- Email: [email protected]
Report of a Replantation Case*
R E P O R T O F A R E P L A N T A T IO N
CASE*
By J. R. BLAYNEY, B.S., D.D.S., Chicago, Illinois U C H has been w ritte n concern in g the success or fa ilu re o f re p la n tatio n cases. T h is report is given in an effo rt to add an o th er bit o f evidence to support either the success or fa ilu re o f the procedure, as the read er m ay determ in e fo r h im self.
M
REPORT OF CASE
In May, 1920, a boy, aged 10 years, fell against the edge of a school desk, knocking out the permanent upper central and lateral incisors and the deciduous upper cuspids. Frightened by the accident, he immediately ran home, but, later in the day, his mother had him return to the school room and secure the teeth. The follow ing afternoon, he came to the dental infirmary o f the University of Illinois for treatment. His mother, who accompanied him, brought with her the six teeth, which she removed from her coin purse and gave to me. A fter an examination, the patient was dismissed with instructions to return the follow in g morning. The pulp chamber of each incisor was opened through the lingual surface, the pulp tissue thoroughly removed and the root canal filled with guttapercha. Bracket bands were then adapted to the crowns, and the teeth were placed in a satu rated solution of boric acid and allowed to remain there until the follow ing morning. At this time, anchor bands were placed on the upper first permanent molars; a ribbon arch was adapted to fit the case, and the *From the Department of Materia Medica and Therapeutics, University o f Illinois Col lege o f Dentistry.
Jour. A .D .A ., August, 1927
bracket bands were cemented to the crowns o f each central and lateral incisor. The an terior portion o f the maxilla was anesthetized with procain to permit the removal o f the blood clot that had formed in the socket. Each tooth was now placed in its respective socket and firmly but gently held in position by the ribbon arch. The radiogram that was made immediately after the replantation has been lost. Figure 1 illustrates the condition of the case one month later. A careful examination o f the film shows that absorption is beginning at the apex of all four teeth and also that there is a small area o f absorption on the distal sur face o f each lateral root in the region of the cuspid crown. The films in Figure 2, made about six weeks later, show how rapidly the absorption o f the lateral incisors is progress ing. Figure 3 depicts the condition four months after replantation. Pressure caused by the developing cuspids is undoubtedly responsi ble for the rapid destruction of the lateral incisors. Figure 4 shows the condition one year after replantation, and Figure 5 shows the right lateral incisor, which came out shortly before the patient returned for the films shown in Figure 4. Clinical examination revealed that the left lateral was quite loose, so it was not expected to remain in position much longer. A fter this examination, in June, 1921, the patient failed to respond to all requests to return, so the case was given up as lost. In September, 1925, he unexpectedly returned to the clinic and, much to our surprise, both centrals were in position and quite firmly fixed. 1442
Blayney— Re-port o f a Replantation Case Figure 6 shows a photograph o f the mouth; Figure 7, a plaster cast, and Figure 8, a radiogram, all made at this time. In spite o f the fact that the last radiogram
1443
indicates absorption o f all the root portion o f each central incisor, the crowns are firmly fixed. The cuspids are completely developed and in fairly good position, although they have moved forward 2 or 3 mm.
F'ig. ].— Condition o f case, one month after replantation. Fig. 4.— Condition o f case, one year after replantation.
Fig. 2.— Condition o f case, two months and a half after replantation. Rapid absorp tion o f the lateral incisors is evident.
Fig. 6 .— Appearance o f mouth after four years had elapsed. Fig. 3.— Condition of case, four months after replantation. Pressure from the devel oping cuspids is undoubtedly responsible for the rapid destruction o f the lateral incisors.
F ig u re 9 is a recen t film fro m a case in w hich the pulp w as rem oved a n d the root canal filled w ith the tooth in situ in 1920, about the tim e th a t the teeth w ere
1444
T h e Journal o f the Am erican D ental Association
rep lanted in the first case. I t is evident th a t absorption is n o t ta k in g place in the
case illu strate d in F ig u re 9. T h ese tw o cases clearly illu strate the d ifferen t type o f tissue reaction w hich occurs in the case o f a dead tooth an d a pulpless tooth. I have u n d e r observation o th er cases quite sim ilar. I n these, the teeth w ere
Fig. 7.— Plaster cast made at the same time as the photograph shown in Figure 6 .
Fig. 9.— A case in which the pulp was removed and the root canal filled with the tooth in situ. It is evident that absorption is not taking place.
Fig. 8 .— Film taken at the same time as the photograph shown in Figure 6 .
broken in such a w ay as to expose the pulps, the teeth being extrem ely loose b ut still in th eir sockets. T h e outcom e o f these cases w ill be reported a f te r the elapse o f an equal am o u n t o f tim e.
CASE*
By J. R. BLAYNEY, B.S., D.D.S., Chicago, Illinois U C H has been w ritte n concern in g the success or fa ilu re o f re p la n tatio n cases. T h is report is given in an effo rt to add an o th er bit o f evidence to support either the success or fa ilu re o f the procedure, as the read er m ay determ in e fo r h im self.
M
REPORT OF CASE
In May, 1920, a boy, aged 10 years, fell against the edge of a school desk, knocking out the permanent upper central and lateral incisors and the deciduous upper cuspids. Frightened by the accident, he immediately ran home, but, later in the day, his mother had him return to the school room and secure the teeth. The follow ing afternoon, he came to the dental infirmary o f the University of Illinois for treatment. His mother, who accompanied him, brought with her the six teeth, which she removed from her coin purse and gave to me. A fter an examination, the patient was dismissed with instructions to return the follow in g morning. The pulp chamber of each incisor was opened through the lingual surface, the pulp tissue thoroughly removed and the root canal filled with guttapercha. Bracket bands were then adapted to the crowns, and the teeth were placed in a satu rated solution of boric acid and allowed to remain there until the follow ing morning. At this time, anchor bands were placed on the upper first permanent molars; a ribbon arch was adapted to fit the case, and the *From the Department of Materia Medica and Therapeutics, University o f Illinois Col lege o f Dentistry.
Jour. A .D .A ., August, 1927
bracket bands were cemented to the crowns o f each central and lateral incisor. The an terior portion o f the maxilla was anesthetized with procain to permit the removal o f the blood clot that had formed in the socket. Each tooth was now placed in its respective socket and firmly but gently held in position by the ribbon arch. The radiogram that was made immediately after the replantation has been lost. Figure 1 illustrates the condition of the case one month later. A careful examination o f the film shows that absorption is beginning at the apex of all four teeth and also that there is a small area o f absorption on the distal sur face o f each lateral root in the region of the cuspid crown. The films in Figure 2, made about six weeks later, show how rapidly the absorption o f the lateral incisors is progress ing. Figure 3 depicts the condition four months after replantation. Pressure caused by the developing cuspids is undoubtedly responsi ble for the rapid destruction of the lateral incisors. Figure 4 shows the condition one year after replantation, and Figure 5 shows the right lateral incisor, which came out shortly before the patient returned for the films shown in Figure 4. Clinical examination revealed that the left lateral was quite loose, so it was not expected to remain in position much longer. A fter this examination, in June, 1921, the patient failed to respond to all requests to return, so the case was given up as lost. In September, 1925, he unexpectedly returned to the clinic and, much to our surprise, both centrals were in position and quite firmly fixed. 1442
Blayney— Re-port o f a Replantation Case Figure 6 shows a photograph o f the mouth; Figure 7, a plaster cast, and Figure 8, a radiogram, all made at this time. In spite o f the fact that the last radiogram
1443
indicates absorption o f all the root portion o f each central incisor, the crowns are firmly fixed. The cuspids are completely developed and in fairly good position, although they have moved forward 2 or 3 mm.
F'ig. ].— Condition o f case, one month after replantation. Fig. 4.— Condition o f case, one year after replantation.
Fig. 2.— Condition o f case, two months and a half after replantation. Rapid absorp tion o f the lateral incisors is evident.
Fig. 6 .— Appearance o f mouth after four years had elapsed. Fig. 3.— Condition of case, four months after replantation. Pressure from the devel oping cuspids is undoubtedly responsible for the rapid destruction o f the lateral incisors.
F ig u re 9 is a recen t film fro m a case in w hich the pulp w as rem oved a n d the root canal filled w ith the tooth in situ in 1920, about the tim e th a t the teeth w ere
1444
T h e Journal o f the Am erican D ental Association
rep lanted in the first case. I t is evident th a t absorption is n o t ta k in g place in the
case illu strate d in F ig u re 9. T h ese tw o cases clearly illu strate the d ifferen t type o f tissue reaction w hich occurs in the case o f a dead tooth an d a pulpless tooth. I have u n d e r observation o th er cases quite sim ilar. I n these, the teeth w ere
Fig. 7.— Plaster cast made at the same time as the photograph shown in Figure 6 .
Fig. 9.— A case in which the pulp was removed and the root canal filled with the tooth in situ. It is evident that absorption is not taking place.
Fig. 8 .— Film taken at the same time as the photograph shown in Figure 6 .
broken in such a w ay as to expose the pulps, the teeth being extrem ely loose b ut still in th eir sockets. T h e outcom e o f these cases w ill be reported a f te r the elapse o f an equal am o u n t o f tim e.