Replantation

Replantation Mario Czonstkowsky, DEPARTMENT

D.D.S.,

OF ENDODONTICS,

and James A. Wallace, D.D.S., M.D.S., UNIVERSITY

OF PITTSBURGH

SCHOOL

Pittsburgh,

OF DENTAL

Pa.

MEDICINE

I

ntentional replantation is the procedure by which a tooth is extracted for extraoral endodontic treatment and immediately replaced in its alveolus.’ Andreasen and Hjorting-Hansen* report a 90% success rate for replantation if accomplished within 30 minutes. Replantation is indicated in cases in which a symptomatic condition is related to a broken instrument projecting into the periapical tissues and surgery is contraindicated because of the risk of injury to the mandibular neurovascular bundle. Another indication is the lateral perforation of a root that cannot be sealed because of poor access. CASE

A as-year-old white woman was referred to the University of Pittsburgh Endodontic Department for treatment. Her medical history was noncontributory, and her dental health was excellent except for the involved tooth for which she was seeking treatment. Her general dentist had prescribed penicillin VK 500 mg four times a day. The general practitioner had performed an endodontic procedure on the mandibular left first molar. In the process, a lentulo was broken in the distal canal extending into the alveolar bone in close proximity to the mandibular canal (Fig. 1). The dentist attempted several times to remove the broken instrument with a Gates-Glidden drill and inadvertently perforated the mesial aspect of the distal root. Surgical treatment was contraindicated in this situation because of the proximity of the mandibular canal and the extent and location of the perforation. Procedure

The patient was apprehensive and in considerable pain at the appointment time. Thus, intravenous sedation with Valium and Demerol was given. The patient was anesthetized with lidocaine 2% with 1: 100,000 epinephrine blocking the mandibular nerve, long buccal, lingual, and possibly the transcutaneous coli. An oral surgeon extracted the tooth with gentle rotation because of the possibility of fracture of the severely weakened tooth. He tried to keep damage to the periodontal membrane to a minimum in order to enhance the possibility of success3 A radiograph was taken after the extraction to ensure the total removal 558

Fig.

1.

Fig.

2.

REPORT

of the instrument. The tooth was held in a 2 X 2 inch gauze square saturated with sterile normal saline solution while the apices were prepared and retrofilled with the new copper-containing amalgams. The perforation of the distal root was also sealed (Fig. 2). The tooth was then replanted with difficulty, and during this procedure amalgam debris was scraped off the perforation area into the interradicular tissues (Fig. 3). Since healing proceeded completely and without incidence, no attempt was made to remove the amalgam flash. Total time outside of the alveolus was 6 minutes. Fixation was not necessary, as the tooth exhibited only

Volume Number

Replantation

57 5

Fig.

3.

very slight mobility. The patient’s penicillin medication was continued for 3 days to prevent infection which might have impeded healing. As an analgesic, Tylenol 3 was prescribed as needed for discomfort. Results

The patient reported that she did not need any analgesic, and at a l-week postoperative visit she was asymptomatic, with the tooth Iexhibiting very slight mobility. When she was seen 6 months later, there were no signs of root resorption and no signs of ankylosis upon percussion (Fig. 4). The patient was extremely well pleased with the treatment, and at that time she was referred back to her general dentist for restoration of the tooth.

Fig.

559

4.

REFERENCES 1. Grossman LI: Intentional reimplantation of teeth: a clinical evaluation. J Am Dent Assoc 104: 633-639, 1982. 2. Andreasen JO, Hjorting-Hansen E: Reimplantation of teeth. I. Radiographic and clinical study of I10 human teeth replanted after accidental loss. Acta Odontol Stand 24: 263-286, 1966. 3. Loe H, Waerhaug J: Experimental replantation of teeth in dogs and monkeys. Arch Oral Biol 3: 176-I 84, 1964. Reprint requests to: Dr. James Wallace Assistant Professor of Endodontics School of Dental Medicine University of Pittsburgh Pittsburgh, PA 15261