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Endo Tribune United Kingdom Edition

June 201418 Endo Tribune United Kingdom Edition page 17DTß Contact Info Dr Muhamad Abu-Hussein 123 Argus St. 10441 Athens Greece abuhusseinmuhamad@gmail.com cline hydrochloride. Thirteen patients (seven women and six men; age range: 35–52 years) with 15 periodontally involved non-salvageable teeth were in- cluded in this study. During the replantation procedure, the affected teeth were gently ex- tracted and the granulation tis- sue, calculus, remaining PDL and necrotic cementum on the root surfaces were removed. Tetracycline hydrochloride, at a concentration of 100mg/ml, was applied to the root surfac- es for five minutes. The teeth were then replaced in their sockets and splinted. After six months, no root resorption or ankylosis was observed radio- graphically. Although the peri- od of evaluation was short, the authors suggest that IR may be an alternative approach to extraction in cases in which advanced periodontal destruc- tion is present and no other treatment can be considered. Araujo et al.24 demonstrated that root resorption, ankylosis and new attachment forma- tion, among other processes, characterised healing of a re- planted root that had been extracted and deprived of vi- tal cementoblasts. It was also demonstrated that Emdogain therapy, that is, conditioning with EDTA and placement of enamel matrix proteins on the detached root surface, did not interfere with the healing pro- cess. Peer25 reviewed nine cases of IR that illustrated the fea- sibility of the procedure for a variety of indications. Only one case of replantation showed evidence of pathosis, reflected by root resorption or ankylosis. His report suggests that IR is a reliable and predictable pro- cedure, and should be consid- ered more often as a treatment method to maintain the natural dentition. Yu et al.26 reported a case in which a combined endo- dontic–periodontic lesion on a mandibular first molar was treated by IR and applica- tion of hydroxyapatite. Four months after the surgery, a porcelain–metal full crown restoration was completed. At the 15-month follow-up exami- nation, the tooth was clinically and radiographically healthy and functioned well. Shintani et al.27 performed an IR of an immature man- dibular incisor that had a re- fractory periapical lesion. The incisor was extracted and the periapical lesion was removed by curettage. The root canal of the tooth was then rapidly ir- rigated, and filled with a cal- cium hydroxide and iodoform paste, after which the tooth was secured with an archwire splint. Five years later, no clin- ical or radiographic abnormal- ities were found, and the root apex was obturated by an api- cal bridge formation. Kaufman28 reported suc- cessful results of a maxillary molar tooth treated with IR after a four-year follow-up pe- riod. A mandibular first mo- lar, which was replanted, by Czonstkowsky and Wallace29 showed no signs of resorp- tion and ankylosis after six months.14 Different investiga- tors reported success rates varying from 52 to 95 per cent with follow-ups of between one to 22 years in posterior teeth.2,15–17 Bender and Rossmann19 re- ported a success rate of 77.8 per cent in molars. Among 14 mandibular molars, the suc- cess rate in first molars was 85.7 per cent, and 71.4 per cent in second molars. Of the four maxillary molars, three first molars and one second mo- lar, one maxillary first molar failed, resulting in a 66.7 per cent success rate in first mo- lars.2 Raghoebar and Vissink30 re- planted 29 teeth, consisting of two mandibular first molars, 17 mandibular second molars, one mandibular third molar and nine maxillary second mo- lars, and followed them for an average of 62 months. The suc- cess rate was 72 per cent and 25 of them were still in func- tion.18 Conclusion For extraction and replanta- tion to be successful, the fol- lowing criteria must be met: • Informed consent must be obtained from the patient. • All roots need to be coni- cally shaped. • The teeth need to be some- what mobile. • A good knowledge of oral surgery is needed with re- spect to extraction. Intentional replantation is a treatment alternative that should not be underrated, es- pecially when conventional endodontic or surgical treat- ment is not possible. This is an excellent treatment with a predictable result. I have per- formed approximately 30 re- plantations, and have lost only one tooth to date. In order to be successful with extraction and replan- tation cases, the practitioner must have the right patient and the right rapport with that patient. The practitioner must also be able to assess the tooth and be confident that it can be extracted without breakage. Additionally, the practitioner must be able to recognise tooth morphologies that may lead to extraction problems. This is a skill that is perfected through experience. Replantation is a predictable and acceptable method of treatment in my office when patients present with root canals that require retreatment due to failure or those that cannot be completed owing to sclerosing of the ca- nals. DT Editorial note: A complete list of references is available from the publisher. ‘In order to be successful with extraction and replantation cases, the practitioner must have the right patient and the right rapport with that patient’ Fig. 6_Intra-oral photograph showing the clinical situation. Fig. 7_Closed contacts between teeth. Fig. 8_Gingival recession present, periodontal pocket depths were 2–3mm around the tooth. There was little bleeding on probing. Fig. 9_A follow-up radiograph after one year. Fig. 10_A follow-up radiograph after three years. Fig. 11_A follow-up radiograph after four years. Fig. 12_A follow-up radiograph after eight years.

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