Dental Tribune United Kindom Edition

21Endo TribuneJuly 30 - August 5, 2012United Kingdom Edition ... Special Launch Offer inc accessories, delivery, online training ex vat We inserted tricalcium phos- phate in the apical 3-4mm of the socket and reinserted the tooth with a 180° rota- tion to bring the deep fracture line into a more accessible labial side. The tooth was then splinted with fibre in- forced composite for a period of three weeks. The root-canal treatment was completed at a later date, and the facial surface was built up with composite. We decided not to proceed with the crown immediately after stabilisation to prevent load- ing of the tooth. The patient was recalled periodically for follow-up. Case III A 23-year-old female patient presented with pain in her up- per right anterior tooth. There was no history of trauma, and clinical examination re- vealed a deep palato-gingival groove (PGG) with respect to tooth #12 (Figs 2a–e). The intra-oral peri-apical radio- graph revealed a peri-apical radiolucency. We decided to extract the tooth, seal the groove and then replant the tooth. After adequate anaes- thesia had been obtained, the tooth was extracted with all the necessary precautions and immersed in Viaspan. With help of the forceps, it was then held by its crown. The PGG was debrided with the tip of the ultrasonic scaler and sealed with glass-ionomer ce- ment (GIC). The socket was then gently curetted and the tooth reinserted. Sutures were placed in the minter-dental area and endodontic treat- ment was completed one week later. The apical 4-5mm of the root were sealed with MTA, and the rest of the root canal was back-filled with thermo- plasticised guttapercha. The patient was re-evaluated after seven days. Discussion Intentional replantation in dentistry has been performed for more than 10 centuries and was used extensively to manage odontalgia.4 In 1561, Pare recommended its use when a healthy instead of a diseased tooth was mistaken- ly extracted!5 In 1712, Pierre Fauchard6 replanted a tooth and reported it to be stable on follow-up. Several steps in the replantation were debated, for instance the need for amputa- tion of root apices, immedi- ate or delayed replantation, root-canal obturation before or after replantation, removal or preservation of periodontal ligament cells and the goal of ultimate healing— bony anky- losis or ligament repair. It was in 1881 that Thomp- son7 presented the treatise on the replantation of teeth and emphasised the impor- tance of peri-cemental tissues for treatment success. Later, Fredel8 in 1887 and Scheff9 in 1890 addressed the role of periodontal ligament cells with regard to external root resorption after replantation. As the replantation tech- nique became increasingly refined, it was used as an easy alternative for failing root-canal treatment and hence evoked sharp criticism for the technique of replanta- tion per se. There are many reasons for an adverse outcome of a replantation: the tooth can fracture during extraction and may be completely lost; peri-cemental tissues can be damaged, reducing the likeli- hood of reattachment; infec- tion; external root resorption; and ankylosis. Therefore, it is extremely important to un- derstand that intentional re- plantation should be the last choice, selected only when all the other options of treat- ment (non-surgical and surgi- cal) have been exhausted. Re- plantation can be a treatment of choice in cases in which page 22DTà ‘Intentional replan- tation in dentistry has been performed for more than 10 centuries and was used extensive- ly to manage odontalgia’