J Periodontal Implant Sci.  2014 Feb;44(1):13-19. 10.5051/jpis.2014.44.1.13.

Delayed intentional replantation of periodontally hopeless teeth: a retrospective study

• Lee EU
• Lim HC
• Lee JS
• Jung UW
• Kim US
• Lee SJ
• Choi SH

• KMID: 1845874
• DOI: http://doi.org/10.5051/jpis.2014.44.1.13

Abstract

PURPOSE
The purpose of this study was to retrospectively evaluate the survival of periodontally hopeless teeth that were intentionally extracted and replanted after a delay and to compare the radiographic characteristics of the survival group with those of the failure group.
METHODS
The clinical and radiographic data from patients who underwent delayed intentional replantation between March 2000 and July 2010 were reviewed. Twenty-seven periodontally hopeless teeth were extracted and preserved in medium supplemented with antibiotics for 10-14 days. The teeth were then repositioned in the partially healed extraction socket and followed for 3 to 21 months. The radiographic parameters were analyzed using a paired t test and the cumulative survival rate was analyzed using Kaplan-Meier analysis.
RESULTS
Seven replanted teeth failed and the overall cumulative survival rate was 66.4%. In the survival group, the amount of bone loss was reduced from 68.45% to 34.66% three months after replantation. There was radiologic and clinical evidence of ankylosis with 5 teeth. However, no root resorption was found throughout the follow-up period. In the failure group, bone formation occurred from the bottom of the socket. However, a remarkable radiolucent line along the root of a replanted tooth existed. The line lengthened and thickened as time passed. Finally, in each case of failure, the tooth was extracted due to signs of inflammation and increased mobility.
CONCLUSIONS
Delayed intentional replantation has many advantages compared to immediate intentional replantation and could serve as an alternative treatment for periodontally involved hopeless teeth. However, techniques for maintaining the vitality of periodontal structures on the tooth surface should be developed for improved and predictable results.

Keyword

Alveolar bone loss; Bone remodeling; Periodontal diseases; Survival rate; Tooth replantation

MeSH Terms

Alveolar Bone Loss
Ankylosis
Anti-Bacterial Agents
Bone Remodeling
Follow-Up Studies
Humans
Inflammation
Intention
Kaplan-Meier Estimate
Osteogenesis
Periodontal Diseases
Replantation*
Retrospective Studies*
Root Resorption
Survival Rate
Tooth Replantation
Tooth*
Anti-Bacterial Agents

Figure

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  Figure 1 Extraction and preparation of a tooth before storage. (A) The tooth subjected to delayed replantation was extracted atraumatically. (B) Then the tooth surface was debrided and polished with an ultrasonic scaler and fine diamond bur.

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  Figure 2 Measurement for radiographic evaluation. ht: total root length, hi: intra-alveolar root length.

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  Figure 3 Cumulative survival rate of teeth replanted after a delay.

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  Figure 4 Radiographs taken before (A) and 1 (B), 3 (C), 6 (D), 9 (E), 12 (F), and 15 (G) months after replantation.

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  Figure 5 Amount of bone loss before and 3 months after tooth replantation, *P<0.05.

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  Figure 6 The rate of bone loss (%) 1 to 21 months after tooth replantation.

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  Figure 7 The rate of bone gain (%) 1 to 21 months after tooth replantation.

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  Figure 8 Radiographs taken before (A) and 1 (B), 3 (C), 6 (D), and 9 (E) months after replantation. The tooth was removed 9 months after replantation due to loss of tooth stability.

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