Autogenous tooth transplantation: Evaluation of pulp tissue ... - RIHUC

Med Oral Patol Oral Cir Bucal. 2011 Nov 1;16 (7):e984-9.Autogenous tooth transplantationMalmo, Sweden) on 14 teeth, or saline (isotonic solutionof Sodium Chloride - Paracelsus - Pharmaceutical Industry,SA Porto-Portugal) also on 14 teeth. Emdogain ®(EMD) is a derivative of the matrix of enamel, whichcontains proteins belonging to the amelogenin family,extracted from embryonic porcine enamel. This productnot only stimulates the proliferation of pre-odontoblastsand the differentiation of immature osteoblasts,it also has an antibacterial action, due to its pH beingbetween 4 and 5 and effective in tooth transplantation(8-13). As a negative control, we used saline solution. Itwas used as a local anesthetic, the lidocaine hydrochlorideanhydrous, 20 mg / mL with adrenaline tartrate,corresponding to 12.5 g / ml of adrenaline, Adrenalinexylocaine ® . The space of the local receptor was evaluatedclinically and on the radiographs. The mesi-distal,vestibular-lingual and vertical spaces were evaluated.The donor tooth was measured in the periapical radiographyand an acrylic model tooth was made with thesame shape and dimensions of the tooth to transplant.This model was used in the preparation of the alveolarreceptor (Fig. 1A and B).Thus, the recipient bed was prepared for immediatetransplantation or deferred by ten days. The teeth to betransplanted were cleaned with a polishing brush andtoothpaste, and disinfection of the oral cavity was carriedout with a solution of chlorhexidine digluconate,0.1%; clorbutanol hemi-hydrate 0.1% (Eludril ® - PierreFabre Dermo-Cosmétique, Portugal). After local anesthetic,atraumatic extraction, avoiding disruption of theroot sheath and root buds, was performed. The extra alveolartime was minimal (less than 5 minutes), in orderto maintain the vitality of periodontal ligament. Whereintentional reimplantation was performed, the extraoraltime was longer (about 15 minutes), due to theperformance of apicoectomy, for the preparation of theapical cavity and placing the sealing material (MTA ® -Mineral Trioxide Agregate).After the topical application of SS or EMD on the rootsurface of teeth for transplantation, they were gentlyinserted into the alveolar, slightly below the oclusalplane to avoid premature oclusal contacts (11). The occlusionwas checked and controlled with interarticularpaper blue/red 60 μm, Bausch KG ® , (Köln, Germany).The setting of the teeth was done during a period of tendays, using for this purpose, silk yarn 3/0, to cross theocclusal face of the tooth (14).Postoperative PeriodIn all patients an antibiotic was performed, starting 24hours before the intervention (amoxicillin - 1 gram tablets:1 tablet each 12 hours), and for a subsequent periodof six days. Indications were given for analgesictreatment (paracetamol, 500 mg tablets: 1 tablet each 6hours, if pain) and the application of an ice-pack on theface, protected with fabric or paper.ABFig. 1. Image of the model tooth made in acrylic resin (A),and periapical radiograph (B), after the socket was made, inthe region of the tooth 46 (clinical case 3).A soft diet was advised for the 48 hours after the transplantation.Chewing with the quadrant was contra-indicatedfor a period of seven days. Careful oral hygienewas also recommended, followed by a mouthwash withchlorhexidine digluconate to 1mg/ml (Eludril ® - PierreFabre Dermo-Cosmétique, Portugal), diluted in 5 mlof water, to remove the suture, 10 days post-operation.The day after the treatment the patient was observedand questioned regarding the occurrence of pain, swellingand bleeding. Control check-ups were done after 10days, one month, three months, six months and annuallyafter the transplantation. In each control check-up, aradiographic examination, observation of the gums, themarginal groove, dental mobility and sensitivity testingto cold and percussion were performed. These data wereall referenced in the previously defined protocol.Methods of AnalysisPeriapical radiographs by the orthogonal techniquewere taken, and evaluated according to the existence ofperiapical pathology, the state of root development, thepresence of apical closure and the state of the hard layerof the alveolar. For the performance of the radiographs,e986