rare dental malformation and a developmental anomaly where there is an infolding of enamel into dentin. The prevalence of this condition is 0.3 - 10%, affecting males more frequently than females. The condition presents in two forms, coronal involving tooth crown and radicular involving tooth root, with the former being more common.

Dental pertains to the teeth, including dentistry. Topics related to the dentistry, the human mouth and teeth include:

<span class="mw-page-title-main">Pulpotomy</span> Dental procedure to clean out diseased inner tissue from a primary tooth

Pulpotomy is a minimally invasive procedure performed in children on a primary tooth with extensive caries but without evidence of root pathology. The minimally invasive, endodontic techniques of vital pulp therapy (VPT) are based on improved understanding of the capacity of pulp tissues to heal and regenerate plus the availability of advanced endodontic materials. During caries removal, this results in a carious or mechanical pulp exposure from the cavity. During pulpotomy, the inflamed/diseased pulp tissue is removed from the coronal pulp chamber of the tooth, leaving healthy pulp tissue which is dressed with a long-term clinically successful medicament that maintains the survival of the pulp and promotes repair. There are various types of medicament placed above the vital pulp such as Buckley's Solution of formocresol, ferric sulfate, calcium hydroxide or mineral trioxide aggregate (MTA). MTA is a more recent material used for pulpotomies with a high rate of success, better than formocresol or ferric sulfate. It is also recommended to be the preferred pulpotomy agent in the future. After the coronal pulp chamber is filled, the tooth is restored with a filling material that seals the tooth from microleakage, such as a stainless steel crown which is the most effective long-term restoration. However, if there is sufficient remaining supporting tooth structure, other filling materials such as amalgam or composite resin can provide a functional alternative when the primary tooth has a life span of two years or less. The medium- to long-term treatment outcomes of pulpotomy in symptomatic permanent teeth with caries, especially in young people, indicate that pulpotomy can be a potential alternative to root canal therapy (RCT).

<span class="mw-page-title-main">Tooth resorption</span> Breakdown of the tooth root to be absorbed by the blood

Resorption of the root of the tooth, or root resorption, is the progressive loss of dentin and cementum by the action of odontoclasts. Root resorption is a normal physiological process that occurs in the exfoliation of the primary dentition. However, pathological root resorption occurs in the permanent or secondary dentition and sometimes in the primary dentition.

Pulp necrosis is a clinical diagnostic category indicating the death of cells and tissues in the pulp chamber of a tooth with or without bacterial invasion. It is often the result of many cases of dental trauma, caries and irreversible pulpitis.

<span class="mw-page-title-main">Dental trauma</span> Medical condition

Dental trauma refers to trauma (injury) to the teeth and/or periodontium, and nearby soft tissues such as the lips, tongue, etc. The study of dental trauma is called dental traumatology.

<span class="mw-page-title-main">Dental avulsion</span> Medical condition

Dental avulsion is the complete displacement of a tooth from its socket in alveolar bone owing to trauma, such as can be caused by a fall, road traffic accident, assault, sports, or occupational injury. Typically, a tooth is held in place by the periodontal ligament, which becomes torn when the tooth is knocked out.

<span class="mw-page-title-main">Regenerative endodontics</span> Dental specialty

Regenerative endodontic procedures is defined as biologically based procedures designed to replace damaged structures such as dentin, root structures, and cells of the pulp-dentin complex. This new treatment modality aims to promote normal function of the pulp. It has become an alternative to heal apical periodontitis. Regenerative endodontics is the extension of root canal therapy. Conventional root canal therapy cleans and fills the pulp chamber with biologically inert material after destruction of the pulp due to dental caries, congenital deformity or trauma. Regenerative endodontics instead seeks to replace live tissue in the pulp chamber. The ultimate goal of regenerative endodontic procedures is to regenerate the tissues and the normal function of the dentin-pulp complex.

<span class="mw-page-title-main">Tooth mobility</span> Medical condition

Tooth mobility is the horizontal or vertical displacement of a tooth beyond its normal physiological boundaries around the gingival (gum) area, i.e. the medical term for a loose tooth.

Tooth ankylosis refers to a fusion between a tooth and underlying bony support tissues. In some species, this is a normal process that occurs during the formation or maintenance of the dentition. By contrast, in humans tooth ankylosis is pathological, whereby a fusion between alveolar bone and the cementum of a tooth occurs.

Pulp canal obliteration is a condition which can occur in teeth where hard tissue is deposited along the internal walls of the root canal and fills most of the pulp system leaving it narrowed and restricted.

Root fracture of the tooth is a dentine cementum fracture involving the pulp.

Tooth transplantation is mainly divided into two types:

Dental intrusion is an apical displacement of the tooth into the alveolar bone. This injury is accompanied by extensive damage to periodontal ligament, cementum, disruption of the neurovascular supply to the pulp, and communication or fracture of the alveolar socket.

Apexification is a method of dental treatment to induce a calcific barrier in a root with incomplete formation or open apex of a tooth with necrotic pulp. Pulpal involvement usually occurs as a consequence of trauma or caries involvement of young or immature permanent teeth. As a sequelae of untreated pulp involvement, loss of pulp vitality or necrotic pulp took place for the involved teeth.

References

  1. 1 2 "Clinical Practice Procedures: Trauma/Tooth Replantation" (PDF). Queensland Government. 16 September 2024.
  2. ↑ Yu, Sang-Joun; Lee, Jung-Seok; Jung, Ui-Won; Park, Joo-Cheol; Kim, Byung-Ock; Choi, Seong-Ho (2015). "Effect of fibroblast growth factor on injured periodontal ligament and cementum after tooth replantation in dogs". Journal of Periodontal & Implant Science. 45 (3): 111–9. doi:10.5051/jpis.2015.45.3.111. ISSN   2093-2278. PMC   4485061 . PMID   26131371.
  3. ↑ Natiella, Joseph R.; Armitage, Jack E.; Greene, George W. (March 1970). "The replantation and transplantation of teeth". Oral Surgery, Oral Medicine, Oral Pathology. 29 (3): 397–419. doi:10.1016/0030-4220(70)90143-X. PMID   4983973.
  4. ↑ "Transplanting of teeth". bda.org. Retrieved 2019-05-21.
  5. ↑ Nimčenko, Tatjana; Omerca, Gražvydas; Varinauskas, Vaidas; Bramanti, Ennio; Signorino, Fabrizio; Cicciù, Marco (2013). "Tooth auto-transplantation as an alternative treatment option: A literature review". Dental Research Journal. 10 (1): 1–6. doi: 10.4103/1735-3327.111756 (inactive 1 November 2024). ISSN   1735-3327. PMC   3714809 . PMID   23878556.{{cite journal}}: CS1 maint: DOI inactive as of November 2024 (link)
  6. ↑ Northway, W. M.; Konigsberg, S. (February 1980). "Autogenic tooth transplantation. The "state of the art"". American Journal of Orthodontics. 77 (2): 146–162. doi:10.1016/0002-9416(80)90003-2. ISSN   0002-9416. PMID   6986782.
  7. ↑ Hale, M. L. (November 1965). "Autogenous transplants". The British Journal of Oral Surgery. 3 (2): 109–113. doi:10.1016/s0007-117x(65)80016-6. ISSN   0007-117X. PMID   5222733.
  8. ↑ Clokie; Yau; Chano (2001). "Autogenous Tooth Transplantation: An Alternative to Dental Implant Placement". Journal of the Canadian Dental Association. 67 (2): 92–6. PMID   11253297.
  9. ↑ Nagappa, G.; Aspalli, Shivanand; Devanoorkar, Archana; Shetty, Sudhir; Parab, Prachi (September 2013). "Intentional replantation of periodontally compromised hopeless tooth". Journal of Indian Society of Periodontology. 17 (5): 665–669. doi: 10.4103/0972-124X.119291 . ISSN   0972-124X. PMC   3808026 . PMID   24174765.
  10. ↑ Weinberger, Bernhard Wolf (1948). An introduction to the history of dentistry. St. Louis: C.V. Mosby Co.
  11. ↑ Kingsbury, Bernard C.; Wiesenbaugh, Joseph M. (November 1971). "Intentional Replantation of Mandibular Premolars and Molars". The Journal of the American Dental Association. 83 (5): 1053–1057. doi:10.14219/jada.archive.1971.0425. ISSN   0002-8177. PMID   5286134.
  12. ↑ "Transplanting of Teeth". British Dental Association.
  13. ↑ Cvek, M.; Hollender, L.; Nord, C. E. (1976). "Treatment of non-vital permanent incisors with calcium hydroxide. VI. A clinical, microbiological and radiological evaluation of treatment in one sitting of teeth with mature or immature root". Odontologisk Revy. 27 (2): 93–108. ISSN   0029-8441. PMID   1064826.
  14. 1 2 3 Trope, Martin (August 2011). "Avulsion of permanent teeth: theory to practice: Avulsion of permanent teeth". Dental Traumatology. 27 (4): 281–294. doi: 10.1111/j.1600-9657.2011.01003.x . PMID   21635689.
  15. ↑ Heithersay, G. S.; Hirsch, R. S. (September 1993). "Tooth discoloration and resolution following a luxation injury: significance of blood pigment in dentin to laser Doppler flowmetry readings". Quintessence International. 24 (9): 669–676. ISSN   0033-6572. PMID   8272505.
  16. 1 2 Holan, Gideon (June 2013). "Replantation of avulsed primary incisors: a critical review of a controversial treatment". Dental Traumatology. 29 (3): 178–184. doi: 10.1111/edt.12038 . PMID   23480044.
  17. ↑ Campbell, Karen M.; Casas, Michael J.; Kenny, David J. (2005). "Ankylosis of Traumatized Permanent Incisors: Pathogenesis and Current Approaches to Diagnosis and Management" (PDF). Journal of the Canadian Dental Association. 71 (10): 763–8. PMID   16324230.
  18. ↑ Day, Peter F; Duggal, Monty; Nazzal, Hani (2019-02-05). Cochrane Oral Health Group (ed.). "Interventions for treating traumatised permanent front teeth: avulsed (knocked out) and replanted". Cochrane Database of Systematic Reviews. 2019 (2): CD006542. doi:10.1002/14651858.CD006542.pub3. PMC   6363052 . PMID   30720860.
  19. ↑ Zamon, Erica L.; Kenny, David J. (2001). "Replantation of Avulsed Primary Incisors: A Risk–Benefit Assessment". Journal (Canadian Dental Association). 67 (7): 386. PMID   11468096.
  20. 1 2 Khinda, Vineet IS; Kaur, Gurpreet; Brar, Gurlal S; Kallar, Shiminder; Khurana, Heena (2017). Marwah, Nikhil (ed.). "Clinical and Practical Implications of Storage Media used for Tooth Avulsion". International Journal of Clinical Pediatric Dentistry. 10 (2): 158–165. doi:10.5005/jp-journals-10005-1427. PMC   5571385 . PMID   28890616.
  21. ↑ Hassel, Henry J. Van; Harrington, Gerald W.; Oswald, Robert J. (1980-05-01). "A postreplantation evaluation of air-dried and saliva-stored avulsed teeth". Journal of Endodontics. 6 (5): 546–551. doi:10.1016/S0099-2399(80)80148-8. ISSN   0099-2399. PMID   6935358.
  22. ↑ Pohl, Yango; Filippi, Andreas; Kirschner, Horst (2005). "Results after replantation of avulsed permanent teeth. II. Periodontal healing and the role of physiologic storage and antiresorptive-regenerative therapy". Dental Traumatology. 21 (2): 93–101. doi:10.1111/j.1600-9657.2004.00298.x. ISSN   1600-9657. PMID   15773888.
  23. ↑ Flores, Marie Therese; Andersson, Lars; Andreasen, Jens Ove; Bakland, Leif K.; Malmgren, Barbro; Barnett, Frederick; Bourguignon, Cecilia; DiAngelis, Anthony; Hicks, Lamar (2007). "Guidelines for the management of traumatic dental injuries. II. Avulsion of permanent teeth". Dental Traumatology. 23 (3): 130–136. doi: 10.1111/j.1600-9657.2007.00605.x . ISSN   1600-9657. PMID   17511833.
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