Tooth replantation: Difference between revisions

From WikiMD's Wellness Encyclopedia

Newer edit →
CSV import
 
CSV import
Line 1: Line 1:
Replantation is defined as intentional removal of a tooth and after examination, diagnosis, endodontic therapy and repair, placing it back into the original socket<ref>Grossman LI. International replantation of teeth: A clinical evaluation. J Am Dent Assoc 1966;72(5):1111-18.</ref>.
{{Short description|A dental procedure involving the reinsertion of a tooth into its socket}}
{{Infobox medical procedure
| name        = Tooth replantation
| image        = Periodontium.svg
| caption      = Diagram of the periodontium, which is crucial in tooth replantation
| ICD10        = K08.1
| ICD9        = 525.89
| MeshID      = D014081
}}


== Indications ==
'''Tooth replantation''' is a dental procedure that involves reinserting a tooth into its original socket after it has been avulsed, or knocked out. This procedure is most commonly performed on permanent teeth, as primary teeth are typically not replanted due to the risk of damaging the developing permanent tooth beneath.
* Tooth avulsion injury with intact tooth socket.
* Separated instrument at apex of the tooth.
* Unable to perform non surgical endodontic treatment due to limited mouth opening.
* Persistent infection even after root canal treatment.
* Inaccessibility for surgical approach for periradicular surgery due to anatomic factors.
* Perforations in inaccessible areas where for surgery excessive bone loss is required.


==Indications==
Tooth replantation is indicated primarily in cases of traumatic dental injuries where a tooth has been completely avulsed. The success of the procedure depends on several factors, including the time elapsed since the avulsion, the condition of the periodontal ligament, and the storage medium in which the tooth was kept prior to replantation.


== Contraindications ==
==Procedure==
* Grossly decayed tooth.
The procedure for tooth replantation involves several steps:
* Missing interseptal bone.
* Moderate to severe periodontal disease.
* Curved and flared canals.


== Classification ==
# '''Immediate Action:''' If a tooth is avulsed, it should be handled by the crown, not the root, to avoid damaging the periodontal ligament fibers. The tooth should be rinsed gently with saline or milk if dirty, but not scrubbed.
* Intentional replantation
# '''Storage:''' If immediate replantation is not possible, the tooth should be stored in a suitable medium such as milk, saline, or a specialized storage solution like Hank's Balanced Salt Solution.
* Unintentional replantation
# '''Replantation:''' The dentist will clean the socket and gently reinsert the tooth into its original position. Proper alignment is crucial.
# '''Stabilization:''' The tooth is then stabilized using a flexible splint for a period of 1-2 weeks to allow for reattachment of the periodontal ligament.
# '''Follow-up Care:''' Antibiotics may be prescribed, and the patient is advised to maintain good oral hygiene and avoid biting on the replanted tooth.


== Factors affecting replantation procedure ==
==Prognosis==
* Root surface (with PDL cells) should be kept moist with Hanks balanced salt solution (HBSS) or saline during the time tooth is out of socket.
The prognosis for a replanted tooth depends on several factors:
* Out of socket time should be shortest possible
* One should take care not to damage PDL cells and cementum. Avoid touching forcep’s beaks on cementum.


== Techniques ==
- '''Time:''' The sooner the tooth is replanted, the better the prognosis. Ideally, replantation should occur within 30 minutes of avulsion.
* Incise periodontal fibers using No. 15 scalpel blade
- '''Storage Medium:''' Teeth stored in an appropriate medium have a better chance of successful replantation.
* Gently elevate the tooth using forceps in rocking motion until grade I mobility is achieved. The forceps should be placed away from the cementum so as to avoid damage to periodontal ligament.
- '''Root Development:''' Teeth with incomplete root development have a better prognosis due to the potential for continued root growth and revascularization.
* Take out the tooth using forceps whose beaks have been wrapped with a sterile gauze piece which is saturated with HBSS or normal saline.
* Thoroughly examine the roots for defects or fractures
* Repair the root defects if indicated. Any repair or procedure should be done as quickly as possible in the bath of normal saline or HBSS solution so as to prevent desiccation.
* Irrigate the extraction socket using normal saline
* Gently place the tooth back in the socket
* After placing tooth back, place a rolled gauze piece on occlusal surface of the tooth and ask patient to bite on it. This will help in seating the tooth into socket. Ask patient to maintain biting pressure for at least 5-10 minutes.
* Stabilize the tooth using periopack, sutures or splints. Recall the patient after 7-14 days so as to remove the stabilization and to evaluate the mobility.
* Follow-up after 2, 6, 9 and 12 months is done following surgery.


== Causes of failure of reimplantation ==
==Complications==
* Extended extraoral time resulting in damage to periodontal cells.
Complications of tooth replantation can include:
* Contamination during procedure resulting in infection and resorption.
* Undetected fracture of tooth.
* Mishandling of tooth during reimplantation procedure.


== Complications and risk ==
- '''Ankylosis:''' The tooth may fuse to the bone, leading to resorption and eventual loss.
* Pulp necrosis
- '''Infection:''' There is a risk of infection if the tooth or socket is not properly cleaned.
* Root resorption
- '''Pulp Necrosis:''' The pulp inside the tooth may die, necessitating root canal treatment.
* Infection related resorption
* Tooth discolouration
* Ankylosis


 
==Also see==
<youtube>
* [[Dental trauma]]
title='''Documentary Film - {{PAGENAME}}'''
* [[Periodontal ligament]]
movie_url=http://www.youtube.com/v/YqIQ2FWQ_Ls
* [[Root canal treatment]]
&rel=1
* [[Dental avulsion]]
embed_source_url=http://www.youtube.com/v/YqIQ2FWQ_Ls
&rel=1
wrap = yes
width=750
height=600
</youtube>


==References==
==References==
{{reflist}}
{{Reflist}}


{{stub}}
[[Category:Dental procedures]]
{{dictionary-stub1}}
[[Category:Emergency medicine]]

Revision as of 03:01, 11 December 2024

A dental procedure involving the reinsertion of a tooth into its socket


Diagram of the periodontium, which is crucial in tooth replantation
Pronunciation
Other names
Specialty
Uses
Complications
Approach
Types
Recovery time
Other options
Frequency



Tooth replantation is a dental procedure that involves reinserting a tooth into its original socket after it has been avulsed, or knocked out. This procedure is most commonly performed on permanent teeth, as primary teeth are typically not replanted due to the risk of damaging the developing permanent tooth beneath.

Indications

Tooth replantation is indicated primarily in cases of traumatic dental injuries where a tooth has been completely avulsed. The success of the procedure depends on several factors, including the time elapsed since the avulsion, the condition of the periodontal ligament, and the storage medium in which the tooth was kept prior to replantation.

Procedure

The procedure for tooth replantation involves several steps:

  1. Immediate Action: If a tooth is avulsed, it should be handled by the crown, not the root, to avoid damaging the periodontal ligament fibers. The tooth should be rinsed gently with saline or milk if dirty, but not scrubbed.
  2. Storage: If immediate replantation is not possible, the tooth should be stored in a suitable medium such as milk, saline, or a specialized storage solution like Hank's Balanced Salt Solution.
  3. Replantation: The dentist will clean the socket and gently reinsert the tooth into its original position. Proper alignment is crucial.
  4. Stabilization: The tooth is then stabilized using a flexible splint for a period of 1-2 weeks to allow for reattachment of the periodontal ligament.
  5. Follow-up Care: Antibiotics may be prescribed, and the patient is advised to maintain good oral hygiene and avoid biting on the replanted tooth.

Prognosis

The prognosis for a replanted tooth depends on several factors:

- Time: The sooner the tooth is replanted, the better the prognosis. Ideally, replantation should occur within 30 minutes of avulsion. - Storage Medium: Teeth stored in an appropriate medium have a better chance of successful replantation. - Root Development: Teeth with incomplete root development have a better prognosis due to the potential for continued root growth and revascularization.

Complications

Complications of tooth replantation can include:

- Ankylosis: The tooth may fuse to the bone, leading to resorption and eventual loss. - Infection: There is a risk of infection if the tooth or socket is not properly cleaned. - Pulp Necrosis: The pulp inside the tooth may die, necessitating root canal treatment.

Also see

References

<references group="" responsive="1"></references>

Retrieved from "https://wikimd.com/index.php?title=Tooth_replantation&oldid=6036805"