Effect of systemic antibiotic therapy on pulp repair following extrusive luxation and avulsion in a murine model: A histomorphological study.

BACKGROUND/AIM: The evidence for any benefit of systemic antibiotic therapy on pulp survival following extrusive luxation and avulsion is inconclusive. The aim of this study was to evaluate the effect of systemic antibiotic therapy with amoxycillin and tetracycline for 7 days on different aspects of dental pulp repair in a murine model. MATERIAL AND METHODS: The right maxillary incisor of 180 4 to 8-week-old male Wistar rats underwent extrusive luxation or avulsion. The animals were then treated with saline solution (control), tetracycline, or amoxicillin administered intra-gastrically for 7 days, and euthanized at 7, 15, and 30 days post-operatively. The layer of odontoblast cells, reparative dentin deposition, Hertwig's epithelial root sheath, pulp necrosis, and periapical inflammatory infiltrate were histomorphologically analyzed and scored. Mann-Whitney, Kruskal-Wallis, and Dunn tests were used to compare mean scores for the different procedures, treatments, and times (p ≤ .05). RESULTS: Significant differences were observed between luxated and avulsed teeth (p < .05). In luxated teeth, no differences were observed among treatments and times, except for more tertiary dentin deposition in the coronal third with the use of tetracycline compared with amoxicillin at 15 days (p < .05). In avulsed teeth, higher scores for the layer of odontoblast cells and lower scores for periapical inflammatory infiltrate at 7 days and pulp necrosis at 7 and 15 days were observed in the amoxicillin group compared to the saline and tetracycline groups (p < .05). At 30 days, however, no differences were observed among treatments. CONCLUSIONS: The use of systemic antibiotic therapy with tetracycline or amoxicillin for 7 days did not contribute to pulp repair following extrusive luxation or avulsion in rats. However, the results warrant further research into the use of amoxicillin for a more extended period of time in cases of avulsion.

Immediate tooth replantation in rats: effect of systemic antibiotic therapy with amoxicillin and tetracycline.

OBJECTIVES: The aim of this study was to evaluate the influence of systemic administration of antibiotics (amoxicillin and tetracycline) at the different phases of the repair process (7, 15, 30 days) in immediate rat tooth replantation. MATERIALS AND METHODS: Ninety rats had their incisors extracted and stored in saline for 5 min. Next, the teeth were replanted, and the animals were assigned to three groups according to the antibiotic administered by oral gavage: control group, amoxycillin group, and tetracycline group. Euthanasia was performed at 7, 15, and 30 days after replantation. RESULTS: Regardless of the evaluation period, the connective tissue underlying the epithelial attachment and the periodontal ligament showed statistically significant difference relative to the acute inflammatory infiltrate, which was more intense in the control group followed by the tetracycline group. CONCLUSION: These results point to the fact that systemic antibiotic therapy (SAT) in immediate tooth replantation is beneficial to pulpal and periodontal ligament repair and that amoxycillin is an excellent option. CLINICAL RELEVANCE: There is a lack of randomized studies assessing how the use of systemic antibiotics could influence tooth healing after immediate replantation.

Delayed tooth replantation in rats: effect of systemic antibiotic therapy with amoxicillin and tetracycline.

Systemic antibiotic therapy (SAT) has usually been recommended after tooth replantation, but its actual value has been questioned. As there are no reports in the literature about its influence on tooth replantation, the aim of this study was to evaluate the influence of systemic administration of antibiotics (amoxicillin and tetracycline) at the different phases of the repair process (7, 15, 30 days) in delayed rat tooth replantation. Ninety Wistar rats (Rattus norvegicus albinus) had their maxillary right incisors extracted and bench-dried for 60 min. The dental papilla, enamel organ, pulp tissue, and root surface-adhered periodontal ligament were removed, and the teeth were replanted. The animals received no antibiotics (n = 30) or were medicated systemically with amoxicillin (n = 30) and tetracycline (n = 30), and were euthanized after 7, 15, and 30 days. Regardless of the evaluation period, the acute inflammatory infiltrate was less intense and root resorption presented smaller extent and depth in the group treated with amoxicillin. The results suggest that SAT has a positive influence on the repair process in delayed tooth replantation and that amoxicillin is an excellent treatment option.

Storage Media For Avulsed Teeth: A Literature Review

Dental avulsion is the most severe type of traumatic tooth injuries because it causes damage to several structures and results in the complete displacement of the tooth from its socket in the alveolar bone. The ideal situation is to replant an exarticulated tooth immediately after avulsion because the extraoral time is a determinant factor for treatment success and for a good prognosis. However, it is not always possible. The success of replantation depends on a number of factors that may contribute to accelerate or minimize the occurrence of root resorption or ankylosis, among which is the type and characteristics of the medium used for temporary storage during the time elapsed between avulsion and replantation. Maintaining the tooth in an adequate wet medium that can preserve, as longer as possible, the vitality of the periodontal ligament cells that remain on root surface is the key to success of replantation. Recent research has led to the development of storage media that produce conditions that closely resemble the original socket environment, with adequate osmolality (cell pressure), pH, nutritional metabolites and glucose, and thus create the best possible conditions for storage. Although these storage media can now be purchased in the form of retail products, the most common scenario is that such a product will not be readily available at the moment of the accident This paper reviews the literature on the different storage media that have been investigated for avulsed teeth based on full-length papers retrieved from PubMed/Medline, Lilacs, BBO and SciELO electronic databases using the key words ‘storage medium’, ‘transportation medium’, ‘avulsion’, ‘tooth avulsion’, ‘replantation’, ‘tooth replantation’, ‘milk’ and ‘propolis’. After application of inclusion and exclusion criteria, 39 papers were selected and critically reviewed with respect to the characteristics, efficacy and ease of access of the storage medium. The review of the literature showed that a wide array of types of wet storage media have been evaluated in laboratory studies and clinical reports, including cell and tissue culture solutions like Hank's Balanced Salt Solution (HBSS); medical/hospital products developed specifically for organ storage purposes, such as Viaspan® and Euro-Collins®; culture media, like Minimum Essential Medium (MEM); saline; natural products like water, saliva, bovine milk and its variations, propolis, green tea, Morus rubra (red mulberry), egg white and coconut water; rehydrating solutions, like Gatorade® and Ricetral, and even contact lens solutions. Based on the literature, it could be stated that, so far, apart from Based on the literature, it could be stated that, so far, apart from solutions designed specifically for storage and culture purposes, regular pasteurized whole milk is the most frequently recommended and with the best prognosis among other solutions that are likely to be available at the scene of an accident, such as water, saline or saliva. Its advantages include its high availability, ready accessibility, physiologically compatible pH and osmolality (fluid pressure) with the root-surface adhered PDL cells, presence of nutrients and growth factors. However, there is not yet a single solution that fulfills all requirements to be considered as the ideal medium for temporary storage of avulsed teeth, and research on this field should carry on.

Dentre os traumatismos dento-alveolares, a avulsão dentária é a mais severa por causar danos em muitas estruturas e por consistir num deslocamento total do dente de seu alvéolo ósseo. O tratamento ideal é o reimplante dentário imediatamente após avulsão, pois o tempo extra-bucal é fator determinante para um bom prognóstico e o sucesso do tratamento. Infelizmente, isto nem sempre é possível. O sucesso do reimplante depende de muitos fatores que podem acelerar ou retardar a reabsorção radicular ou mesmo a anquilose e entre eles estão o tipo e as características do meio de armazenamento no qual esse dente foi mantido entre a avulsão e o reimplante. Manter o dente num meio úmido adequado que possa preservar pelo maior tempo possível a vitalidade das células do ligamento periodontal na superfície radicular é o elemento-chave do reimplante bem sucedido. Pesquisas recentes levaram ao desenvolvimento de meios de armazenamento que tem condições muito próximas às do alvéolo dental, possuindo osmolalidade (pressão celular) adequada, pH, metabólitos nutrientes e glicose. Embora estes meios de armazenamento possam ser adquiridos comercialmente, a situação mais comum é que o produto não esteja facilmente acessível no momento do acidente. Frente a isto, o objetivo deste artigo é apresentar uma revisão da literatura sobre diversos meios de armazenamento para dentes avulsionados, considerando suas características, efetividade e acessibilidade. Para isto, foi realizada uma busca de artigos nas bases de dados PubMed/Medline, Lilacs, BBO e Scielo por meio das palavras-chave: ‘storage media’, ‘tooth replantation’, ‘tooth avulsion’, ‘milk’ e ‘propolis’. Após a avaliação dentro dos critérios de inclusão e exclusão, 39 artigos foram selecionados e os meios de armazenamento neles descritos foram criteriosamente estudados quanto às suas características, efetividade e acessibilidade. A revisão da literatura revelou uma grande variedade de meios úmidos de estocagem avaliada em estudos laboratoriais e casos clínicos, incluindo soluções para cultura de células e tecidos, como a Hank's Balanced Salt Solution (HBSS); produtos médico-hospitalares desenvolvidos especificamente para armazenamento de órgãos, como Viaspan® e Euro-Collins®; meios de cultura como o Meio Mínimo Essencial (MEM); solução fisiológica; produtos naturais, como água, saliva, leite bovino em suas diferentes apresentações, própolis, chá verde, Morus rubra, clara de ovo e água de coco; produtos reidratantes como Gatorade® e Ricetral, até mesmo soluções para lentes de contato. Com base na literatura, pode-se afirmar que até agora, com exceção das soluções específicas para armazenamento e culturas, o leite pasteurizado integral é o mais indicado e o que tem o melhor prognóstico dentre as substâncias que estejam mais provavelmente disponíveis no local do acidente, como água, solução fisiológica ou saliva. Suas vantagens são a grande disponibilidade, fácil acesso, pH fisiologicamente compatível e osmolalidade (pressão do líquido) com as células do ligamento periodontal aderidas à superfície radicular, presença de nutrientes e fatores de crescimento. Apesar disso, o fato é que não se tem um produto que preencha todos os requisitos para ser considerado ideal para o armazenamento temporário de dentes avulsionados e as pesquisas para tanto devem prosseguir.

Storage media for avulsed teeth: a literature review.

Dental avulsion is the most severe type of traumatic tooth injuries because it causes damage to several structures and results in the complete displacement of the tooth from its socket in the alveolar bone. The ideal situation is to replant an exarticulated tooth immediately after avulsion because the extraoral time is a determinant factor for treatment success and for a good prognosis. However, it is not always possible. The success of replantation depends on a number of factors that may contribute to accelerate or minimize the occurrence of root resorption or ankylosis, among which is the type and characteristics of the medium used for temporary storage during the time elapsed between avulsion and replantation. Maintaining the tooth in an adequate wet medium that can preserve, as longer as possible, the vitality of the periodontal ligament cells that remain on root surface is the key to success of replantation. Recent research has led to the development of storage media that produce conditions that closely resemble the original socket environment, with adequate osmolality (cell pressure), pH, nutritional metabolites and glucose, and thus create the best possible conditions for storage. Although these storage media can now be purchased in the form of retail products, the most common scenario is that such a product will not be readily available at the moment of the accident This paper reviews the literature on the different storage media that have been investigated for avulsed teeth based on full-length papers retrieved from PubMed/Medline, Lilacs, BBO and SciELO electronic databases using the key words 'storage medium', 'transportation medium', 'avulsion', 'tooth avulsion', 'replantation', 'tooth replantation', 'milk' and 'propolis'. After application of inclusion and exclusion criteria, 39 papers were selected and critically reviewed with respect to the characteristics, efficacy and ease of access of the storage medium. The review of the literature showed that a wide array of types of wet storage media have been evaluated in laboratory studies and clinical reports, including cell and tissue culture solutions like Hank's Balanced Salt Solution (HBSS); medical/hospital products developed specifically for organ storage purposes, such as Viaspan® and Euro-Collins®; culture media, like Minimum Essential Medium (MEM); saline; natural products like water, saliva, bovine milk and its variations, propolis, green tea, Morus rubra (red mulberry), egg white and coconut water; rehydrating solutions, like Gatorade® and Ricetral, and even contact lens solutions. Based on the literature, it could be stated that, so far, apart from Based on the literature, it could be stated that, so far, apart from solutions designed specifically for storage and culture purposes, regular pasteurized whole milk is the most frequently recommended and with the best prognosis among other solutions that are likely to be available at the scene of an accident, such as water, saline or saliva. Its advantages include its high availability, ready accessibility, physiologically compatible pH and osmolality (fluid pressure) with the root-surface adhered PDL cells, presence of nutrients and growth factors. However, there is not yet a single solution that fulfills all requirements to be considered as the ideal medium for temporary storage of avulsed teeth, and research on this field should carry on.

Efeito da antibioticoterapia sistêmica com amoxicilina ou tetraciclina no reimplante dentário imediato em rato / The effect of systemic antibiotic therapy with amoxicillin and tetracycline in immediate tooth replantation in rat

O reimplante dentário é o tratamento de escolha para a avulsão e o seu sucesso tem relação direta com a vitalidade do ligamento periodontal e controle da contaminação. O controle da inflamação durante o processo de reparo do periodonto após o reimplante tem grande importância porque a sua persistência pode favorecer a reabsorção dentária. Tem-se recomendado a antibioticoterapia sistêmica, porém faltam estudos que demonstrem o seu real papel nesse processo. Portanto, o objetivo do trabalho foi avaliar o efeito da antibioticoterapia sistêmica com amoxicilina e tetraciclina após reimplante dentário imediato em ratos. Noventa ratos (Rattus norvegicus albinus, variedade Wistar) tiveram os incisivos extraídos e armazenados em 20 ml de solução de soro fisiológico por 5 minutos. Em seguida, os dentes foram reimplantados e os animais divididos em 3 grupos de acordo com o antibiótico administrado por via intragástrica (Técnica de Gavagem): Grupo I - soro fisiológico, Grupo II - Amoxicilina e Grupo III - Tetraciclina. A eutanásia ocorreu aos 7, 15 e 30 dias após o reimplante. Os dados obtidos foram submetidos na análise histomorfométrica foram submetidos a análise estatística. Independente do período analisado o tecido conjuntivo subjacente à reinserção epitelial e o ligamento periodontal mostraram diferença estatística quanto ao infiltrado inflamatório aguda que se apresentava mais intenso no grupo controle seguido pelo grupo da Tetraciclina. Esses resultados permitem concluir que a antibioticoterapia sistêmica, no reimplante dentário imediato, favorece o processo de reparo da polpa e do ligamento periodontal e que a Amoxicilina foi mais efetiva que a Tetraciclina

Tooth replantation is the choice treatment for avulsion and its success has a direct relationship with the vitality of the periodontal ligament and contamination control. The control of inflammation during periodontal repair after replantation is quite important, because it’s persistence may promote resorption. It has been recommended the systemic antibiotic therapy, although there are just a little studies that demonstrate its real effect in the process. Therefore, the aim of the study was to evaluate the effect of systemic antibiotic therapy with amoxicillin and tetracycline after immediate tooth replantation in rats. The incisors of 90 rats (Rattus norvegicus albinus variety Wistar) were extracted and stored in 20 ml of saline solution for 5 minutes. Then, the teeth were replanted and the animals were divided into 3 groups according to the antibiotic administered by gavage: Group I – saline, Group II - amoxicillin and Group III - tetracycline. The rats were euthanized at 7, 15 and 30 days after reimplantation. Regardless of the analyzed period, the connective tissue underlying the epithelial reattachment and periodontal ligament showed a more intense infiltrate inflammatory acute in the control group followed by the Tetracycline group. These results indicate that systemic antibiotic therapy promotes the healing process of imediate tooth replantation and that the Amoxicillin is greater than Tetracycline

Short-term vs long-term calcium hydroxide therapy after immediate tooth replantation: a histomorphometric study in monkey's teeth.

Endodontic treatment is an important step of tooth replantation protocols, but the ideal moment for definitive obturation of replanted teeth has not yet been established. In this study, a histomorphometric analysis was undertaken to evaluate the repair process on immediate replantation of monkey's teeth after calcium hydroxide (CH) therapy for 1 and 6 months followed by root canal filling with a CH-based sealer (Sealapex(®) ). The maxillary and mandibular lateral incisors of five female Cebus apella monkeys were extracted, kept in sterile saline for 15 min, replanted and splinted with stainless steel orthodontic wire and composite resin for 10 days. In Group I (control), definitive root canal filling was performed before tooth extraction. In Groups II and III, CH therapy started after removal of splint, and definitive root canal filling was performed 1 and 6 months later, respectively. The animals were euthanized 9 months after replantation, and specimens were processed for histomorphometric analysis. In all groups, epithelial attachment occurred at the cementoenamel junction or very close to this region; the areas of resorption on root surface had small extension and depth and were repaired by newly formed cementum; and the periodontal ligament was organized. Statistical analysis of the scores obtained for the histomorphometric parameters did not show any statistically significant difference (P = 0.1221) among the groups. The results suggests that when endodontic treatment is initiated 10 days after immediate replantation and an antibiotic regimen is associated, definitive root canal filling can be performed after a short-term CH therapy.