Monday, February 19, 2018

7 Yr Recall on Intentional Replantation

It just so happens that in the last couple weeks I got the chance to do some long term recalls on a couple of intentional replantation cases.  I don't do a lot of these cases, but am surprised how many people are unfamiliar with this treatment option or have never seen one before.  Sometimes it makes me wonder if we should consider this treatment option more often when we have failure with traditional approaches.

This most recent case is a periodontist who came to our practice.  I originally did the root canal in 2005.  It had an odd lateral lucency - which might be suggestive of a root fracture.  We completed root canal without finding a fracture. 

Unfortunately, at the 2 year re-evaluation, the lateral lesion did not resolve. Since I'm working on a periodontist friend of mine, why not try a retreat again?  We tried it and again found no root fracture, or obvious reason for the failure to heal.

Four years later at another re-evaluation, the bone loss on the lateral is even worse. We are still puzzled at why this has not resolved, but not convinced there is a root fracture, so we decided to try intentional replantation.   So, here are some of the best photos I have to document the process.

The tooth is gently extracted. Here it is immediately after extraction.

The root is kept moist and quickly examined for fractures.  None found, so we did retro preparation using and ultrasonic instrument.

An MTA retrofit is placed.

The tooth is replanted into the socket within 10 minutes of extraction.  Firm pressure is placed for an extended period of time. No splinting

A seven year recall finds tooth #31 asymptomatic and fully functional.  While the mesial bone looks irregular, there is no periodontal pocket.  If you look at the initial photo of the extracted tooth, you can see the periodontal ligament, but there appears to be an area where the ligament had been lost.  There was not visible fracture on that area of the root at that time.  My assumption is that the pdl may not have ever reformed in that area - causing the current radiographic appearance. 
It is interesting how a perfectly good root canal and retreatment failed to give the desired results, but a last ditch effort with replantation has been successful up to this point.

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