Continued root formation after delayed replantation of an avulsed immature permanent tooth.

Introduction. Tooth avulsion in the young permanent dentition is a frequent finding, and its prognosis depends on the treatment of the avulsed tooth before replantation, the extra-alveolar time, the storage medium, and the patient's general health. The present report describes management of an immature avulsed lower central incisor 90 minutes after the accident. Methods. A right lower central incisor of a 7-year-old girl was avulsed, and it was soaked in a glass of milk. 90 minutes after avulsion, replantation was performed, and the tooth was splinted; but after two weeks the replanted tooth's pulp was necrotic. Thus, endodontic treatment was performed and root canal was filled using a calcium hydroxide and iodoform paste (Metapex). Three months later, the intracanal medication was washed out and the canal was sealed using an apical plug of calcium enriched mixture (CEM) cement. Results. 20 months after replantation the tooth was completely asymptomatic, with physiologic mobility. Also, continued root formation including an apical segment beyond the artificial apical plug was observed. Conclusion. Creation of an appropriate apical barrier following the disinfection of root canal system promoted continued root-end growth in a replanted immature permanent tooth.

Treatment of necrotic calcified tooth using intentional replantation procedure.

Introduction. If the teeth are impacted by a chronic irritant, the pulp space possibly will undergo calcific changes that may impede access opening during root canal treatment. In such cases that conventional endodontic treatment is impossible or impractical, intentional replantation may be considered as a last solution to preserve the tooth. Methods. After failing to perform conventional root canal therapy for a necrotic calcified right mandibular second premolar, the tooth was gently extracted. The root apex was resected and the root end cavity was prepared and filled with calcium enriched mixture (CEM) cement. Then, the extracted tooth was replanted in its original position. Results. After a year the tooth was asymptomatic, and the size of periapical radiolucency was remarkably reduced and no clinical sign of ankylosis was observed. Conclusion. Intentional replantation of the necrotic calcified teeth could be considered as an alternative to teeth extraction, especially for the single-rooted teeth and when nonsurgical and surgical endodontic procedures seem impossible.