Intentional replantation and management of avulsion related ankylosis and external cervical resorption. A 10-year follow up case report.

Replantation is the treatment of choice for avulsed permanent teeth; ankylosis and cervical root resorption are among survival complications. A 9.5-year-old boy presented with an avulsed maxillary permanent central incisor with an open root apex following a school accident. The tooth was kept in milk, after a dry time of 15-20 min. Its replantation was performed 60 min after the accident. At 8 months, apexification with apical plug was attempted upon radiographic evidence of apical periodontitis. Ankylosis sound with infraocclusion and radiographic evidence of external cervical root resorption (ECR) were evident at 3 years and 3 months. At the patient's return one year later with esthetic concerns (2 mm infraocclusion) there was a 5 mm diameter ECR cavity. After intentional atraumatic extraction the resorptive cavity was debrided and restored with Biodentine; subsequently the tooth was reimplanted and splinted at an extruded position. At the 10-year follow up since the first avulsion the tooth remains esthetically pleasing, asymptomatic, non-ankylotic and functional. The present case supports intentional replantation as an option in managing infraoccluded teeth with advanced ECR.

Intentional Replantation of a Second Premolar with Internal Resorption and Root Fracture: A Case Report.

AIM: This case aims to detail intentional replantation as a last resort to save an otherwise hopeless premolar with perforated internal resorption and root fracture. BACKGROUND: Internal root resorption, progressive destruction of intraradicular dentin, is a condition that sometimes renders a tooth non-restorable. In the rare cases reported where severe internal resorption leads to root fracture, extraction of the tooth seemed to be a common treatment of choice, and a few literatures had reported endodontic surgery as an alternative treatment option. To date, there had been no report of treating internal root resorption using intentional replantation. CASE DESCRIPTION: A 20-year-old male presented swelling at the buccal region of his left maxillary second premolar (#13). Clinical examination revealed a sinus tract and fractured dens evaginatus at the occlusal surface of the tooth. Radiographically, a large area of radiolucency was detected within the middle third of the root, where root fracture was present, leaving a triangular-shaped mature root apex. The condition was diagnosed as internal root resorption and root fracture. Endodontic surgery was excluded from treatment choices due to potential damage of periodontal bone. Instead, intentional replantation was performed, with the application of biomaterials including mineral trioxide aggregate (MTA) and platelet-rich fibrin (L-PRF). The tooth achieved satisfactory healing and remained asymptomatic after 2 years of follow-up. CONCLUSION: The successful outcome of the case suggests that intentional replantation could preserve a fractured tooth caused by internal root resorption. Incorporated application of biomaterials, such as MTA and L-PRF, might as well improve the chances of saving this otherwise hopeless tooth. CLINICAL SIGNIFICANCE: Through careful planning and execution, intentional replantation is a viable alternative treatment option to preserve a fractured tooth caused by internal root resorption, while leaving periodontal bone architecture almost intact. How to cite this article: Yang Y, Zhang B, Huang C, et al. Intentional Replantation of a Second Premolar with Internal Resorption and Root Fracture: A Case Report. J Contemp Dent Pract 2021;22(5):562-567.

The effectiveness of various irrigation protocols on organic tissue removal from simulated internal resorption defects.

AIM: To evaluate the effectiveness of NaOCl, NaOCl-EDTA and NaOCl + HEBP activated by ultrasonics and XP-endo Finisher on organic tissue removal from simulated internal root resorption cavities. METHODOLOGY: The root canals of 144 single-rooted teeth were instrumented. The teeth were split longitudinally, and semicircular cavities were prepared in the canal walls on each half of the roots. Samples obtained from ground bovine muscle tissue were weighed and adapted into the semicircular cavities. The root fragments were reassembled and cemented to create a circular simulated resorption cavity within the canal. Teeth were divided into twelve groups (n = 12) according to the irrigation protocols: group 1: NaOCl, no activation; group 2: NaOCl, passive ultrasonic irrigation (PUI); group 3: NaOCl, XP-endo Finisher; group 4: NaOCl-EDTA, no activation; group 5: NaOCl-EDTA, PUI; group 6: NaOCl-EDTA, XP-endo Finisher; group 7: NaOCl + HEBP, no activation; group 8: NaOCl + HEBP, PUI; group 9: NaOCl + HEBP, XP-endo Finisher; group 10: distilled water, no activation; group 11: distilled water, PUI; and group 12: distilled water, XP-endo Finisher. The teeth were disassembled, and the tissue remaining inside the resorption cavities were weighed. The data were analysed statistically using two-way anova and Fisher's LSD tests with a significance level of 0.05. RESULTS: The use of XP-endo Finisher with the experimental solutions resulted in the greatest tissue weight loss compared to the other activation protocols (P < 0.001). There was no significant difference between NaOCl and NaOCl + HEBP in terms of tissue removal. CONCLUSION: The use of a NaOCl + HEBP mixture activated with XP-endo Finisher was an effective irrigation regimen for removing simulated organic tissues from artificial internal root resorption cavities in the straight root canals of single-rooted teeth.

External cervical resorption: part 2 - management.

Effective management of external cervical resorption (ECR) depends on accurate assessment of the true nature and accessibility of ECR; this has been discussed in part 1 of this 2 part article. This aim of this article was firstly, to review the literature in relation to the management of ECR and secondly, based on the available evidence, describe different strategies for the management of ECR. In cases where ECR is supracrestal, superficial and with limited circumferential spread, a surgical repair without root canal treatment is the preferred approach. With more extensive ECR lesions, vital pulp therapy or root canal treatment may also be indicated. Internal repair is indicated where there is limited resorptive damage to the external aspect of the tooth and/or where an external (surgical) approach is not possible due to the inaccessible nature of subcrestal ECR. In these cases, root canal treatment will also need to be carried out. Intentional reimplantation is indicated in cases where a surgical or internal approach is not practical. An atraumatic extraction technique and short extraoral period followed by 2-week splinting are important prognostic factors. Periodic reviews may be indicated in cases where active management is not pragmatic. Finally, extraction of the affected tooth may be the only option in untreatable cases where there are aesthetic, functional and/or symptomatic issues.

Severe root resorption of the upper central incisors as a consequence of playing the flute.

This study presents a case of severe root resorption of the maxillary central incisors in an 18-year-old woman who was referred for orthodontic treatment of irregular dental arches. A detailed history revealed that she used to play the block flute on an everyday basis during childhood. Against all warnings, she continued to firmly press her teeth into the mouthpiece of the instrument. Impressions of the upper central incisors were clearly visible on the instrument. Although it is well known that excessive occlusal forces can result in root resorption, to the authors' knowledge, this case involves one of the first reported occurrences of extensive root resorption that was most likely caused by playing a wind instrument during childhood.

Orthodontic-surgical retreatment of facial asymmetry with occlusal cant and severe root resorption: A 3-year follow-up.

Our objective was to report the orthodontic and surgical retreatment of a patient who had undergone a prolonged orthodontic treatment with extractions, but who had unsatisfactory results and persistent side effects. The man, aged 25 years 3 months, sought treatment with major complaints of facial and smile asymmetries. The clinical examination showed a mandibular deviation to the right and a maxillary occlusal cant. A Class II Division 1 subdivision right was observed. Radiographic examination showed extensive root resorptions in the maxillary second premolars and absence of the 4 first premolars. The maxillary midline was deflected 2 mm to the left, and the mandibular midline was shifted 5 mm to the right. Aligning and leveling were performed with orthodontic fixed appliances, with a standard edgewise system (0.022 × 0.028 in), followed by LeFort I maxillary impaction and bilateral sagittal split osteotomy with asymmetrical advancement. Retreatment showed outstanding results that remained stable after 3 years of follow-up. Root resorption in the second premolars did not seem to increase. Orthodontic-surgical intervention is the main choice for correcting esthetic and functional problems in facial asymmetry, particularly in cases of retreatment.

Technological advances in endodontics: treatment of a mandibular molar with internal root resorption using a reciprocating single-file system.

The field of endodontics has become increasingly successful due to technological advances that allow clinicians to solve clinical cases that would have been problematic a few years ago. Despite such advances, endodontic treatment of teeth with internal root resorption remains challenging. This article presents a clinical case in which a reciprocating single-file system was used for endodontic treatment of a mandibular molar with internal root resorption. Radiographic examination revealed the presence of internal root resorption in the distobuccal root canal of the mandibular right first molar. A reciprocating single-file system was used for root canal instrumentation and final preparation, and filling was obtained through a thermal compaction technique. No painful symptoms or periapical lesions were observed in 12 months of follow-up. The results indicate that a reciprocating single-file system is an adequate alternative for root canal instrumentation, particularly in teeth with internal root resorption.

Autotransplantation: A Reliable Treatment Modality for Severely Malpositioned Teeth.

Maxillary canines are the most commonly impacted teeth, second only to third molars. Various treatment methods may be used to recover impacted maxillary canines. This is a report of a 14-year-old girl with a severely malpositioned impacted right maxillary canine which accompanied severe root resorption of adjacent tooth, treated by autotransplantation with a computer aided rapid prototyping model as a surgical guide. This case report demonstrates that autotransplantation can be a reliable treatment alternative, in cases with a severely malpositioned impacted canine, providing acceptable prognosis.

Unusual Adenomatoid Odontogenic Tumor.

The adenomatoid odontogenic tumor is a rare benign neoplasm. It can, however, have locally aggressive behavior. This is a case of an adenomatoid odontogenic tumor of unusual location and behavior in a 15-year-old female patient. A panoramic radiograph revealed a large radiolucent lesion involving the retained tooth 33. Teeth involved in this lesion were displaced and with apparent root resorption. A prototype of the mandible showed a marked expansion of cortical bone, fenestration points in the lingual cortex, and fragility of the base of the mandible. Therefore, because of the risk of postoperative pathologic fracture the placement of a 2.4-mm reconstruction plate was indicated. Total enucleation of the lesion, as well as placement of a reconstruction plate were performed. Despite the large bone destruction, with the correct surgical procedure and the use of the reconstruction plate the patient recovered without incidents and a 24-month postoperative radiography showed satisfactory bone formation.

Rescue therapy with orthodontic traction to manage severely impacted mandibular second molars and to restore an alveolar bone defect.

This case report describes the successful treatment of severely impacted mandibular second molars with severe apical root resorption of the mandibular first molars. The vertically impacted second molars were orthodontically moved (using orthodontic mini-implants) without additional root resorption of the first molars. The orthodontic treatment provided a satisfactory and stable outcome by improving the periodontium surrounding the first and second molars. The treatment also eliminated the need for prosthetic treatment by preserving the first and second molars.

Management of progressive apical root resorption 13 years after dental trauma and primary endodontic treatment.

Many studies have focused on the search for a restorative material with good sealing properties and biocompatibility for treatment of teeth with open apices and necrotic pulps, which can result from periradicular disease and root resorption. Mineral trioxide aggregate (MTA) has exhibited promising clinical results in retrograde fillings and pulpotomies as well as for treatment of root perforations, root resorptions, incomplete root formations, and pulpal necrosis. This case report describes the management of a progressive apical root resorption in a previously traumatized tooth that had been endodontically treated. Five years of clinical and radiographic follow-up demonstrated the clinical efficacy of MTA in limiting the inflammatory resorptive process and promoting apexification and regeneration of periradicular tissue.

Bimaxillary protrusion with an atrophic alveolar defect: orthodontics, autogenous chin-block graft, soft tissue augmentation, and an implant.

Bimaxillary protrusion in a 28-year-old woman was complicated by multiple missing, restoratively compromised, or hopeless teeth. The maxillary right central incisor had a history of avulsion and replantation that subsequently evolved into generalized external root resorption with Class III mobility and severe loss of the supporting periodontium. This complex malocclusion had a discrepancy index of 21, and 8 additional points were scored for the atrophic dental implant site (maxillary right central incisor). The comprehensive treatment plan included extraction of 4 teeth (both maxillary first premolars, the maxillary right central incisor, and the mandibular right first molar), orthodontic closure of all spaces except for the future implant site (maxillary right central incisor), augmentation of the alveolar defect with an autogenous chin-block graft, enhancement of the gingival biotype with a connective tissue graft, and an implant-supported prosthesis. Orthodontists must understand the limitations of bone grafts. Augmented alveolar defects are slow to completely turn over to living bone, so they are usually good sites for implants but respond poorly to orthodontic space closure. However, postsurgical orthodontic treatment is often indicated to optimally finish the esthetic zone before placing the final prosthesis. The latter was effectively performed for this patient, resulting in a total treatment time of about 36 months for comprehensive interdisciplinary care. An excellent functional and esthetic result was achieved.

Surgical repair of invasive cervical root resorption with calcium-enriched mixture cement: a case report.

Invasive cervical resorption (ICR) occurs in the cervical area of the teeth due to the formation of a soft tissue that progressively resorbs dentin. The disease is asymptomatic unless the pulp is exposed. This article presents a case involving a mandibular canine that was treated with a calcium-enriched mixture (CEM) cement. After a full mucoperiosteal flap was performed, the soft tissue was curetted away and the cavity filled with CEM biomaterial. One week later, the supragingival surface of the CEM was polished and covered with composite resin. At a 1-year follow-up visit, the pulp was healthy and the gingival probing depth decreased from >3 mm to 1 mm, showing attachment gain. As a biocompatible material, CEM has proven its ability in dentinogenesis, cementogenesis, and osteogenesis; it may prove to be a suitable biomaterial for treating ICR cases.

Orthodontic retraction of autotransplanted premolar to replace ankylosed maxillary incisor with replacement resorption.

This case report describes the successful treatment of an adult with lip protrusion and a previously traumatized maxillary central incisor that had experienced replacement root resorption. An extracted premolar was transplanted into the incisor space and retracted orthodontically. Autotransplantation was successful with complete root formation and, combined with orthodontic treatment, provided a satisfying esthetic outcome.

Ankylosed maxillary incisor with severe root resorption treated with a single-tooth dento-osseous osteotomy, vertical alveolar distraction osteogenesis, and mini-implant anchorage.

Dentoalveolar ankylosis interferes with the vertical growth of the alveolar process, which can lead to an open bite, an unesthetic smile, and occlusal disharmony. This case report presents a new treatment protocol for an ankylosed tooth with severe root resorption using a combined surgical orthodontic management protocol involving a single-tooth dento-osseous osteotomy and vertical alveolar distraction osteogenesis with intraoral elastics and mini-implant anchorage. After distraction and active orthodontic treatment, the patient's anterior open bite was corrected. A Class I dental relationship was achieved, overjet was decreased, and a normal incisor relationship was obtained.

Accelerating orthodontic tooth movement with the aid of periodontal surgery--the practitioner viewpoint.

INTRODUCTION: There has been a revival of interest in the acceleration of orthodontic tooth movement (OTM) by inducing injury to dentoalveolar cortical bone. Termed corticotomy, the procedure offers an advantage to adult patients whose bone metabolism is such that any reduction in treatment time would be welcomed. The procedure has been refined for over 100 years and recent research indicates treatment duration may be reduced often by as much as a third, but it is not clear how widely the method is applied in practice. For the procedure to be successful, careful interdisciplinary management by orthodontists and periodontists is required. However, information regarding the attitude and knowledge of practitioners and the frequency of the procedure performed in Australia and New Zealand is lacking. METHODS: A questionnaire was formulated and tested in a pilot study on postgraduate orthodontic and periodontic students at The University of Adelaide. As a consequence of the responses, the wording of several questions was clarified and the sequence modified to produce the final format. Separate questionnaires were developed for specialist orthodontists and periodontists in keeping with their different backgrounds and were distributed at two relevant conferences. RESULTS AND CONCLUSIONS: The number of practitioners who had been involved with at least one corticotomy per annum was low for orthodontists (12%) and periodontists (18%). The majority of those surveyed believed that more research was required on corticotomy-facilitated OTM and would not recommend the procedure to patients without greater investigation of the technique. More than half of the sampled orthodontists indicated that they would never recommend corticotomy-facilitated orthodontics to their patients. The minority who were willing to recommend the procedure would limit involvement to adult patients, the management of ankylosed teeth, impacted canines and patients susceptible to root resorption. Over 90% of the sampled periodontists believed that there were adverse side effects.

Enucleation of jaw cyst combined with intentional replantation to retain cyst-involved teeth.

BACKGROUND: Jaw cysts often deeply involve adjacent tooth roots, making it difficult to preserve them. The purpose of this retrospective study was to investigate the effectiveness of an intentional replantation (IR) strategy combined with cyst enucleation in preserving cyst-involved teeth during jaw cyst removal. MATERIALS AND METHODS: Fifteen patients with jaw cysts and deeply involved teeth were treated with IR and cyst enucleation. All patients received root canal therapy prior to surgery, except for one patient who received it during surgery. The involved teeth were extracted, and the root surface was carefully cleaned before IR and cyst enucleation. Patients were followed up for 12-14 months, with indicators including clinical complaints, replanted tooth stability, and root resorption. RESULTS: No cyst recurrence was observed, and all replanted teeth survived with good local gingival condition and no marked swelling or recession. Radiographic findings showed clear periodontal space surrounding the replanted teeth. One replanted tooth exhibited slight root resorption due to occlusal trauma, but the resorption ceased after occlusal adjustment. CONCLUSIONS: IR combined with cyst enucleation is an effective strategy for thoroughly cleaning jaw cysts and preserving teeth involved in the cyst.

Intrusion of overerupted maxillary molars with miniscrew implant anchorage: a radiographic evaluation.

The aim of this retrospective study was to quantitatively evaluate the treatment effects of intrusion of overerupted maxillary molars using miniscrew implant anchorage and to investigate the apical root resorption after molar intrusion. The subjects included 30 patients whose average ages were 35.5±9.0 years. All patients had received intrusion treatments for overerupted maxillary molars with miniscrew anchorage. There were 38 maxillary first molars and 26 maxillary second molars to be intruded. Two miniscrews were inserted in the buccal and palatal alveolar bone mesial to the overerupted molar. Force of 100-150 g was applied by the elastic chains between screw head and attachment on each side. Lateral cephalograms and panoramic radiographs taken before and after intrusion were used to evaluate dental changes and root resorption of molars. Only 6 of the 128 miniscrews failed. The first and second molars were significantly intruded by averages of 3.4 mm and 3.1 mm respectively (P<0.001). The average intrusion time was more than 6 months. The crown of the molars mesially tilted by averages of 3.1 degrees and 3.3 degrees (P<0.001) for first and second molars. The amounts of root resorption were 0.2-0.4 mm on average. The intrusion treatment of overerupted molars with miniscrew anchorages could be used as an efficient and reliable method to recover lost restoration space for prosthesis. Radiographically speaking, root resorption of molars was not clinically significant after application of intrusive forces of 200 to 300 g.

[Decoronation: treatment protocol for ankylotic root resorption as a consequence of dental trauma].

Severe dental traumatic injuries, such as the complete displacement of a tooth from its socket (Avulsion) or the displacement of a tooth within its socket (Intrusive Luxation), may result in extensive injury to the root surface. As a result, the root surface injury heals without cementum and there is fusion between the alveolar bone and the exposed dentin or anorganic exposed cementum, without any attachment apparatus between them. This phenomenon is known as "dento-alveolar ankylosis" and is accompanied by ankylotic resorption of the root. In a process that results subsequent to the ankylosis, the root surface resorbs, and this is part of the remodeling of the alveolar bone (ankylotic resorption). When the traumatic injury occurs at a young age, lateral and apical growth of the alveolar bone continues without continued physiological eruption of the tooth. As a result, the position of the ankylotic tooth does not change, and with time thetooth appears infra-occluded resulting in severe esthetic and functional consequences. Extraction of the ankylotic tooth is difficult and sometimes even impossible due to the rigid fusion between the bone and the tooth. In addition, attempted extraction of the ankylotic tooth may lead to fracture of the buccal plate and resorption of the alveolar bone. Retention of the ankylotic tooth may lead to damage in bone deposition in the verticaldimension, leading to difficulties in future prosthodonticrehabilitation, research-based information has been incorporated