Search Results (21)

Background/Objectives: Avulsion is a major cause of tooth loss, and its treatment involves replantation. This study analyzed the repair process of incisive teeth subjected to delayed replantation after topical treatment with ampicillin and tetracycline. Methods: Forty male rats were equally divided into four groups: immediate replantation (IM), ampicillin (AM), tetracycline (TR), and dry medium (SE). In the IM group, replantation was performed 5 min after experimental avulsion, whereas in the SE group, the teeth were kept in a dry medium for 60 min. In the AM and TR groups, the teeth were stored in whole bovine milk for 60 min, and then immersed in their respective ampicillin and tetracycline solutions for 5 min. Euthanasia was performed 60 days after the experimental surgery. Histological slides were stained with Hematoxylin and Eosin for quantitative and qualitative analyses. Results: No statistically significant differences were observed among the IM, AM, and TR groups regarding the total resorption area, reattached periodontal ligament fibers, and ankylosis. However, when compared to the SE group, these groups exhibited a smaller total resorption area (IM: p = 0.005; AM: p = 0.0007; TR: p = 0.03), a larger area of periodontal ligament fibers reattachment (IM: p = 0.0002; AM: p = 0.0002; TR: p = 0.02), and a lower presence of ankylosis (IM: p = 0.005; AM: p = 0.0002; TR: p = 0.03). The AM group exhibited the smallest inflammatory resorption. Conclusions: It is concluded that, in an aseptic environment, the use of topical antibiotics such as ampicillin and tetracycline in the treatment of the root surface during replantation of teeth stored in milk is beneficial to the periodontal repair process and root resorption. Notably, ampicillin demonstrated superior efficacy in mitigating inflammatory root resorption and better periodontal ligament reattachment. Full article

Background/Objectives: Dental avulsion involves the complete displacement of the tooth from its socket and falls into the most severe categories of the various types of traumatic dental injuries. Successful replantation of the tooth depends on various factors such as the time between the event and replantation, as well as the extra-alveolar storage medium and duration. The adoption of the correct handling measures and use of an appropriate storage medium are key factors that affect the long-term prognosis of the avulsed tooth following replantation. This systematic review and meta-analysis aim to determine if Hank’s Balanced Salt Solution (HBSS) is the most effective storage medium to preserve periodontal (PDL) cell viability following avulsion. Methods: A comprehensive review of the literature available was conducted on the 18 November 2024 across three databases, namely EBSCO (including PubMed-Medline), Scopus, and Web of Science. The review was written according to and following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement created in 2009 and updated in 2020. The following PICO question was constructed for the systematic review: “In patients with avulsed permanent teeth, is Hank’s balanced salt solution more effective in preserving periodontal cell viability to increase the likelihood of a more successful replantation than any other storage media technique available?” A meta-analysis was also conducted with the selected studies, and the software used for this was R 4.3.1 (R Core Team (2018)). Results: A total number of 443 articles were found in the initial search. Of these 443, 9 articles were included in the final systematic review and meta-analysis. 6 out of the 9 articles conclude HBSS to be the most superior storage medium for the preservation of the PDL cells, whilst the other three concluded PDL cell preservation was higher in Morinda citrifolia juice, propolis, and coconut water, suggesting a suitable alternative to HBSS. Nonetheless, the meta-analysis indicated that PDL cell viability was significantly higher using HBSS compared to all other storage media. Conclusions: The systematic review and meta-analysis have provided adequate data in favor of the alternative hypothesis, indicating that Hank’s balanced salt solution is the most effective storage medium in the preservation of periodontal cell viability following the avulsion of permanent teeth. Full article

Introduction and Clinical Significance: Tooth ankylosis is a serious complication that can occur because of the replantation of an avulsed tooth. However, few reports have investigated the follow-up of replanted or ankylosed primary incisors because the replantation of primary teeth is not recommended in the guidelines of the International Association of Dental Traumatology. Case Presentation: A boy aged 4 years and 8 months was referred to hospital for further evaluation of the maxillary right primary central incisor. It had been avulsed and replanted 2 years earlier. The tooth was positioned higher than the central incisor on the left side, and a metallic percussion sound was noted, leading to a diagnosis of tooth ankylosis. Long-term follow-up revealed the progression of ankylosis, and the tooth was finally extracted. At the age of 7 years and 6 months, permanent tooth eruption was detected, and no pathological finding was observed. Conclusions: In this case, root resorption of the replanted primary incisor was observed with age, but tooth ankylosis progressed, and natural exfoliation was difficult. The authors extracted the primary incisor appropriately, which aided the eruption of a successor permanent tooth. This report suggests the importance of patients visiting the dentist regularly after trauma to primary teeth and appropriate treatment by dentists to erupt the permanent teeth. Full article

Background: In Saudi Arabia, dental trauma is regarded as one of the most important issues affecting schoolchildren. This study evaluated Saudi Arabian schoolteachers’ knowledge, attitude, and practice regarding emergency dental trauma management. Methods: A cross-sectional study was conducted on 263 schoolteachers from 25 schools; 50.9% were females. A questionnaire was used to collect respondents’ personal and professional data and information on managing dental injury scenarios and the respondents’ attitudes toward dental injuries. A multivariate logistic regression analysis was carried out for the independent and outcome variable of inadequate knowledge regarding dental trauma management. Results: Male teachers had better knowledge than female teachers regarding emergency management of avulsed teeth. Compared to female teachers, male teachers would scrub a tooth with a toothbrush to replant it back into its socket if it fell onto the ground and was covered with dirt. Males had a significantly higher percentage of believing it is not teachers’ responsibility to care for tooth injuries in schools. Teachers with teaching experience of 5–10 years had a significantly higher percentage of training in dental emergencies. Teachers with bachelor’s degrees agreed on the need for teacher involvement to save the tooth in a timely manner. Compared to general teachers, physical education teachers would put the tooth back in the mouth and send the child to the dentist immediately if they were hit in the face and the upper front tooth fell out of their mouth. Teachers with a diploma level of education and teachers with a general type of teaching qualification were 2.15 times (CI = 0.98–3.11, p = 0.002) and 3.19 times (CI = 1.71–4.22, p = 0.0001) more likely to have a higher level of inadequate knowledge regarding dental trauma management. Conclusions: There is a need to raise teachers’ awareness and improve their dental trauma emergency management training. Full article

This study aimed to evaluate the effect of leukocyte and platelet-rich plasma (L-PRP) on the pulpal healing process following immediate and intentionally delayed tooth replantation in mice. After the maxillary first molars of 3-week-old mice were extracted, the teeth were immersed for 1 min [immediate reimplantation (IR)] or 30 min [intentionally delayed reimplantation (IDR)] in phosphate-buffered saline (PBS) solution. The alveolar socket was filled with or without 1.5 μL of L-PRP [experimental or control groups (EG or CG)] followed by tooth replantation. Samples were collected from day 1 to week 4 after the operation, processed for histology, and evaluated by immunohistochemistry for Nestin and Ki-67 expression. Quantitative analysis revealed positive Nestin staining during pulpal healing in the EG at week 1 following IR and week 2 following IDR. Hard tissue deposition was significantly increased in the EG after IR at week 2. Cell proliferation was higher in the EG compared with that in the CG at week 1 and significantly decreased in the coronal pulp of the EG after the IDR at week 2. Our data suggest that treatment with L-PRP may have a positive effect on pulpal healing, even in teeth replanted after an extended extra-oral period. Full article

Human periodontal ligament cells (hPDLCs) express matrix metalloproteinases (MMPs), a group of enzymes responsible for the destruction of most extracellular matrix proteins in dental tissues, especially MMP-1, MMP-2, and MMP-13. Exploring the regulatory mechanism of MMPs is crucial for understanding external root resorption (ERR), one of the most severe complications, along with substantial loss of dental tissue, induced by trauma, pulpal infection, tooth bleaching, and orthodontic treatment, etc. Discoidin domain receptor 1 (DDR1), a cell surface receptor binding to collagen, has the potential to regulate the expression of MMP-1, MMP-2, and MMP-13, but the mechanism remains unclear. Thus, the present study aimed to investigate the connection and underlying mechanism between MMP-1, MMP-2, MMP-13, and DDR1 in hPDLCs. Our post-replantation ERR model revealed that Mmp-1, Mmp-2, Mmp-13, and Ddr1 all increased in the sites of ERR. hPDLCs with DDR1 knockdown exhibited a substantial reduction in MMP-1, MMP-2, and MMP-13 expression. To further confirm the underlying mechanism, we conducted further in vitro experiments, including RNA sequencing, RNA interference, RT-qPCR, Western blotting, and ELISA. Based on our results, MMP-1 was positively regulated by the Smad2/3 and MEK-ERK1/2 pathways and negatively regulated by the PI3K-Akt pathway through CCN2. MMP-2 and MMP-13 were positively regulated by the Smad2/3 pathway. MMP-13 was positively regulated by the MEK-ERK1/2 and PI3K/Akt signaling pathways. Collectively, DDR1 is a potent regulator of MMP-1, MMP-2, and MMP-13 expression through the Smad2/3, MEK-ERK1/2, and PI3K/Akt signaling pathways. Clarifying the significance and underlying mechanism by which DDR1 is involved in ERR might bring the chances to hinder the pathogenic process of ERR, hence reducing its incidence rate. Full article

Background: Traumatic dental injuries (TDIs) are a common complication in sports, with an overall prevalence ranging from 0.71% to 60%. Kickboxing is a high-risk combat sport for trauma to the facial region. Methods: A total of 142 5-to-65-year-old amateur athletes participated in the survey with a questionnaire that was released during their regular practice days. The questionnaire was structured into three parts: (1) questions about age, gender, type, and time of sports practice; (2) questions about dental injuries, personal experience, and awareness of emergency management, particularly about tooth avulsion; (3) questions about wearing a mouthguard for TDI prevention. Results: A total of 13 percent of athletes suffered a TDI while training or fighting. Regarding first aid, 61% of the participants in this survey are aware of the possibility of replanting a tooth after its avulsion; 10% believe that the tooth should be replanted within 15 min, and 37% of athletes believe that it should be kept wet. The mouthguard is known to the majority of athletes (94%), and 66% were informed by the coach; 68% of the athletes use it. Seventy-four percent of the mouthguards were purchased in a sports shop. Conclusions: A relatively low prevalence of TDIs was observed in players in the sample. A lack of information about the emergency management of tooth avulsion and about the type of mouthguard to wear emphasizes the importance of educational training by dentists to athletes and coaches. Full article

Synthetic oligodeoxynucleotides (ODNs) containing unmethylated cytosine–phosphate–guanine (CpG) motifs (CpG-ODNs) are ligand molecules for Toll-like receptor 9 (TLR9), which is expressed by odontoblasts in vitro and dental pulp cells. This study determined the effects of CpG-ODNs on pulpal immunomodulatory response and repair following injury. Briefly, the upper right first molars of three-week-old mice were extracted, immersed in Type A (D35) or B (K3) CpG-ODN solutions (0.1 or 0.8 mM) for 30 min, and then replanted. Pulpal healing and immunomodulatory activity were assessed by hematoxylin–eosin and AZAN staining, as well as immunohistochemistry. One week following the operation, inflammatory reactions occurred in all of the experimental groups; however, re-revascularization and newly formed hard tissue deposition were observed in the pulp chamber of all groups at week 2. A positive trend in the expression of immune cell markers was observed toward the CpG-ODN groups at 0.1 mM. Our data suggest that synthetic CpG-ODN solutions at low concentrations may evoke a long-lasting macrophage–TLR9-mediated pro-inflammatory, rather than anti-inflammatory, response in the dental pulp to modulate the repair process and hard tissue formation. Further studies are needed to determine the effects of current immunomodulatory agents in vitro and in vivo and develop treatment strategies for dental tissue regeneration. Full article

Background/Aim: Tooth avulsion and delayed replantation may cause inflammatory responses and root resorption of the tooth. The aim of this study is to investigate the effect of a doxycycline-loaded nitric oxide-releasing nanomatrix (DN) gel on the delayed replantation of avulsed rat teeth, with a focus on assessing the gel’s potential to promote regeneration and inhibit complications associated with the replantation process. Materials and Methods: Twenty-four right maxillary first molars from male Sprague-Dawley rats were atraumatically extracted using sterile extraction forceps. The molars were dried for 1 h at room temperature (approximately 23 °C) and divided into four groups according to the root conditioning methods after extra-alveolar 60-min drying: Group 1, no root conditioning treatment prior to replantation; Group 2, soaking in 2% NaF solution for 5 min before replantation; Group 3, 5-min soaking in NO gel and injection of the gel into the alveolar socket; Group 4, 5-min soaking in DN gel and injection of the gel into the alveolar socket before replantation. The animals were euthanized four weeks after the operation and the specimens were evaluated histologically. Results: The use of NO gel alone showed better anti-inflammatory and periodontal effects than the control group, but it did not show a significant effect compared to the group using NaF. When using NO gel loaded with doxycycline, it showed a significant anti-inflammatory effect compared to the control group and showed a similar inhibitory effect to the group using NaF. Conclusions: Within the limits of this study, in delayed replantation situations, the control of inflammatory resorption and replacement resorption is an important factor for achieving a better prognosis of replanted teeth. Root surface treatment with DN gel decreased root resorption after delayed replantation. Full article

Dental autotransplantation is an effective alternative to conventional dental treatment, and it involves removing a tooth and repositioning it in a new position within the same patient. Although this procedure might pose more intraoperative challenges, it provides a great solution for replacing missing teeth or aiding difficult eruption in young patients. This prospective method is also advocated as a use of treatment for unrestorable teeth. The success rates of autotransplantation cases with and without replicas were compared in a retrospective analysis of the data. By reducing donor tooth manipulation and ensuring a proper fit and positioning in the recipient socket, replicas significantly increased success rates of the procedure. CBCT scans were used to collect data. Data exported to the Mimics system were then processed in order to achieve a model of the donor tooth. Additive manufacturing technology was used to create the replicas. Specialized biocompatible material was used. Details of the replantation site and the donor tooth requirements were described, as well as the step-by-step surgical technique. For the best results, variables, like patient selection, surgical technique, and long-term monitoring, were found to be essential. The study highlights the significance of dental professionals and biomedical engineering staff working together to develop standard operating procedures and achieve predictable outcomes in autotransplantation procedures. The results suggest that 3D printed replicas could be a useful tool for improving the effectiveness and success of dental autotransplantation. Full article

Background and Objectives; This study aimed to evaluate the clinical outcomes and bone changes before and after intentional replantation (IR) for periodontally compromised teeth by using cone–beam computed tomography (CBCT). Materials and Methods; Fourteen periodontally involved teeth were selected for IR. A preoperative orthodontic procedure was performed to apply luxation, and the tooth was then gently extracted. Retrograde filling of the root-end canal was performed. Once the tooth was repositioned in the socket, it was splinted with the adjacent tooth. After three months, prosthetic restoration was performed. Results; Clinical parameters and CBCT images were obtained before and after the IR procedure. The height of the alveolar bone was measured on the CBCT images by using software. Most preoperative symptoms, including pain, mobility, probing depth (PD) and bleeding on probing (BOP), significantly decreased after IR (pain: 4.71 to 1.00; mobility: 1.36 to 0.29; PD: 5.60 to 2.85; BOP: 3.50 to 0.79). CBCT analysis indicated an increase in bone height after IR (the amount of change: maxilla, 4.00; mandible, 1.95). Conclusions; A previous study reported that IR for periodontally involved teeth is quite limited. However, in this study, IR of periodontally compromised teeth showed favorable results in clinical and radiographic evaluations, suggesting that IR may be an alternative to extraction of teeth with periodontal disease. Full article

The technique of intentional replantation can provide a second chance to save teeth that would be destined for extraction. Therefore, the present systematic review aimed primarily to estimate tooth survival after intentional replantation and secondarily to compare treatment outcomes in single-rooted and multi-rooted teeth. The study protocol was developed before the analysis according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Articles were electronically searched in PubMed/MEDLINE, the COCHRANE library and Google Scholar by two independent reviewers, and those that met the eligibility criteria were included. A statistical analysis using the chi-square test with a p-value of <0.05 was performed on the reported outcomes of intentional replantation. A total of 44 single-rooted replanted teeth with five failures (11.36%) and 42 multi-rooted replanted teeth with six failures (14.28%) were reported in the literature, corresponding to a survival rate of 88.64% and 85.57%, respectively. The overall survival rate for the replantation procedure was 86.7%, indicating that intentional replantation can be considered a safe therapeutic choice, with no statistically significant difference between the survival rates of single-rooted and multi-rooted replanted teeth. Full article

Intentional replantation (IR) may offer a solution for persistent periapical lesions associated with endodontically treated teeth. A 35-year-old male patient presented with pain associated with the left mandibular second molar and hypoesthesia. Upon clinical examination, increased probing pocket depth in the mid-buccal surface was detected. Cone beam computed tomography revealed a previous non-surgical root canal treatment, with root canal filling material extrusion adjacent to the inferior alveolar nerve, a fractured instrument in the mesial root, and a large periapical radiolucency involving both teeth 37 and 36. A diagnosis of symptomatic post-treatment apical periodontitis was established. After discussing treatment options with the patient, an IR of tooth 37 was performed. Extra-oral procedures were completed in 17 min. At 9 months, hypoesthesia resolution was reported, and apical healing was radiographically observed. After 2.5 years, the replanted tooth showed extensive root resorption. An extraction with alveolar ridge preservation, using leukocyte-platelet rich fibrin (L-PRF), was performed. Six months after tooth extraction and regeneration, implant placement surgery was carried out. IR presents a valid treatment modality for the management of post-treatment apical periodontitis. When orthograde retreatment or apical microsurgery prove to be unfeasible, IR is a unique procedure with the potential to promote tooth preservation in properly selected cases. Although unsuccessful after 2.5 years, the IR of tooth 37 allowed for bone regeneration, the maintenance of tooth 36 vitality, and hypoesthesia resolution. Full article

Introduction: In many cases, the replanted teeth may undergo resorption or ankyloses. Recent studies show that autologous platelet concentrates (APCs) may improve the outcomes of tooth replantation. The aim of this systematic review was to summarize and critically appraise the currently available literature on the use of APCs before tooth replantation. Methodology: An electronic search was conducted on the following research databases: PubMed/MEDLINE, ISI Web of Science, EMBASE and Scopus. The following medical subject heading (MeSH) keywords used were: ((tooth replantation) OR (replanted tooth) OR (teeth replantation) OR (replanted teeth)) AND ((autologous platelet concentrate) OR (platelet-rich plasma) OR (platelet-rich fibrin) OR (autologous platelet)). The studies’ data was extracted, and the research’ quality was rated using the CARE and ARRIVE protocols. Results: Ten case reports and three animal studies, one cell study and one study, which included both animal and in vitro experiments, were included in this review. In majority of the studies, APCs improved the outcomes of tooth replantation. However, there were various sources of bias in the most of the research, which may have influenced the results. Conclusions: Although majority of the studies indicate that APCs may improve outcomes of tooth replantation, majority of the studies contained numerous sources of bias. Additionally, the sample size of the included subjects is inadequate to predict the clinical efficacy of APCs in management of replanted teeth. Large-scale, multi-center and long-term studies are required to ascertain the efficacy of APCs in improve the outcomes of tooth replantation. Full article

Replacement and inflammatory resorption are serious complications associated with the delayed replantation of avulsed teeth. In this study, we aimed to assess whether deferoxamine (DFO) can suppress inflammation and osteoclastogenesis in vitro and attenuate inflammation and bone resorption in a replanted rat tooth model. Cell viability and inflammation were evaluated in RAW264.7 cells. Osteoclastogenesis was confirmed by tartrate-resistant acid phosphatase staining, reactive oxygen species (ROS) measurement, and quantitative reverse transcriptase–polymerase chain reaction in teeth exposed to different concentrations of DFO. In vivo, molars of 31 six-week-old male Sprague–Dawley rats were extracted and stored in saline (n = 10) or DFO solution (n = 21) before replantation. Micro-computed tomography (micro-CT) imaging and histological analysis were performed to evaluate inflammation and root and alveolar bone resorption. DFO downregulated the genes related to inflammation and osteoclastogenesis. DFO also reduced ROS production and regulated specific pathways. Furthermore, the results of the micro-CT and histological analyses provided evidence of the decrease in inflammation and hard tissue resorption in the DFO group. Overall, these results suggest that DFO reduces inflammation and osteoclastogenesis in a tooth replantation model, and thus, it has to be further investigated as a root surface treatment option for an avulsed tooth. Full article