Tooth transplantation and replantation: Biological insights towards therapeutic improvements.

Transplantation and replantation of teeth are effective therapeutic approaches for tooth repositioning and avulsion, respectively. Transplantation involves transplanting an extracted tooth from the original site into another site, regenerating tissue including the periodontal ligament (PDL) and alveolar bone, around the transplanted tooth. Replantation places the avulsed tooth back to its original site, regenerating functional periodontal tissue. In clinical settings, transplantation and replantation result in favorable outcomes with regenerated PDL tissue in many cases. However, they often result in poor outcomes with two major complications: tooth ankylosis and root resorption. In tooth ankylosis, the root surface and alveolar bone are fused, reducing the PDL tissue between them. The root is subjected to remodeling processes and is partially replaced by bone. In severe cases, the resorbed root is completely replaced by bone tissue, which is called as "replacement resorption." Resorption is sometimes accompanied by infection-mediated inflammation. The molecular mechanisms of ankylosis and root resorption remain unclear, although some signaling mechanisms have been proposed. In this mini-review, we summarized the biological basis of repair mechanisms of tissues in transplantation and replantation and the pathogenesis of their healing failure. We also discussed possible therapeutic interventions to improve treatment success rates.

Diagnosis of tooth ankylosis using panoramic views, cone beam computed tomography, and histological data: a retrospective observational case series study.

Objectives: The aim of this study was to determine whether cone beam computed tomography is a reliable radiological method to diagnose tooth ankylosis. Materials and methods: A series of teeth clinically diagnosed as ankylosed were collected after extraction in a private practice from 2009 to 2015 and analyzed retrospectively. Inclusion criteria comprised permanent molars extracted due to failed tooth eruption in the absence of any visible mechanical obstruction, existing panoramic view (PV), and cone beam computed tomography (CBCT) and histological sections of sufficient quality. The CBCT scans and PVs were evaluated twice for signs of ankylosis by two independent observers using the following score: clear signs, possible signs, and no signs. The histological sections were evaluated and graded similarly to the radiographs by a specialist blinded to the radiographs and treatment. Results: Out of an initial group of 22 patients, 9 subjects with 10 affected teeth were included for final evaluation. The age ranged from 8.3 to 17 years. No agreement was seen in comparing the PV scores to the histological sections. Fair to moderate agreement was seen in comparing the CBCT scores to the histological sections. All histologically confirmed ankylosis were detected in CBCT by both observers but some false positive results were found. Limitation: Only a small sample size was available as the disorder is rare. It is difficult to distinguish ankylosis from primary failure of eruption. Conclusion: CBCT images can be a useful adjunctive diagnostic tool to diagnose ankylosed teeth, but cannot be recommended as a single diagnostic modality as false positive results were found.

Effects of the bisphosphonate alendronate on molars of young rats after lateral luxation.

BACKGROUND AND AIM: The bisphosphonate alendronate (ALN) was employed with the aim of investigating its effects on dental and periodontal tissues after lateral luxation of developing molars. MATERIAL AND METHODS: Twenty-one-day-old Wistar rats had their second upper molars laterally luxated. Daily 2.5 mg kg(-1) ALN injections started at the day of the luxation; controls received sterile saline solution. The teeth were analyzed 7, 14, and 21 days after the procedure. On the days cited, the maxillae were fixed, decalcified, and embedded in paraffin or Spurr resin. The paraffin sections were stained with H&E, incubated for TRAP histochemistry or immunolabeled for osteopontin (OPN). Spurr ultrathin sections were examined in a transmission electron microscope. RESULTS: After 21 days, the root apex of luxated molars without ALN was wide open and disorganized and also covered by an irregular layer of cellular cementum, which was not observed in ALN-treated animals. Ankylosis sites were observed in ALN rats in both luxated and non-luxated teeth. The TRAP-positive osteoclasts were more numerous in ALN group, despite their latent ultrastructural appearance without the presence of resorption apparatus compared to controls. OPN immunolabeling revealed a thick immunopositive line in the dentin that must be resultant from the moment of the luxation, while ALN-treated specimens did not present alterations in dentin. CONCLUSION: The present findings indicate that alendronate inhibits some alterations in dentin and cementum formation induced by dental trauma.

A qualitative investigation of RANKL, RANK and OPG in a rat model of transient ankylosis.

INTRODUCTION: Previous studies have found ankylosis occurs as a part of the inflammatory process of aseptic root resorption initiated in a rat model. The physiologic mechanisms behind the development of dentoalveolar ankylosis and healing response are still unclear. While receptor activator of nuclear factor-κß ligand (RANKL), receptor activator of nuclear factor-κß (RANK) and osteoprotegerin (OPG) have gained momentum in the understanding of resorption, no study to date has investigated their role in dentoalveolar ankylosis. AIMS: The aims of this study were to investigate if, and when, ankylosis occurred in the rat PDL, whether the resolution of ankylosis occurred with time and, finally, to observe the expression of RANKL, RANK and OPG during the ankylotic process. MATERIALS AND METHODS: Dry ice was applied for 20 minutes to the upper right first molar crown of 15 eight-week-old, male Sprague-Dawley rats. An additional three rats served as untreated external controls. Groups of three rats were sacrificed after the thermal insult on day 0, 4, 7, 14 and 28 respectively. Each maxilla was dissected out and processed for histological examination and RANKL, OPG and RANK immunohistochemistry. RESULTS: By the use of light microscopy and H&E staining, no ankylosis was detected in the external control group and the experimental groups at days 0 and 4. On day 7, disruption within the periodontal ligament was observed in the interradicular region and the initial signs of ankylosis were seen in the form of finger-like projections extending from the alveolar bone towards the cementum. Fourteen days after the thermal insult, all animals exhibited extensive ankylosis that spanned the entire interradicular periodontal space. At 28 days, the development of ankylosis appeared to have ceased and repair was observed, together with an intact periodontal ligament in all but one rat. Positive staining results were obtained with RANKL, RANK and OPG antibodies. The expressions of RANKL, RANK and OPG were similar in the external control group, 0-, 4-, and 28-day experimental groups. In the 7- and 14-day experimental groups, RANKL, RANK and OPG were expressed in the blood vessels within the ankylotic regions. CONCLUSIONS: During the development of ankylosis and its resolution, it was concluded from their simultaneous presence that there is a complex interaction between RANKL, RANK and OPG that requires further investigation.

Evaluation of the anti-resorptive ability of an experimental acetazolamide paste for the treatment of late replanted teeth: a study in rats.

When late replantation is performed, the root surface and root canal should be treated. Notwithstanding failures still occur, because of the high rates of root resorption, evidencing the need to search for substances that may inhibit root resorption. The acetazolamide is a known anti-resorptive agent, and its use as root canal dressing may increase the success rates in the treatment of root resorption. Therefore, this study evaluated the effect of an acetazolamide paste used as root canal dressing in late replanted teeth. The study was conducted on 24 maxillary right incisors of rats, which were avulsed and divided in two groups. In group I, the teeth were kept dry for 30 min, had their root surfaces rubbed with a blade, and were treated with 2% sodium fluoride at pH 5.5 for 20 min; the root canals were instrumented and filled with acetazolamide paste; and then the teeth were replanted. In group II, the treatment was similar to group I, except for the root canal dressing, with utilization of calcium hydroxide in group II. At 15 and 60 days after replantation, the animals were killed and the specimens were processed in a histotechnical laboratory for microscopic and morphometric analysis. The results demonstrated the ability of both intracanal substances to limit root resorption, yet they were unable to completely inhibit the root resorption. Replacement resorption lacunae were present in greater proportion in group II, at 60 days. It was concluded that the acetazolamide paste was effective to limit the root resorption, being more effective in limiting the replacement resorption compared with calcium hydroxide.

Resonance frequency analysis: a new diagnostic tool for dental ankylosis.

Ankylosed teeth are considered in orthodontic treatment planning; however, diagnostic tools to quantify the rigidity of the tooth-to-bone connection are rare. Resonance frequency analysis (RFA) can quantify the rigidity of the dental implant-to-bone connection and thus may serve as a potential diagnostic tool to identify ankylosed teeth. To test this assumption, we examined 15 and 30 primary mandibular molars, with and without clinical signs of ankylosis, using the Osstell Mentor system. A cut-off implant stability quotient (ISQ) of 43 provided a specificity of 100% and a sensitivity of 53.3% when measured in the mesio-distal direction or a sensitivity of 20% when measured in the bucco-lingual direction. Based on a receiver-operating characteristic (ROC), the area under the curve (AUC) of 0.807 showed the mesio-distal direction of measurement to be a test of moderate discriminatory power. Given its non-invasiveness, RFA may serve as a quantitative diagnostic supplement to the clinical examination of potentially ankylosed primary molars.

Platelet-derived growth factor-BB regenerates functional periodontal ligament in the tooth replantation.

Tooth ankylosis is a pathological condition of periodontal ligament (PDL) restoration after tooth replantation. Platelet-derived growth factor-BB (PDGF-BB) has been proposed as a promising factor for preventing tooth ankylosis. Using rat tooth replantation model, we investigated whether PDGF-BB accelerates the repair of PDL after tooth replantation without ankylosis, and its molecular mechanisms. In PDGF-BB pretreated replanted teeth (PDGF-BB group), ankylosis was markedly reduced and functionally organized PDL collagen fibers were restored; the mechanical strength of the healing PDL was restored to an average of 76% of that in non-replanted normal teeth at 21 days. The numbers of PDGF-Rß- and BrdU-positive cells in the periodontal tissues of the PDGF-BB group were greater than those of atelocollagen pretreated replanted teeth (AC group). Moreover, in the PDGF-BB group, the periodontal tissues had fewer osteocalcin-positive cells and decreased number of nuclear ß-catenin-positive cells compared to those in the AC group. In vitro analyses showed that PDGF-BB increased the proliferation and migration of human periodontal fibroblasts. PDGF-BB downregulated mRNA expressions of RUNX2 and ALP, and inhibited upregulatory effects of Wnt3a on ß-catenin, AXIN2, RUNX2, COL1A1, and ALP mRNA expressions. These findings indicate that in tooth replantation, topical PDGF-BB treatment enhances cell proliferation and migration, and inhibits canonical Wnt signaling activation in bone-tooth ankylosis, leading to occlusal loading of the PDL tissues and subsequent functional restoration of the healing PDL. This suggests a possible clinical application of PDGF-BB to reduce ankylosis after tooth replantation and promote proper regeneration of PDL.

Analysis of the cells isolated from epithelial cell rests of Malassez through single-cell limiting dilution.

The epithelial cell rests of Malassez (ERM) are essential in preventing ankylosis between the alveolar bone and the tooth (dentoalveolar ankylosis). Despite extensive research, the mechanism by which ERM cells suppress ankylosis remains uncertain; perhaps its varied population is to reason. Therefore, in this study, eighteen unique clones of ERM (CRUDE) were isolated using the single-cell limiting dilution and designated as ERM 1-18. qRT-PCR, ELISA, and western blot analyses revealed that ERM-2 and -3 had the highest and lowest amelogenin expression, respectively. Mineralization of human periodontal ligament fibroblasts (HPDLF) was reduced in vitro co-culture with CRUDE ERM, ERM-2, and -3 cells, but recovered when an anti-amelogenin antibody was introduced. Transplanted rat molars grown in ERM-2 cell supernatants produced substantially less bone than those cultured in other cell supernatants; inhibition was rescued when an anti-amelogenin antibody was added to the supernatants. Anti-Osterix antibody staining was used to confirm the development of new bones. In addition, next-generation sequencing (NGS) data were analysed to discover genes related to the distinct roles of CRUDE ERM, ERM-2, and ERM-3. According to this study, amelogenin produced by ERM cells helps to prevent dentoalveolar ankylosis and maintain periodontal ligament (PDL) space, depending on their clonal diversity.

The presence of TNF-alpha and TNFR1 in aseptic root resorption. A preliminary study.

BACKGROUND: It is hypothesised that osteoprotegerin (OPG), as an osteoclast antagonist, may offer molecular control over the process of orthodontic root resorption. Previous work investigating OPG in a rat periodontal ligament (PDL) ankylosis model found no inhibitory effect on osteoclasts and odontoclasts when given at a recommended dosage of 2.5 mg/kg. It was considered that traumatically-induced PDL inflammation produces mediators and cytokines with the ability to stimulate clast cell differentiation and counter the effects of OPG. AIMS: The present study investigated the presence of Tumour Necrosis Factor Alpha (TNF-alpha) and its receptor Tumour Necrosis Factor Receptor 1 (TNFR1) in a PDL sterile inflammatory model. METHODS: Dry ice was applied for 15 minutes to the upper right first molar crown of eighteen, 8-week-old, male Sprague-Dawley rats of which 9 were injected with OPG at a dose of 2.5 mg/kg of body weight at the time of freezing. After 7 days, the rats were sacrificed and each maxilla processed for immunohistochemical identification of TNF-alpha and TNFR1. RESULTS: Results showed the presence of root resorption in varying amounts and locations in both experimental and control rats. Reparative processes appeared greater in the OPG-treated rats, often with the presence of an ankylotic union. Immunolabelling showed the presence of TNF-alpha and TNFR1 in the sterile inflammation located mainly in the interradicular PDL area. More definitive labelling appeared in OPG-treated rats. CONCLUSION: The results indicated that TNF-alpha, and its receptor TNFR1, by their presence, may modify OPG effectiveness by offering an alternative pathway for osteoclast formation, which counters the anti-resorptive effects of OPG.

Influence of defect dimensions on periodontal wound healing/regeneration in intrabony defects following implantation of a bovine bone biomaterial and provisions for guided tissue regeneration: an experimental study in the dog.

OBJECTIVE: To evaluate the influence of defect dimensions on periodontal wound healing/regeneration in intrabony defects following implantation of a deproteinized bovine bone/collagen matrix under provisions for guided tissue regeneration. MATERIAL AND METHODS: Contra-lateral one-wall intrabony [6 x 6 mm (wide/deep) versus 4 x 4 mm (narrow/shallow)] periodontal defects were surgically created at the edentulated mesial aspect of the mandibular first molars in three Labradors, i.e., three defects in each category. The defects were implanted with the bovine bone/collagen matrix and covered with a collagen membrane. Histologic/histometric analysis followed an 18-month healing interval. RESULTS: New cementum encompassed the entire intrabony component in both wide/deep (5.6 +/- 0.5 mm) and narrow/shallow (4.2 +/- 0.1 mm) defects; bone formation amounted to 5.6 +/- 0.6 and 4.0 +/- 0.8 mm, respectively. Mineralized bone encompassed 57.5%versus 65% and the bone biomaterial 11.6%versus 13.1% of the defect space. A periodontal ligament with a width and composition similar to that of the resident periodontal ligament encompassing the entire aspect of the defects was observed. Root resorption/ankylosis was rare. CONCLUSIONS: Both wide/deep and narrow/shallow intrabony defects showed a substantial potential for periodontal regeneration in this pre-clinical model. The contribution of the bovine bone/collagen matrix and guided tissue regeneration to this regenerative potential is not clear.

Disruptions of the pulp-dentin complex in an investigated case of pink secondary retained molar.

A pink retained left mandibular first molar without carious lesions was diagnosed in a healthy 12-year-old girl presenting normal clinical tests. An orthopantomogram failed to detect other retained teeth. Both periapical radiography and computed tomography showed the absence of a periodontal ligament space in the bifurcation area and the presence of radiolucency or calcifications in the pulp cavity. The coronal part of the removed tooth was subjected to histological and immunohistochemical analysis using anti-PCNA (proliferation marker) and anti-p53 (apoptosis marker) antibodies. Root surfaces were observed by scanning electron microscopy. The pink color of the molar reflected the extension of resorptive tissue into the clinical crown and the underlining proliferation of pulp vessels. Ankylosis observed in the bifurcation area was also detected in the coronal part of the pulp. Whereas odontoblasts secreted tertiary dentin despite no evidence for a carious lesion, only osteocytes in the newly formed bone were apoptotic and the root surfaces were free of resorption lacunae. The etiopathology of the lesion in this case indicated a pulp origin, suggesting that new therapies targeting this tissue should be developed.

Treatment of an ankylosed maxillary incisor by intraoral alveolar bone distraction osteogenesis.

An ankylosed tooth and adjacent alveolar process can lead to the development of an open bite, an unesthetic smile line, and abnormal function in mastication. Intraoral alveolar bone distraction osteogenesis is an option for treating an ankylosed tooth. The purpose of this clinical report was to show the treatment of a growing patient with an ankylosed maxillary central incisor. A simple tooth-borne intraoral distractor was made with an expansion screw and 0.9-mm stainless steel wire, which enabled it to move easily. Intraoral alveolar bone distraction osteogenesis will give the best results in patients with favorable root length and severely resorbed alveolar bone in the vertical dimension.

Root and bone response to the proximity of a mini-implant under orthodontic loading.

OBJECTIVE: To determine the histological reaction of the root and bone as a mini-implant approaches the root. MATERIALS AND METHODS: Two kinds of mini-implants were inserted into the buccal alveolar bone of 4 beagles (2 males and 2 females). The specimens were classified as the near-root group, the PDL contact group, the root contact group, and the root perforation group. Cementum resorption, dentin resorption, cementum repair, cementum growth, ankylosis, root cracking, and root fracture were assessed as the implant neared the root. RESULTS: The incidence of root resorption increased when the mini-implant was less than 0.6 mm from the root in the near-root group and PDL contact group. Root cracking and root fracture occurred in the root contact group and root perforation group. Bone resorption and ankylosis were observed in some specimens. However, some specimens of the PDL contact group and root contact group had cementum growth or little root resorption despite proximity to the root. In the root perforation group, root resorption and ankylosis occurred on the side opposite the insertion. CONCLUSIONS: There is a risk of root contact and severe tissue damage from a thick mini-implant and the drilling procedure, either of which can induce root resorption or ankylosis. Use of smaller mini-implants may reduce root contact and tissue damage. However, the small mini-implant may need enhancement of its stability.

Transcriptome analysis of ankylosed primary molars with infraocclusion.

Primary molar ankylosis with infraocclusion can retard dental arch development and cause dental asymmetry. Despite its widespread prevalence, little is known about its molecular etiology and pathogenesis. To address this, RNA sequencing was used to generate transcriptomes of furcal bone from infraoccluded (n = 7) and non-infraoccluded (n = 9) primary second molars, all without succeeding biscuspids. Of the 18 529 expressed genes, 432 (2.3%) genes were differentially expressed between the two groups (false discovery rate < 0.05). Hierarchical clustering and principal component analysis showed clear separation in gene expression between infraoccluded and non-infraoccluded samples. Pathway analyses indicated that molar ankylosis is associated with the expression of genes consistent with the cellular inflammatory response and epithelial cell turnover. Independent validation using six expressed genes by immunohistochemical analysis demonstrated that the corresponding proteins are strongly expressed in the developing molar tooth germ, in particular the dental follicle and inner enamel epithelium. The descendants of these structures include the periodontal ligament, cementum, bone and epithelial rests of Malassez; tissues that are central to the ankylotic process. We therefore propose that ankylosis involves an increased inflammatory response associated with disruptions to the developmental remnants of the dental follicle and epithelial rests of Malassez.

Cementum, pulp, periodontal ligament, and bone response after direct injury with orthodontic anchorage screws: a histomorphologic study in an animal model.

PURPOSE: To assess the histologic response of the periodontium, cementum, and pulp after intentional root injury with titanium screws. MATERIALS AND METHODS: Three female beagle dogs were used, and a total of 60 self-drilling/self-tapping miniscrews were manually inserted into the maxilla and the mandible with the intention of placement in close proximity or in direct contact with the roots. Digital radiographs were taken to select the sites with root injuries. After a 3-month period, the animals were killed and serial nondecalcified histologic sections were obtained with the miniscrew in place. RESULTS: Sixteen sites with significant root injury were identified. Four sites presented with cementum abrasion, 7 sites had dentin penetration up to 50% of the diameter of the screw, and 5 sites had miniscrew penetration into the pulp space with root fragmentation. At all damaged sites, continuous cementum repair could be observed. There was no evidence of external resorption or pulpal necrosis and/or inflammatory infiltrate. Point ankylosis was seen only in cases of severe injury with root fragmentation. Finally, woven bone was present along the miniscrew threads. CONCLUSION: When titanium screws penetrate root cementum or dentin, pulpal necrosis and/or inflammation was not observed at 12 weeks in an animal model. Cementum regenerates at every injury site, but ankylosis can occur with root fragmentation. Woven bone is present at the screw-bone interface even with root contact suggesting osteointegration.

Intracanal bisphosphonate does not inhibit replacement resorption associated with delayed replantation of monkey incisors.

Progressive replacement resorption following delayed replantation of avulsed teeth has proved to be an intractable clinical problem. A wide variety of therapeutic approaches have failed to result in the predictable arrest of resorption, with a good long-term prognosis for tooth survival. Bisphosphonates are used in the medical management of a range of bone disorders and topically applied bisphosphonate has been reported to inhibit root resorption in dogs. This study evaluated the effectiveness of a bisphosphonate (etidronate disodium) as an intracanal medicament in the root canals of avulsed monkey teeth, placed before replantation after 1 h of extraoral dry storage. Incisors of six Macaca fascicularis monkeys were extracted and stored dry for 1 h. Teeth were then replanted after canal contamination with dental plaque (negative control) or after root canal debridement and placement of etidronate sealed in the canal space. A positive control of calcium hydroxide placed 8-9 days after replantation was also included. All monkeys were sacrificed 8 weeks later and block sections were prepared for histomorphometric assessment of root resorption and periodontal ligament status. Untreated teeth showed the greatest extent of root resorption (46% of the root surface), which was predominantly inflammatory in nature. Calcium hydroxide treated teeth showed the lowest overall level of resorption (<30% of the root surface), while the bisphosphonate-treated group was intermediate (39%). Ankylosis, defined as the extent of the root surface demonstrating direct bony union to both intact and resorbed root surface, was the lowest in the untreated control group (15% of the root surface), intermediate in the calcium hydroxide group (27%) and the highest in the bisphosphonate group (41%). Bony attachment to the tooth root was divided approximately equally between attachment to intact cementum and to previously resorbed dentin. Overall, bisphosphonate resulted in a worse outcome than calcium hydroxide in terms of both root resorption and ankylosis.

Healing of the roots and surrounding structures after intentional damage with miniscrew implants.

INTRODUCTION: In this study, we evaluated the healing potential of the roots and surrounding periodontium (cementum, periodontal ligament [PDL], and bone) after intentional damage during miniscrew implant (MSI) placement. METHODS: A randomized split-mouth design was used to evaluate healing 6 and 12 weeks after intentional root damage. Seven skeletally mature male beagle dogs had MSIs placed into the roots of 8 mandibular teeth (6 premolars, 2 first molars). After root contact had been verified by using insertion torques and radiographs, the MSIs were immediately removed, and the sites were allowed to heal for 6 or 12 weeks. Sequential point labeling was performed at 6-week intervals with tetracycline and calcein. Demineralized and undemineralized sections were stained, and healing was histologically evaluated. RESULTS: The placement torque was twice as high with root contact than without contact (23.8 vs 50.7 Ncm). Damage to the roots and periodontium ranged from cementum interruption to pulp invasion. New bone, PDL, and cementum were observed in 64.3% of the teeth, with significant (P <0.05) increases in the percentages of cementum over time. Sequential labeling confirmed healing at both 6 and 12 weeks. Abnormal healing was found in 35.7% of teeth; it included lack of PDL and bone regeneration, bone degeneration in the furcation area, ankylosis, and no healing associated with inflammatory infiltrate or pulpal invasion. CONCLUSIONS: Under favorable conditions (no inflammatory infiltrate or pulpal invasion), healing can occur when root damage caused by MSIs is limited to the cementum or the dentin. Increased resistance should be used as an indicator of possible root contact during MSI placement.

Effect of root surface treatment with propolis and fluoride in delayed tooth replantation in rats.

Replantation is an acceptable option for treatment of an avulsed permanent tooth. Nevertheless, an extended extraoral period damages the periodontal ligament and results in external root resorption. The purpose of this study was to assess by histologic and histometric analysis, the influence of propolis 15% (natural resinous substance collected by Apis mellifera bees from various plants) and the fluoride solution used as root surface treatment on the healing process after delayed tooth replantation. Thirty Wistar (Rattus norvegicus albinus) rats were submitted to extraction of their upper right incisor. The teeth were maintained in a dry environment for 60 min. After this, the pulp was extirpated and the papilla, enamel organ and periodontal ligament were removed with scalpel. The teeth were divided into three experimental groups: Group I - teeth immersed in 20 ml of physiologic saline; Group II - teeth immersed in 20 ml of 2% acidulated phosphate sodium fluoride; Group III - teeth immersed in 20 ml of 15% propolis. After 10 min of immersion in the solutions, the root canals were dried and filled with calcium hydroxide paste and the teeth were replanted. The animals were euthanized 60 days after replantation. The results showed that similar external root resorption was seen in the propolis and fluoride groups. Teeth treated with physiologic saline tended to have more inflammatory root resorption compared with those treated with fluoride or propolis. However, the comparative analysis did not reveal statistically significant differences (P > 0.05) between the treatment modalities when used for delayed tooth replantation.

Analysis of the healing process in delayed tooth replantation after root canal filling with calcium hydroxide, Sealapex and Endofill: a microscopic study in rats.

The major concern in the therapeutics of tooth replantation refers to the occurrence of root resorption and different approaches have been proposed to prevent or treat these complications. The purpose of this study was to evaluate tissue response to delayed replantation of anterior rat teeth treated endodontically using calcium hydroxide, Sealapex, and Endofill without the placement of gutta-percha cones. Thirty rats had their right upper incisor extracted and maintained in dry storage for 60 min. After removal of the dental papilla, enamel organ, pulp tissue, and periodontal ligament remnants, the teeth were immersed in 2% sodium fluoride phosphate acidulated, pH 5.5, for 10 min. The root canals were dried with absorbent paper points and the teeth were assigned to three groups (n = 10) according to the filling material. Group I - calcium hydroxide and propyleneglycol paste, Group II - Sealapex, and Group III - Endofill. The sockets were irrigated with saline and the teeth were replanted. Replacement resorption, inflammatory resorption and ankylosis were observed in all groups. Although the occurrence of inflammatory resorption was less frequent in Group I, there were no statistically significant differences among the groups. It may be concluded that compared to the paste, filling the root canals with Sealapex and Endofill sealers without the placement of gutta-percha cones did not provide better results.

An impacted malformed primary maxillary central incisor diagnosed as a compound odontoma.

An odontoma is usually found in the surrounding area of the unerupted permanent tooth bud and rarely adjacent to the primary central incisor This report presents a case of an unerupted malformed primary central incisor, histologically diagnosed as a compound odontoma. A 5.5 year-old healthy boy presented with an unerupted maxillary left primary central incisor and mild gingival buccal swelling. No history of traumatic injury was recorded. Radiological examination revealed a tooth-like mass with a partially developed root and a malformed crown in the area of the left primary central incisor Delayed development of the successor left permanent incisor in comparison to the right one was noted. The rational for early surgical intervention to enable normal development and eruption of permanent incisors is described. Clinical and radiographic diagnoses as well as several etiological factors and a differential diagnosis are considered and reviewed.