Tooth replantation

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>.

Indications

• 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.

Contraindications

• Grossly decayed tooth.
• Missing interseptal bone.
• Moderate to severe periodontal disease.
• Curved and flared canals.

Classification

• Intentional replantation
• Unintentional replantation

Factors affecting replantation procedure

• 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.
• 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

• Incise periodontal fibers using No. 15 scalpel blade
• 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.
• 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

• Extended extraoral time resulting in damage to periodontal cells.
• Contamination during procedure resulting in infection and resorption.
• Undetected fracture of tooth.
• Mishandling of tooth during reimplantation procedure.

Complications and risk

• Pulp necrosis
• Root resorption
• Infection related resorption
• Tooth discolouration
• Ankylosis

References

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