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

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Med Oral Patol Oral Cir Bucal. 2011 Nov 1;16 (7):e984-9.Autogenous tooth transplantationa generated X-ray source was used, a portable devicePort-X II (Genoray Co. Ltd.) producing up to 60 kVp,for a current intensity of 2mA. The timer was set to theminimum value of 0.03 s. These images were viewed ona computer monitor, using for this purpose, the VixWinPro Software, version 1.5 (KaVo Dental Gendex DentalSystems, Germany) and a qualitative assessment wasdone. The maintenance of the pulp vitality and the rootdevelopment occurs when the donor tooth joints the openapex at the time of being transplanted (14). One of thesigns to assess the pulp vitality is the consequent partialor total obliteration of the canal and the root development(14). For the evaluation of root growth, we developeda protocol, as described below, which was adoptedin the controls of the teeth with open apex. The periapicalradiographs were evaluated on a computer programNemocef 5.0 ® (Nemotec Dental Systems, Spain). Thisprogram allowed measurements with approximationto a hundredth of a millimeter to be made. This waywe obtained values for the length of the root (from theamelo-cemental junction to the most apical point of theroot). The root growth was calculated by subtracting theinitial length to the final length of the root. A correctionfactor was introduced (f), to correct any differencebetween the initial and final radiographs:f = C1: C2, where C1 corresponds to the height of thecrown in the initial radiograph and C2 to the crown inthe final radiograph. The height of the crown was definedas the distance between the midpoint of the line ofunion of the amelo-cemental junction and the midpointof the line that joins the tips of the cusps (Fig. 2).Then the increment of root growth was calculated usingthe following formula:FLR = FMR x fRI = CFR-ILRWhere FLR = final length of the root; FMR = final measurementof the root; ILR = initial length of the rootand RI=root increase (15). It was considered that rootgrowth occurred when there was an increase of at least0.5 mm. The cold test was done with a small ball ofcotton soaked in ethyl chloride, placed on the cervicalthird of the dry tooth, which was isolated with cottonrolls. Whenever a reference of pain existed, its durationwas measured in seconds. For the cold test four gradationswere considered: T0 for the absence of response tothe test, T1 for a positive response, which ceases whenthe stimulation ends, T2 for the duration of a responsebetween 6 to 9 seconds and T3 for the duration of sensitivitysuperior or equal to 10 seconds. The percussiontest was performed with the lead of the clinical mirror,exerting a gentle swat on the occlusal surface of the toothin evaluation. To test the impact felt P0, for no pain,P1 for the presence of pain and P2 for when the percussionsound was metallic.Statistical analysis of dataIn this clinical study, we used the Chi-square, as proportionswere compared. The tests were evaluated at asignificance level of 0.05.ResultsOf the 28 teeth transplanted, monitored for 24 to 65months (48 ± 12.96; MED ± SD), one of these, whichhad the open apex and appeared only for the first controlconsultation, was excluded and 4 were intentional reimplantations.For the remaining 23 an endodontic therapywas performed on 9 teeth (39%), 1 with an open apexand 8 with a closed apex. The remaining 14 teeth werenot subjected to endodontic therapy (Fig. 3).From the results of this clinical study, an analytical evaluationwas done, where we found that there were significantdifferences between teeth with an open apex, incomparison to those which had a closed apex. In these,of the 11 transplants performed it was necessary to performan endodontic therapy in 8 teeth, corresponding to73% of the cases. From the statistical analysis, there isa tendency that the need for endodontic therapy occurssignificantly more often (p=0.083), although this significanceis not confirmed to the level of 5%.On the 12 teeth with an open apex, it was only necessaryto perform an endodontic therapy in one case, correspondingto a value of 8% and a statistically significantdifference (p=0.0002).Fig. 2. Method used to analyse root development.C= crown height; CR= length of theroot.61%n=23ETHVital39%Fig. 3. Endodontic therapy (ETH), performed on the transplanted.e987
Med Oral Patol Oral Cir Bucal. 2011 Nov 1;16 (7):e984-9.Autogenous tooth transplantationTable 2. Comparison between the length of the root and revascularization.Open apex (N=12)Closed apex (N=11)Length of the root (mm) 8.07±2.88 10.82±1.89Revascularization n=11 n=3The relationship between the root length and the revascularization,although this occurred more frequently inteeth with short roots, there no statistically significantdifference (p=0.149) (Table 2). The relationship betweenthe two surgical techniques used and the Emdogain ® orsaline solution, there´s no difference.DiscussionStudies on the complications of root resorption aftertooth transplantation have been based on models inmonkeys, rats and dogs (4,10). Transplantation to a recipientbed in which the tissue was under regenerationdescribed by Nethander et al. (4) in 2003, implies thatthe recipient bed is prepared surgically prior to transplantationand allowed to heal for 5 days. In this study,we used transplant teeth after 10 days of regeneration.The periodontal ligament has demonstrated a remarkablecapacity for repair and regeneration.Katayama et al. (5) demonstrated in dogs that transplantedproliferating tissues promoted reconstructionof a normal periodontium in injured teeth. The effectis probably due to the expression of fibroblast growthfactor (FGF) that is a potent mitogen for mesenchymalcells, including bone and periodontal ligament cells(PDL), and also stimulates osteogenic expression ofstromal bone marrow cells. They demonstrated thatthe mRNA expression of FGF and alkaline phosfatase(ALP) increased in proliferating tissue. They concludedthat this tissue may promote the regeneration of PDLtissue and prevent ankilosis and root resorption followingthe transplantation of teeth.This experimental study demonstrated that there wereno differences in the wound healing process betweenone-stage and two-stage techniques in transplantedteeth. From the results obtained we considered the existenceof pulpal necrosis, when the sensitivity tests werenegative, when there was pain on the vertical percussionand when radiographically there were signs of inflammatoryreabsorption with the presence of a periapicalradio transparent area (15,16).These signals allow us todraw conclusions on performing the revascularizationor not of the transplanted tooth. On the transplantedteeth that presented an open apex, revascularizationoccurred in 92% of cases, which is in agreement withthe literature data (3, 16). It should also be taken intoaccount that the revascularization and pulpar healingare dependent on the diameter of the foramen and thelength of the root (17).Our results indicate that the shorter the root is(L1mm), the greater the possibility of pulp revascularization.When during our study clinical signs andradiographic indicators of pulp or periapical pathologyappeared, we performed endodontic therapy, which occurredin 39% of transplants performed. On the otherhand, on the teeth with an open apex it was only necessaryto perform endodontic therapy on 8% of them. Althoughour results are in agreement with the literaturean issue that remains controversial is knowing the righttime for the performance of endodontic therapy posttransplantation. Our option was to do it when there wereclinical and radiographic signs compatible with pulpnecrosis, and not during a constant time interval rightafter the transplant, as suggested by other authors (18).In our favor are also results from animal experiments,which refer that there are no differences in performingthe endodontic treatment on the 15th or 40th days afterthe transplantation, since the inflammatory reabsorptionwas not significantly different (19). According toour results and supported by this experimental study,we can say that the performance of endodontic treatmentshould be done after the complete healing of theperiodontal ligament. This has a great significance andclinical relevance, as a very early endodontic treatment,may find the tooth with some mobility, which is uncomfortablefor the patient and for the dentist.Almost all teeth with no root canal filling showed pulpobliteration. This can be explained by the fact that pulpobliteration increases with time.These results have clinical implications and suggest thatif nonfunctional teeth such as third molars are available,autotransplantation can be considered the treatment ofchoice. Autotransplantation can be an alternative to dentalimplant in some patients in whom dental implantsbecome impossible due to inadequate bone support andpatients in growing stages.References with links to Crossref - DOIReferences1. Clokie CM, Yau DM, Chano L. Autogenous tooth transplantation:an alternativeto dental implant placement? J Can Dent Assoc. 2001;67:92-6.2. Northway WM, Konigsberg S. Autogenic tooth transplantation.The “state of the art”. Am J Orthod. 1980;77:146-62.3. Andreasen JO, Paulsen HU, Yu Z, Schwartz O. A long-term studyof 370 autotransplanted premolars. Part III. Periodontal healing subsequentto transplantation. Eur J Orthod. 1990;12:25-37.4. Nethander G, Skoglund A, Kahnberg KE. Experimental autoge-e988
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