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How useful is three-dimensional imaging in predicting a positive outcome for intentional tooth replantation?

This abstract is presented by the JCDA Oasis Team from the article published in the Journal of Oral Sciences (Open Access): The usefulness of three-dimensional imaging for prognostication in cases of intentional tooth replantation

Authors

  • Hiroaki Kabashima, Section of Periodontology, Division of Oral Rehabilitation, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
  • Kunitaka Mizobe, Section of Periodontology, Division of Oral Rehabilitation, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
  • Takako Sakai, Section of Fixed Prosthodontics, Division of Oral Rehabilitation, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
  • Hiroyoshi Nakamuta, Private Practice, Fukuoka, Japan
  • Kenichi Kurita, Section of Fixed Prosthodontics, Division of Oral Rehabilitation, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
  • Yoshihiro Terada, Section of Fixed Prosthodontics, Division of Oral Rehabilitation, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
 
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Abstract
 
The article describes the utility of three-dimensional (3D) images obtained with cone beam computed tomography (CBCT) for prediction of successful clinical outcome in two cases of intentional tooth replantation (IR). IR was performed for teeth affected by vertical root fracture and root perforation with local application of blood clot and oxy-tetracycline antibiotic. High-resolution 3D images demonstrated no evidence of ankylosis, but did reveal the presence of alveolar bone regeneration, suggesting a good long-term prognosis. Our observations in these cases suggested that local application of the above two materials might help to induce the regeneration of lost periodontal tissues in IR. 

 
Clinical Cases
  • A 45-year-old woman was referred to the periodontic clinic of Kyushu University Hospital for assessment of a fistula on the buccal gingival of the right maxillary second premolar, which was causing slight persistent pain when the tooth was used for biting. 
  • Patient’s medical history was non-contributory and she reported no allergies or medication use. She had undergone endodontic and prosthetic treatment of the right maxillary second premolar seven years earlier. 
  • Periodontal examination revealed a 7-mm probing depth in the distal pocket of the second premolar and an intraoral fistula on the buccal side of the tooth. 
  • There was no tooth mobility. When an accessory guttapercha point was inserted into the sinus tract, intraoral radiography showed that the tip had not reached the apex, but only the middle part, of the second premolar root. 
  • The lesion had expanded along the distal side of the root of the second premolar, revealing a radiolucent area around the middle part of the root. These findings led us to speculate that a vertical root fracture might be present. 
  • The patient’s oral hygiene condition was good. 
  • We explained the benefits and risks of replantation as a treatment procedure, and thereafter the patient made an informed decision to undergo IR.
 
  • A 35-year-old woman was referred to the periodontic clinic of Kyushu University Hospital for assessment of a fistula on the buccal gingiva of the left mandibular second molar. She complained of pain on biting.
  • Her medical history was non-contributory, and she reported no allergies or medication use. She had undergone root canal treatment of the tooth in question 10 years earlier. 
  • Her oral hygiene was good, and periodontal examination revealed slight mobility, with a probing depth within normal limits. The affected tooth was tender to percussion and biting. Conventional intraoral radiography demonstrated previous root canal treatment with a large periapical radiolucency. In addition, sagittal and coronal CT images revealed a large periapical radiolucency associated with the root perforation site in the left mandibular second molar
 
Key Findings
  • The success of IR, in combination with techniques to shorten extraoral working time and minimize the trauma of extraction to preserve the periodontal ligament seems to rely on the maintenance of aseptic conditions and local application of growth factors such asplatelet-rich plasma (PRP), platelet-derived growth factor (PDGF, and enamel matrix derivative (EMD), which have been reported to be critical for reliable tissue regeneration in periodontal surgery.
  • Blood clots also act as a growth factor that can promote tissue healing and regeneration.
  • The good clinical outcomes which were observed were attributable to local application of the two materials, which might have helped to maximize the healing potential of the residual tissues through maintenance of aseptic conditions and regeneration of tissue that had been lost in the circumferential periodontal defects surrounding the affected teeth.
  • High-resolution 3D images obtained with CBCT appear to be very effective for detecting root resorption and ankylosis, and for revealing evidence of bone regeneration on the labial or lingual surface of roots that might otherwise be overlooked when relying on 2D images obtained by conventional intraoral radiography, in which buccal and palatal structures are superimposed.
  • CBCT was shown to be a valuable diagnostic tool at various stages of treatment in the two present cases of IR. Local application of blood clots and oxy-tetracycline might be desirable in order to promote tissue regeneration in the circumferential periodontal defect.
 

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