Volume 2 - Issue 3 (May-Jul)

Case Report
Antibiotics were administered for 7 days and 0.12%
chlorhexidine mouth rinses daily were prescribed for
7 days. One week after replantation, the root canal
of 11 was biomechanically prepared using step back
technique (Fig. 4). A Calcium Hydroxide paste was
used as an intracanal dressing and was changed 14 days
later, when splinting was removed. Radiographs were
taken and intracanal medication was changed at 30 and
60 days after replantation. The root canal of the tooth
was obturated at 90 days with Gutta-percha points
and Sealapex that is a Calcium Hydroxide based sealer
(Fig 5). The patient wanted restoration of aesthetics so,
a fixed bridge of metal –ceramic was given. The patient
was kept on continuous recall.
The clinical and radiographic findings after 1-year
follow-up revealed absence of root radiolucency,
absence of root resorption, ankylosis and abnormal
mobility of the replanted tooth (Fig. 6).
Discussion
Milk is mostly used as a storage medium for accidentally
avulsed teeth and therefore, the case reported is
important in the clinical routine or management of
tooth replantation.
Lack of knowledge and possibility of immediate
replantation and unawareness of ideal conditions and
storage media for exarticulated teeth have contributed
to a poor prognosis. Both, the length of extra-alveolar
time and type of storage are significant factors that
can affect the long-term survival of replanted teeth.
Immersion of avulsed teeth in milk at room temperature
preserves the viability of periodontal ligament cells
for upto one hour; whereas, storage in refrigerated
milk is reported to maintain cell viability for additional
45 minutes. 4,8
Irrespective of the type of root surface treatment,
there is consensus in the literature that replanted teeth
should be endodontically treated because the necrotic
pulp and its toxins affect the periodontal ligament
cells through the dentinal tubules and play a decisive
role in the resorption process. 3,9,10 In this case, calcium
hydroxide is the most recommended material for root
canal filling of teeth to be replanted because of its
well-known capacity of controlling the progression of
inflammatory resorption. 11,12
Another aspect of dental replantation is the preparation
of socket, which consists of removal of destructions as
blood clots and bone fragments in order to facilitate
the replantation. 12-15
Contention of replanted teeth is another variable
that might affect the prognosis of tooth replantation.
Basically, it should not interfere with oral hygiene,
allow physiological mobility and remain for a short
time in order to reduce the incidence of ankylosis. 2,16
The goal of antibiotic therapy is to avoid bacterial
proliferation in the area of ongoing process and
contribute to the prevention of inflammatory
resorption. Ideally a broad-spectrum antibiotic should
be administered for seven days. 17
Nevertheless, in the case presented in this paper,
the 1-year clinical and radiographic controls showed
maintainence of root integrity, intact Lamina dura
periradicularly and absence of abnormal mobility,
which are indicative of successful replantation.
Certain precautions were taken while planning the
replantation procedure. The tooth was immersed
in saline prior to replantation to eliminate cell lysis
products resulting from traumatic injury on root
surface, as well as debris and bacteria from saliva. 18-20
Systemic antibiotic therapy was administered and tooth
was endodontically treated to prevent inflammatory
resorption. 21
Root resorption and ankylosis are frequently observed
complications post-replantation. Therefore, despite
the positive results observed after 1-year, clinical and
radiographic follow-up of tooth replanted under the
condition hereby described should be carried for a
longer period.
References
1.
2.
3.
4.
Grossman LI, Ship II. Survival rate of replanted teeth.
Oral Surg Oral Med Oral Pathol 1970;29(6):899-906.
Andreasan JO, Andreason FM. Textbook and Color Atlas
of Traumatic Injuries to Teeth. 3rd edition, Munksgaard:
Copenhagen 1994:p.771.
Andreasen JO, Borum MK, Jacobsen HL, Andreasen
FM. Replantation of 400 avulsed permanent incisors. 4.
Factors related to periodontal ligament healing. Endod
Dent Traumatol 1995;11(2):76-89.
Lekic P, Kenny D, Moe HK, Barretti E, McCulloch CA.
Relationship of clonogenic capacity to plating efficiency
and vital dye staining of human periodontal ligament
cells: implications for tooth replantation. J Periodontal
Res 1996;31(4):294-300.
Indian Journal of Multidisciplinary Dentistry, Vol. 2, Issue 3, May-July 2012
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