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A histologic study of replanted and transplanted endodontically and nonendodontically treated teeth in dogs
Endodontics American
Association
of Endodontists
I. B. Bender, Editor
A histologic study of replanted and
transplanted endodontically and nonendodsntically treated teeth in dogs D. L. Rothschild, A. A. Goodman, Washingtott, D. C. HOM-ARD UNIVERSITY
cud K. R. Blakety, D.D.S.,
COLLEGE OF DESTISTRY
T
he purpose of this study was to examine histologically the tissue changes associated with the teeth. and surrounding structures when endodontically and nonendodontically treated maxillary incisors were replanted and transplanted in dogs. A review of the literature indicates that previous replantation and transplantation studies had been performed, but it was our opinion that further investigation was necessary. MATERIALS
AND
METHODS
Four beagle dogs, weighing 7 to ?YV$‘~ kilograms each, were used in this study. Preoperative radiographs were taken, and alginate impressions were made and poured in stone for the fabrication of a transplantation-stabilizing appliance. The dogs were anesthetized intravenously with 3 per cent Nembutal, 1 ml. per kilogram of body weight. Four maxillary incisors were extracted from each dog, utilizing both a labial and a lingual mucoperiostcal flap. Every effort was made to remove as little bone as possihlt. Sixteen teeth from four beagle dogs were used. Preoperative and postoperatire radiographs were .:aken. A stabilizing appliance was fabricated and used along with ligature wire and autocuring acrylic for fixation. Four maxillary incisors were extracted from each dog. Eight teeth, four This project
was supported
Grant 501-FR-5307. Association for Dental Research, San Fran-
by General Research Support
Presented at the meeting of the International cisco, Calif., March, 1968.
871
Pig. 1. Transplantation-stabilizing
spplinnw
in place.
endodontically treated, were repIante(I. Likewise, t,he other eight teeth (four endodontically treated and four nonenclodontic;~lly treated) were transplanted. All teeth were maintained in physiologic saline solution for approximately 30 minutes, during which time endodontie procedures were performed. The tissues were then sutured. The transplantation appliance was placed, with ligature wire and &f-curing acrylic use’~l for additional fixation (Fig. 1). Functional bite registration was pl*ocurctl at the time of placements of the appliance. Postoperative radiographs were taken, and the dogs were placed on a soft diet. The involved teeth were examined regularly for mobility and for the development of infection. At the time of death the involved teeth were excised with a surrounding area of bone and soft tissue. Block sections were made serially at designated levels and stained with hematoxylin and eosin for histologic examination. RESULTS
The dogs were killed at intervals of 15 and 30 days. The animals showed no clinical evidence of infection, and the soft tissue was normal and healthy in appearance. In each instance, endodontically treated replanted teeth appeared to be better accepted by the host than the transplanted teeth that had not been treated endodontically. Replanted
endodontically
treated
teeth
Fibrous attachment was observed in the 15da.y section areas of bone and cementurn resorption, as demonstrated osteoclastic activity and Howship’s lacnnae. The presence tory cells in the periodontal membrane space was noted. appear to be reattached.
(Fig. 2). There were by the presence of of a few inflammaSoft tissue did not
Replunted
Volume 2X Number 6
Fig. 8. Fibrous attachment and eosin stain. Magnification
in 15day x450.)
replanted
Pig. 3. hnkylosis at 30 d&ys in replanted eosin stain. Magnification, >:450.)
an.d tmnsplanted
endodontically
endodontically
treated
treated
teeth.
teeth.
teeth
873
(Hemal :oxylin
(Hematoxylin
and
874
Rothschild,
GOO~W~UII,
t111dRlnh( !/
Fig. 4. Ankylosis at 30 days in replanted and frosin stain. Magnification, x:35.)
Fig. 5. Resorption, teeth. (Hematoxylin
non-erldodonticdly
treated
with abundance of osteoclasts, in transplanted and eosin stain. (Magnification, x450.)
teeth.
(Hematoxylin
endodontically
treated
IZeplnmfed am! trmsplmted
Volume 28 Number 6
Fig. 6. Acute inflammatory response in transplanted toxylin and eosin stnin. Magnification, x100.)
nonendodontically
treated
teeth
teeth.
875
(Iiemn-
The 30-day section showed ankylosis with a decrease in fibroblastic activity and an increase in osteoblastic activity (Fig. 3). In some sections, new cementurn formation was observed. Very few inflammatory cells were seen in the periodontal membrane space. Maximum osteoid activity, with the presence of osteoblasts and osteocytts, was noted, particularly in areas of previous bone resorption. Replanted
nonendodontically
treated
teeth
Progressive degener&:ive pulpal changes were observed in both the 15- and the 30-day sections. Minimal cementum and bone resorption was noted at the apical portion of the tooth. Fibroblastic activity was noted at 15 days, with subsequent ankylosis at 30 days (Fig. 4). Transplanted
endodontically
treated
teeth
These sections showed a number of resorption areas in cementum and dentine, with an abundance of osteoclasts (Fig. 5). There were acute inflammatory responses in both of the sections. No evidence of fibroblast or osteoid formation was seen in either tl-,e 15- or the 30-day section. Transplanted
nonendodontically
treated
teeth
An acute inflammatory response was noted in both the 15- and the 30-day sections (Fig. 6). Absence of both fiber attachment and ankylosis was observed. DISCUSSION
Histologic studies indicate that, in dogs, replanted incisors show an attempt at fibroblastic activity with areas of attachment between cementum and bone at the end of 15 days. The inflammatory response is quite minimal.
At the end of 30 days, nnlq-losis OCCUI’S with ostwblastic nctivit4; particnlarly in areas of previous boric resorption. Boric resorption is evident, in all Wplanted teeth, whether endodor~tically or nonendodontically treated. IIoweve~~, this bone resorption wa.s i’ouncl in greater amounts in the replanted nonendodontically treated teeth. There appeared to be very little difference, if any, between cndodontically and nonendodonticallp treatetl tetrth in relation t.o the amount of ankylosis ant1 bone deposition at the end of 30 days. We were unable to observe any evidence of fibrous at,tachment or ankylosis in transplanted teeth; this was true in the endodontically and nonendodontically treated specimens. Inflammatory cells were present in both 15 and 30.day sections. The transplanted endotlontically treated teeth exhibited far greater bone resorption than the nonendoclontically treated teeth. rounding structures when cndodontically and nonendodontically treated maxilObservations were made of t,issue changes associated with teeth and surlary incisors were replanted and transplanted in dogs. SUMMARY
The results of this study indicate that replanted teeth are more acceptable to the host animal than transplanted teeth. The replanted teeth that have been endodontically treated appear to be the most acceptable of the groups studied on the basis of differences observed in bone and cementum resorption. There appears to be little difference between endodontic and nonendodontic replants with respect to ankylosis and bone deposition. Neither ankylosis nor fibrous attachment was observable with any tra.nsplanted specimens. REFERENCES
and Transplantation of Teeth, 1. Buck, I. F., Gray, J. N., and Roncone, P.: Reimplantation J. D. Res. 43: 824-825, 1964. 2. Csereufalvi. Miklos: Homotransalantation of Human Teeth Freshlv Taken From Cadavers, Rev. ?ran$.‘odontostomat. 11: 361-314, 1964. 3. Huebsch, Raymond F.: Implanting Teeth With Met,hyl-2-cyanoacrylate Adhesive, J. D. Res. 46: 337-339, 1967. 4. Loe, J. and Waerhaug,
5. 6. 7. 8. 9.
J.: Experimental Replantation of Teeth in Dogs and Monkeys, Arch. Oral Biol. 3: 176-184, 1961. Metzrow, R. R.: Homologous Viable Tooth Transplantation; a Clinical Immunologic and Histologic Study, ORAL SURG., ORAL MED. & ORAL PATH. 17: 375-388, 1964. Orban, Balint J.: Oral Histology and Embryology, ed. 5, St. Louis, 1962, The C. V. Mosby Company. of an Upper Latera. Incisor; a Pindborg, J. J., and Hansen, J.: Case of Replantation Histological Study, ORAL SURG., ORAL MED. & ORAL PATH. 4: 661-667, 1951. Walter, K. L.: Replantation of Single Rooted Teeth, D. Abstr. 3: 360, 1958. Wilkinson, F. C.: Some Observations of the Replantation and Transplantation of Teeth With Special Reference to the Patho-histology of the Tissues of Attachment, Brit. D. J. 38: 929-939, 1917.
Association
of Endodontists
I. B. Bender, Editor
A histologic study of replanted and
transplanted endodontically and nonendodsntically treated teeth in dogs D. L. Rothschild, A. A. Goodman, Washingtott, D. C. HOM-ARD UNIVERSITY
cud K. R. Blakety, D.D.S.,
COLLEGE OF DESTISTRY
T
he purpose of this study was to examine histologically the tissue changes associated with the teeth. and surrounding structures when endodontically and nonendodontically treated maxillary incisors were replanted and transplanted in dogs. A review of the literature indicates that previous replantation and transplantation studies had been performed, but it was our opinion that further investigation was necessary. MATERIALS
AND
METHODS
Four beagle dogs, weighing 7 to ?YV$‘~ kilograms each, were used in this study. Preoperative radiographs were taken, and alginate impressions were made and poured in stone for the fabrication of a transplantation-stabilizing appliance. The dogs were anesthetized intravenously with 3 per cent Nembutal, 1 ml. per kilogram of body weight. Four maxillary incisors were extracted from each dog, utilizing both a labial and a lingual mucoperiostcal flap. Every effort was made to remove as little bone as possihlt. Sixteen teeth from four beagle dogs were used. Preoperative and postoperatire radiographs were .:aken. A stabilizing appliance was fabricated and used along with ligature wire and autocuring acrylic for fixation. Four maxillary incisors were extracted from each dog. Eight teeth, four This project
was supported
Grant 501-FR-5307. Association for Dental Research, San Fran-
by General Research Support
Presented at the meeting of the International cisco, Calif., March, 1968.
871
Pig. 1. Transplantation-stabilizing
spplinnw
in place.
endodontically treated, were repIante(I. Likewise, t,he other eight teeth (four endodontically treated and four nonenclodontic;~lly treated) were transplanted. All teeth were maintained in physiologic saline solution for approximately 30 minutes, during which time endodontie procedures were performed. The tissues were then sutured. The transplantation appliance was placed, with ligature wire and &f-curing acrylic use’~l for additional fixation (Fig. 1). Functional bite registration was pl*ocurctl at the time of placements of the appliance. Postoperative radiographs were taken, and the dogs were placed on a soft diet. The involved teeth were examined regularly for mobility and for the development of infection. At the time of death the involved teeth were excised with a surrounding area of bone and soft tissue. Block sections were made serially at designated levels and stained with hematoxylin and eosin for histologic examination. RESULTS
The dogs were killed at intervals of 15 and 30 days. The animals showed no clinical evidence of infection, and the soft tissue was normal and healthy in appearance. In each instance, endodontically treated replanted teeth appeared to be better accepted by the host than the transplanted teeth that had not been treated endodontically. Replanted
endodontically
treated
teeth
Fibrous attachment was observed in the 15da.y section areas of bone and cementurn resorption, as demonstrated osteoclastic activity and Howship’s lacnnae. The presence tory cells in the periodontal membrane space was noted. appear to be reattached.
(Fig. 2). There were by the presence of of a few inflammaSoft tissue did not
Replunted
Volume 2X Number 6
Fig. 8. Fibrous attachment and eosin stain. Magnification
in 15day x450.)
replanted
Pig. 3. hnkylosis at 30 d&ys in replanted eosin stain. Magnification, >:450.)
an.d tmnsplanted
endodontically
endodontically
treated
treated
teeth.
teeth.
teeth
873
(Hemal :oxylin
(Hematoxylin
and
874
Rothschild,
GOO~W~UII,
t111dRlnh( !/
Fig. 4. Ankylosis at 30 days in replanted and frosin stain. Magnification, x:35.)
Fig. 5. Resorption, teeth. (Hematoxylin
non-erldodonticdly
treated
with abundance of osteoclasts, in transplanted and eosin stain. (Magnification, x450.)
teeth.
(Hematoxylin
endodontically
treated
IZeplnmfed am! trmsplmted
Volume 28 Number 6
Fig. 6. Acute inflammatory response in transplanted toxylin and eosin stnin. Magnification, x100.)
nonendodontically
treated
teeth
teeth.
875
(Iiemn-
The 30-day section showed ankylosis with a decrease in fibroblastic activity and an increase in osteoblastic activity (Fig. 3). In some sections, new cementurn formation was observed. Very few inflammatory cells were seen in the periodontal membrane space. Maximum osteoid activity, with the presence of osteoblasts and osteocytts, was noted, particularly in areas of previous bone resorption. Replanted
nonendodontically
treated
teeth
Progressive degener&:ive pulpal changes were observed in both the 15- and the 30-day sections. Minimal cementum and bone resorption was noted at the apical portion of the tooth. Fibroblastic activity was noted at 15 days, with subsequent ankylosis at 30 days (Fig. 4). Transplanted
endodontically
treated
teeth
These sections showed a number of resorption areas in cementum and dentine, with an abundance of osteoclasts (Fig. 5). There were acute inflammatory responses in both of the sections. No evidence of fibroblast or osteoid formation was seen in either tl-,e 15- or the 30-day section. Transplanted
nonendodontically
treated
teeth
An acute inflammatory response was noted in both the 15- and the 30-day sections (Fig. 6). Absence of both fiber attachment and ankylosis was observed. DISCUSSION
Histologic studies indicate that, in dogs, replanted incisors show an attempt at fibroblastic activity with areas of attachment between cementum and bone at the end of 15 days. The inflammatory response is quite minimal.
At the end of 30 days, nnlq-losis OCCUI’S with ostwblastic nctivit4; particnlarly in areas of previous boric resorption. Boric resorption is evident, in all Wplanted teeth, whether endodor~tically or nonendodontically treated. IIoweve~~, this bone resorption wa.s i’ouncl in greater amounts in the replanted nonendodontically treated teeth. There appeared to be very little difference, if any, between cndodontically and nonendodonticallp treatetl tetrth in relation t.o the amount of ankylosis ant1 bone deposition at the end of 30 days. We were unable to observe any evidence of fibrous at,tachment or ankylosis in transplanted teeth; this was true in the endodontically and nonendodontically treated specimens. Inflammatory cells were present in both 15 and 30.day sections. The transplanted endotlontically treated teeth exhibited far greater bone resorption than the nonendoclontically treated teeth. rounding structures when cndodontically and nonendodontically treated maxilObservations were made of t,issue changes associated with teeth and surlary incisors were replanted and transplanted in dogs. SUMMARY
The results of this study indicate that replanted teeth are more acceptable to the host animal than transplanted teeth. The replanted teeth that have been endodontically treated appear to be the most acceptable of the groups studied on the basis of differences observed in bone and cementum resorption. There appears to be little difference between endodontic and nonendodontic replants with respect to ankylosis and bone deposition. Neither ankylosis nor fibrous attachment was observable with any tra.nsplanted specimens. REFERENCES
and Transplantation of Teeth, 1. Buck, I. F., Gray, J. N., and Roncone, P.: Reimplantation J. D. Res. 43: 824-825, 1964. 2. Csereufalvi. Miklos: Homotransalantation of Human Teeth Freshlv Taken From Cadavers, Rev. ?ran$.‘odontostomat. 11: 361-314, 1964. 3. Huebsch, Raymond F.: Implanting Teeth With Met,hyl-2-cyanoacrylate Adhesive, J. D. Res. 46: 337-339, 1967. 4. Loe, J. and Waerhaug,
5. 6. 7. 8. 9.
J.: Experimental Replantation of Teeth in Dogs and Monkeys, Arch. Oral Biol. 3: 176-184, 1961. Metzrow, R. R.: Homologous Viable Tooth Transplantation; a Clinical Immunologic and Histologic Study, ORAL SURG., ORAL MED. & ORAL PATH. 17: 375-388, 1964. Orban, Balint J.: Oral Histology and Embryology, ed. 5, St. Louis, 1962, The C. V. Mosby Company. of an Upper Latera. Incisor; a Pindborg, J. J., and Hansen, J.: Case of Replantation Histological Study, ORAL SURG., ORAL MED. & ORAL PATH. 4: 661-667, 1951. Walter, K. L.: Replantation of Single Rooted Teeth, D. Abstr. 3: 360, 1958. Wilkinson, F. C.: Some Observations of the Replantation and Transplantation of Teeth With Special Reference to the Patho-histology of the Tissues of Attachment, Brit. D. J. 38: 929-939, 1917.