Replantation - is it possible to return a fallen or extracted tooth to its place? Replantation or an effective method of returning a tooth to its place. Extirpation of the pulp and filling the canal with calcium hydroxide.

IN modern dentistry appeared new technology, allowing you to return the tooth to its place.

That is, the organ that fell out as a result of injury is installed in its own alveolar bed.

Also, if an element of the dentition was removed by medical indications for the treatment of severe oral pathologies.

Such manipulations in dentistry are called replantation.

General overview

The operation is most often performed on the anterior units, which, having one root, are most susceptible to accidental falling out of the socket due to various injuries.

The success of the operation (i.e., the implantation of the tooth in the bone) directly depends on its integrity, the degree of damage to the socket, and the time that has passed since the loss.

It is noted that the less time has passed since the loss of the tooth, the more likely it is that the healing will be successful, its functionality will be fully restored, and the aesthetics of the smile will be higher.

Indications

IN clinical practice manipulations are performed very rarely and only in cases where preservation of the removed unit is impossible by any conservative or surgical method.

This usually occurs under the following conditions:

• chronic forms of granulating or granulomatous periodontitis lesions of the root unit, when standard therapy and resection of the upper part of the roots are not applicable for a number of reasons;
• development of complications during drug treatment periodontitis of a multi-rooted tooth, during which perforation of the roots occurs, breakage in the canals of the pulp extractor or dental needle;
• exacerbation of periodontitis in a single-root unit;
• severe injury, which is accompanied by accidental tooth loss or dislocation;
• acute form of odontogenic jaw periostitis;
• a fracture of the jaw bone in which a tooth has sunk into the fracture gap.

Important! In all of these cases, tooth return is possible only with one important condition– the tooth should not have carious lesions, the crown part should be free of defects, and the roots should not have curvature or discrepancies.

Contraindications

Replantation as a surgical procedure has several limitations:

• extensive carious process;
• inflammation developing in periodontium and periodontal disease;
• multiple and significant cracking of enamel;
• twisted root system;
• cardiovascular pathologies;
• diseases circulatory system and the blood itself;
• psychoneurological diseases in the active phase;
• malignant neoplasms of any organ;
• acute form of radiation sickness;
• acute infectious diseases.

The operation will also be refused if the results of the examination reveal conditions that have a depressing effect on the regeneration process. These conditions include diabetes, drug addiction, chronic alcoholism and etc.

Important! The doctor makes the decision to perform or refuse surgery based on all the indications and limitations the patient has at the time of seeking medical help.

Intervention methods

Replantation is carried out using two technologies - devital and vital. The first method is applicable in cases where treatment is carried out for one of the pathological conditions (chronic form periodontitis, exacerbation of periostitis, etc.), when traditional methods treatments do not give a positive result.

In this case, the dentist first carefully removes the tooth, without stretching or damaging the surrounding tissue, and then:

• treats with antiseptics;
• removes all deposits;
• removes nerves;
• places fillings in root canals;
• cuts down top part one or all roots at once.

Then the doctor cleans the hole from tissues affected by the pathology, rinses it with an antiseptic and returns the unit to the alveolus.

The second (vital) technology is applicable in case of tooth loss due to severe injuries. In this case, the fallen unit is not filled, the nerves are not removed from the pulp (it remains “alive”).

The specialist only treats the tooth itself and the socket with antiseptics, and then puts it in its place. With this method, the functionality of the unit is fully preserved for 10 years or more.

Preparation

Before proceeding with replantation, the doctor must carefully examine the causative unit.

If it was lost as a result of injury, then the degree of damage to the organ and alveolar walls must be clarified, and the condition of the surrounding tissues and adjacent teeth is determined. The doctor receives this information based on the results of radiography.

If replantation is planned and removal is part of complex treatment periodontal pathologies, then a complex is performed therapeutic measures on health improvement oral cavity and preventing the development of other dental problems, i.e., a complete reorganization is carried out. Manipulation includes:

• deletion various types sediments;
• elimination of caries;
• restoration of the coronal parts of those units in which developmental pathologies or defects were identified (cracks, hypoplasia, chips, etc.);
• anti-inflammatory therapy;
• removal of those teeth that cannot be restored.

Important! Since sanitation can solve several problems at once, its duration will directly depend on the condition of the patient’s oral cavity.

Only after such preparation can the dentist begin to implant the tooth in its original place.

Order of conduct

The operation begins with anesthesia. To do this, conduction anesthesia is performed, and as soon as it begins to take effect, the dentist begins extraction. The manipulation is performed with minimal trauma to the tissue in the alveolus.

1. The chewing organ is placed in a warm (not higher than 37⁰ WITH) saline With mandatory addition into it one of the antibiotics - Penicillin or Gentamicin. This is done to prevent the development of infection and eliminate pathogenic microflora in the root system.
2. The dentist prepares the hole for replantation. To do this, he treats the entire oral cavity and alveolar area with an antiseptic (usually 0.2% Chlorhexidine is used).
3. The hole is very carefully cleaned of granulations and small loose bone fragments using a curettage spoon, treated with a solution of sodium chloride or Furacilin, and covered with a tampon.
4. Afterwards, the specialist treats the tooth. All large deposits are removed from the crown with tweezers, small deposits are washed off with saline solution from a syringe. Holding the tooth by its crown with dental forceps or a fixing device, its cavity is opened and the pulp is removed.
5. Root canals and itself dental cavity filled with filling material. The apex of the tooth root is resected using a special bur.

If for some reason it is impossible to remove the pulp and fill the tooth cavity and its root canals with a filling mass, after cutting down the root tips, retrograde filling with silver amalgam. The tooth treated in this way is again placed in saline solution.

At this time, a stream from the hole antiseptic solution and the blood clot is carefully washed out with a curettage spoon, and it is re-irrigated with antibiotics. The prepared tooth is inserted into the alveolus and strengthened by the doctor with a splint (left for 3-4 weeks).

The video shows a diagram of tooth replantation after injury.

Recovery period

Important! Proper execution operations and strict compliance by the patient with all prescriptions and recommendations of the specialist guarantees a successful outcome of implantation.

The patient must be observed by a dental surgeon throughout the entire postoperative period. According to his recommendation, the replanted unit should be kept in conditions of absolute rest and be excluded from articulation. To do this, doctors often grind off the cusps of the implanted tooth or antagonist teeth.

Also, during this time it is necessary to take analgesics for relief. pain symptom and antibiotics (usually from the sulfonamide group). In some cases (usually if replantation was carried out to relieve inflammation), 3-4 sessions of UHF (ultra-high frequency) therapy may be prescribed.

It is very important for a person to change his diet for the first few days.- All food taken should be liquid. Spicy, fried, smoked, and salty foods should be completely excluded.

Caution should be exercised hygiene procedures. It is forbidden:

• press the brush onto the operated area;
• rinse your mouth intensively with any solutions;
• use an irrigator;
• touch and loosen the tooth with your tongue.

On average, the postoperative period (tooth healing) lasts from 4 to 6 weeks. This period is influenced by the type of fusion and the reason why the unit was removed from the alveolus.

Advantages and disadvantages of the procedure

The main advantages of replantation are the following characteristics:

• preservation and full recovery tooth;
• doing all operational manipulations in one visit to the dentist;
• almost 100% survival rate of the tooth, even if it was outside the mouth for a day;
• return of aesthetics and functionality to the replanted unit for a period of 10 years;
• the manipulation is completely safe for the general condition of the patient, and the likelihood of manifestation adverse consequences reduced to a minimum;
• absence of pain due to high-quality anesthesia.

Disadvantages include the following:

• there is a possibility that the replanted unit will not engraft, when after some time the roots begin to dissolve and the unit itself becomes mobile;
• the entire postoperative period, diet must be combined with treatment with antibiotics and analgesics;
• there are significant restrictions on the operation related to general condition body;
• due to damage to the coronal part, the operation will also be denied.

The most significant drawback, according to patients, is the inability to predict the result of the operation and how the tooth will behave in the future, even if the person strictly followed all the rules and medical prescriptions in the postoperative period.

Price

Replantation is not considered expensive dental service even though this technique is new. The cost of its implementation depends on how many roots there are in the tooth.

Thus, the average cost of implanting a single-root unit is from 800 rubles. up to 1000 rub. A multi-rooted tooth will cost a little more - about 1,400 rubles.

The patient will have to pay separately:

• examination and consultation – from 300 rub. (in many large dental centers this service free);
• extraction (if necessary for medical reasons) - from 1200 rubles;
• anesthesia - from 1 thousand rubles. (depending on the type of anesthesia and the volume of the drug administered);
• radiography - about 800 rub.

The stated cost of replantation and all additional manipulations is approximate and may vary up or down. The final price can only be found out at the clinic where the operation will take place.

In modern dentistry, dentists quite infrequently address the issues of replantation - an operation when a previously extracted tooth a tooth is inserted, but not a different one, but the same one.
Indications for replantation may vary, including:

The main purpose of the replantation operation is to provide the doctor with access to the tooth socket or to its roots to perform necessary treatment in this area.

• treatment chronic periodontitis with complications due to obstructed or curved root canals;
• injuries and dislocations of teeth;
• various complications of endodontic treatment;

But at the same time, it is also important that tooth replantation will be possible only when careful tooth extraction becomes possible. Otherwise, there is a risk of tissue trauma and damage to the tooth itself, and then replantation, in most cases, will be completely excluded.

As an example of successful tooth replantation after injury, in this article we will consider the case of a 10-year-old boy. As a result of an unsuccessful fall from a bicycle, the patient was referred to the children's dental department— as a result of the injury, tooth 11 was knocked out, and the presence of chips and multiple cracks in the enamel of the crown of tooth 21 was noted. The parents also brought the tooth itself, which had been wrapped in a dry napkin for several hours and had not been in a humid environment. During the examination, the patient’s excellent oral hygiene and the absence of carious lesions were noted.

An X-ray examination of the patient was performed, which revealed no bone fractures. In addition, during the examination of the knocked-out tooth, it was noted that there were several layers of enamel on the crown, that the root of the tooth was already fully formed and the apex was closed.

Due to the fact that the tooth being replanted was long time was not placed in a humid environment, the surgeons made an immediate decision to carry out extra-oral endodontic treatment in this case, a filling was performed root canal MTA, a damp cotton swab was applied on top, the access cavity was closed with GIC.

Based on the results of the operation, an X-ray examination of the tooth was carried out and an X-ray image of the location of the specific tooth in the socket was obtained.

The patient was prescribed a course of prophylactic antibiotics. The patient and his parents were warned about the importance of maintaining strict oral hygiene, necessary diet and conducting follow-up inspections.

Based on the results of an X-ray examination of the replanted tooth and examination of the oral cavity, no pathologies in the oral cavity were noted. Subsequently, after another four weeks, the splint was removed and a permanent restoration of the tooth with composite materials was carried out.

Based on the results of periodic control examinations of the patient, it was noted that the patient’s tooth was completely restored, fully integrated into the jaw and retained its functions and external parameters.

Let us once again note the main stages of dental replantation during the operation:

1. administering local anesthesia;
2. tooth extraction; specifically in our case, the tooth was knocked out as a result of injury and was not removed;
3. placement of the replanted tooth in special conditions, in which the vital activity of tissues, especially pulp, is preserved;
4. curettage of the tooth socket;
5. thorough treatment and filling of canals;
6. elimination of damage resulting from periodontitis was not required in our case;
7. repositioning the tooth into the prepared socket;
8. fixation of the replanted tooth using splinting.

The practice of such operations shows that tooth healing can last up to two weeks, and additional fixation may not be required. Replanted teeth, after a successful operation, usually fully engraft into the jaw and fully perform their functions, maintaining their external parameters.

These studies are devoted to the study of factors influencing the prognosis of replantation permanent teeth children with complete traumatic dislocations. One of the main problems of replantation is external (inflammatory) resorption of tooth roots, which develops 2–6 weeks after replantation and leads to tooth loss. Conducted comparative analysis dental indicators, immune status imicrocrystallization of saliva (MCS) in 46 children with a normal type of engraftment (28) and the development of inflammatory root resorption. In children who developed complications, a decrease in secretory immunoglobulin (sIgA) = 0.235 ± 0.015 mg/ml was recorded, high degree caries activity low indicators hygiene level 2.63±0.023 compared to the first group: sIgA=0.37±0.01 mg/ml, IG=2.16±0.27. A decrease in salivary microcrystallization (SMC) indicators was also found. In the first group, type I–II of the pattern predominated, the average score was 3.92 ± 0.23 compared to the second group, which had type III–IV crystallization, 2.58 ± 0.21. Therefore, to solve the problem of replantation, when prescribing therapeutic measures, it is necessary to take into account the degree of caries activity. In children with decompensated forms, a decrease in local immunity in the oral cavity dictates the need to prescribe drugs to increase immune reactivity, as well as administer a complex hygiene measures for the period of tooth splinting.

tooth dislocation

replantation

resorption

immunity

dental status

microcrystallization of saliva

1.Belovolova R.A. Features of the immune status and the possibility of immunocorrection in post-traumatic inflammatory complications of patients with open fractures lower jaw// Immunology. – 2003. – No. 3. – P. 287–293.

2.Belyakov I.M. The immune system mucous // Immunology. – 1997. – No. 4. – P. 7–13.

3.Moskovsky A.V. Assessment of the immune status of patients with scaries and its complications combined with periodontitis // Dentistry. – 2008. – No. 4. –

4. Pitaeva A.N. Physicochemical research methods mixed saliva in clinical and experimental dentistry: tutorial. – Omsk, 2001. – 40 p.

5.Andreasen FM. Transient root resorption after dental trauma: the clinician’s dilemma // J. Esthet Rest Dent. – 2002. – Vol. 14, No. 6. – P. 80–92.

6.Andreasen J.O. Replantation of 400 avulsed permanent incisors. Factors related to periodontal ligament healing // Endodontics & Dental Traumatology. – 1995. – Vol. 26, No. 11. – P. 76–89.

7.Marino T.G. Determination of periodontal ligament cell viability in long shelf-life milk // J. Endod. – 2000. – Vol. 26, No. 14. – P. 699–702.

8.Pacheco L.F. Evaluation of the knowledge of the treatment of avulsions in elementary school teachers in Rio de Janeiro // Brazil, Dent. Traumatol. – 2003. – Vol.19. – P. 76–78.

Complete dislocation is one of the most serious types of dental injuries in children. Most preferred method To treat tooth dislocations, replantation is used (returning the tooth back into the socket followed by fixation in the dentition). The authors noted that most replanted teeth sooner or later undergo resorption. Researchers have identified the main factors influencing the outcome of replantations: the time the tooth remains outside the oral cavity and the conditions for storing the tooth. In 20-40% of cases, inflammatory resorption develops at 1-6 weeks, which, if left untreated, leads to tooth decay. Therefore, the problem of replantation is to predict the development of resorption using preventive corrective measures in children, taking into account the condition of the oral cavity and the degree of caries activity.

Purpose of the study: assessment of the impact of dental and immunological indicators on the results of replantation of children with traumatic dislocations of teeth.

Materials and research methods

Carried out dispensary observation 46 children aged 8 to 15 years with complete traumatic dislocations who came to the children's dental clinic Blagoveshchensk odontology clinic No. 22 Khabarovsk. Conducted comprehensive examination: clinical determination of the intensity of the dental caries process (KPU, KPU+kp), the level of oral hygiene according to the Green-Vermillion index (J.Green, J.Vermillion, 1960), PMA modified Parma %. The state of local immunity in the oral cavity was assessed by the content of saliva IgG, IgA, secretory sIgA using the radial immunodiffusion method in a gel according to G. Manchini.

To assess the level of general resistance of the children's body, microstructural crystallization of mixed saliva was studied according to Leus P.A. modified by microphotography. The MCS was assessed on a five-point scale. B5 and 4 points were assessed for preparations that have a characteristic clear pattern in the form of elongated fern-like crystalloprismatic structures extending from the center of the drop. The more organic matter The more chaotic the arrangement of structures, the lower the number of points corresponding to the drug. Scores of 2 and 3 points were assigned to preparations that had scattered and fractured structures forming crystals.

Clinical follow-up was carried out every week during the splinting period and every two weeks after the splints were removed. Control radiographs were performed on patients at 8-10 weeks postoperative period. According to X-ray data, the presence of areas of discharge in bone tissue around the root was considered a complication. The research results were processed using the Statistics 6 program using nonparametric methods using the Mann-Whitney test.

Research results and discussion

As a result clinical examination 2 groups were formed. The grouping feature was the presence early complications- development of lateral tooth root resorption. When examining children of group 1 - 28 children, physiological mobility of the tooth and the absence of inflammatory changes in the tissues surrounding the tooth were noted. Radiographs revealed an unchanged root contour, sometimes with small areas of resorption, and no loss of surrounding bone tissue (Fig. 1, 2).
In children of group 2 (18 children) complications developed in the form of inflammatory resorption within a period of 1 to 6 weeks, it was noted varying degrees pathological tooth mobility, swollen, hyperemic gum tissue and control radiographs showing areas of rarefaction of bone tissue adjacent to the lateral surfaces of the tooth root (Fig. 3).

Rice. 1. Patient B., 7 years old. Replantation of 21 teeth. Splinting stage

Rice. 2. Patient B., 8 years old. Condition after replantation. Control after 6 months

Rice. 3. Patient Sh. Replantation of the 21st tooth. Splinting stage. Inflammatory tooth root resorption

According to the results of a dental examination in the group of children with postoperative resorption, the CP+CP indicators were 2 times higher: 5.62±2.09 compared to group 1 -2.68±1.67 (p‹0.01). Statistically significant differences were revealed in the study of the hygiene index (table). The oral hygiene of children in group 2 is worse - 2.63±0.23 compared to the hygiene of children in group 1 - 2.16±0.27 (P< 0,01).

Indicators of the dental and immunological status of children with complete traumatic dislocations of teeth

Statistically significant differences were also revealed in the RMA indicators: in children with developed resorption, the degree of inflammatory process in the periodontal tissues was 22.8±1.09 higher than in the group without complications - 16.25±0.87 ( R < 0,01), что соответствует гингивиту легкой степени тяжести. По показателям МКС слюны для детей 1 группы характерен более структурированный и четкий рисунок- 3,92 балла (I-II тип МКС), что свидетельствует о более высокой резистентности к кариесу, а также хорошей общей реактивности организма (рис. 4). У детей 2 группы преобладал III-IV тип, свойственный лицам с ослабленной иммунореактивностью, высокими показателями КПУ и низким уровнем гигиены, что соответствовало 2,58 балла (рис. 5).

Rice. 4. II type ISS - 4 points

Rice. 5. III type ISS - 2 points

When studying the level of immunoglobulins in the oral cavity, no significant difference in the IgA content of the two groups was revealed (table). The average IgG concentrations in children with developed root resorption turned out to be slightly higher than those in children of the first group: 0.055±0.002 and 0.029±0.002, respectively ( R < 0,01). Ведущим признаком специфической защиты в полости рта является sIgA . У детей с наружной резорбцией после реплантации обнаружен дефицит sIgA в ротовой жидкости 0,235 ± 0,015 в сравнении с пациентами первой группы, где показатель составляет 0,37 ± 0,02 (R < 0,01).

Conclusion

One of the serious problems of dental replantation is the lack of guarantee of a positive result. Despite the accompanying favorable anamnestic factors observed in children: a short extra-alveolar period, wet storage of the tooth during transportation, the state of the patient’s dental health has a great influence. In group 2 of children, external inflammatory root resorption revealed deviations in dental and immunological status. Research has revealed in this group high rates of activity of the carious process, a low level of hygiene, more pronounced periodontal inflammation, and a decrease in (sIgA) - the main factor of antimicrobial protection. Studies of microcrystallization of saliva, reflecting both the general somatic state of the body and the icary situation, showed a low degree of structure in the group of children with complications. Such changes in children of the second group indicate an imbalance of the protective systems in the oral cavity. After replantation of an injured tooth, the antigenic load increases, and an inadequate immune response provokes an inflammatory reaction with the participation of immunocompetent cells, connective tissue cells, and osteoclasts, which leads to progressive resorption of root tissue.

Consequently, the main way to solve the problems of dental replantation associated with the development of early root resorption is to prevent complications and improve the condition of the oral cavity during the period of engraftment of replants. It is necessary to include in conservative treatment:

1) prescription of drugs that increase local immunity;

2)carrying out controlled hygiene measures;

3) the appointment of physiotherapeutic procedures that stimulate the engraftment process.

This complex is a prevention of inflammatory-resorptive complications of replantation of permanent teeth in children and a solution to the problem of early loss of replanted teeth.

Reviewers:

Bobylev N.G., Doctor of Medical Sciences, Professor, Head. Department of Maxillofacial Surgery, Far Eastern State Medical University, Khabarovsk;

Danilova M.A., Doctor of Medical Sciences, Professor, Head. Department of Pediatric Dentistry and Orthodontics, Perm State Medical Academy named after. Academician E.A. Wagner, Perm.

The work was received by the editor on November 15, 2012.

Bibliographic link

Dental replantation: clinical and morphological characteristics of possible outcomes, indications and contraindications for use, surgical technique, patient management in the postoperative period.

Replantation refers to the return of an extracted tooth to its alveolus.

Indications

1) Chronic granulating and granulomatous periodontitis of multi-rooted teeth, when neither conservative therapy nor root apex resection surgery can be used.

2) Complications that arise during conservative treatment of chronic periodontitis of multi-rooted teeth (root perforation, fracture in the root canal of the pulp extractor, root needle).

3) Trauma accompanied by tooth dislocation or accidentally removed tooth.

4) Acute odontogenic periostitis of the jaw, exacerbation of chronic periodontitis, which is not subject to conservative treatment (in these cases, delayed tooth replantation is performed).

Contraindications

A tooth with a poorly preserved crown and significantly divergent or curved roots.

Operation technique

Under general anesthesia, the tooth is carefully removed with minimal trauma to the soft and hard tissues in the alveolar area. The extracted tooth is immersed in a warm (37 C) isotonic sodium chloride solution with the addition of antibiotics. The alveolus of the extracted tooth is carefully cleaned of granulations using a sharp curettage spoon and washed from a syringe with an isotonic solution of sodium chloride with antibiotics or furacillin and covered with a sterile gauze swab. Then the tooth is treated, which consists of mechanical and chemical cleaning of the root canals and filling of the crown and roots. During treatment, the tooth is kept in sterile gauze soaked in saline solution with antibiotics. The canals are filled with cement, after which the root apices are resected (the apical area is rich in deltoid branches of the canal with necrotic contents). The tooth prepared for replantation is inserted into the alveolus after the blood clot is removed from it and irrigated with an antibiotic solution.

With exacerbation of chronic periodontitis and acute periostitis of the jaws, delayed replantation is possible. The operation is two-stage. The first stage consists of removing the tooth and preserving it in an antibiotic solution at a temperature of 40°C. The second stage is carried out 14 days after the signs of acute inflammation disappear. The tooth is treated and replanted according to the usual method.

Postoperative period

Single-rooted teeth should be fixed for 2-3 weeks using a wire or pre-prepared plastic splint. Multi-rooted teeth, as a rule, are well retained in the alveolus, and no additional fixation is required. The replanted tooth must first be placed in conditions of complete rest and turned off from articulation, for which in some cases it is advisable to grind off the cusps of the transplanted tooth or the cusps of the antagonist. During the first few days, the patient should eat liquid food. The pain that occurs quite often is relieved with analgesics. Sulfonamides are also prescribed.

Possible outcomes

Healing during tooth replantation lasts from 4 to 6 weeks, depending on the type of fusion. There are three types of fusion of the transplanted

tooth with alveolus:

1) with complete preservation of the alveolar periosteum and periodontal remains on the roots of the tooth - periodontal;

2) with partial preservation of the alveolar periosteum and periodontal remains on the root, tooth-periodontal-fibrous;

3) with complete removal of the periosteum from the alveoli and periodontium from the tooth root - osteoid.

The prognosis for the viability of a replanted tooth is most favorable with the periodontal type and least favorable with the osteoid type of engraftment. The function of the transplanted tooth is preserved from 2 to 10 years or more. The longest periods are observed when transplanting a healthy tooth that was accidentally removed or taken out of its socket.

Sometimes, even with the most impeccable surgical technique, the roots of a planted tooth resolve after some time, the tooth becomes mobile and eventually has to be removed.

Tooth replantation is a dental procedure performed in situations where a healthy tooth falls out of its socket. This is possible as a result of a fall and injury. The tooth can be removed from the alveoli in order to eliminate chronic infectious inflammation. In practice, such manipulation is carried out extremely rarely. In some cases, the procedure is the only option to save the tooth.

The essence of replantation is to return a lost but healthy tooth to its alveolar bed. It may be in the hole, but may not be fixed. Teeth with one root are at risk, as it is easier for them to come off during a fracture or dislocation.

Indications for replantation are as follows:

• Complex endodontic treatment;
• Dislocation of the jaw;
• Ineffective treatment of chronic periodontitis using traditional methods;
• Erroneous deletion;
• Jaw fracture.

The operation can only be performed on permanent teeth. Milk plants have thin roots, so such manipulation will be very difficult. Such replantation is carried out only if the absence of a baby tooth can lead to serious deformations during the development of the jaw.

Replantation is not performed in the following clinical situations:

• psychological disorders;
• cardiovascular pathologies;
• complete tooth destruction;
• blood diseases;
• malignant tumors;
• acute radiation sickness.

For the operation to be effective, the replantant must have a well-preserved crown and there must be no severe damage to the roots. Before performing the procedure, the doctor must make sure that there are no contraindications.

Types, advantages and disadvantages

There are several methods of transplantation: devital and vital. During devital replantation, a nerve is present in the cavity of the extracted tooth. The doctor must fill the root canals and thoroughly clean the hole from affected tissue. Next, the root tip is cut off and the replantant is placed back.

The vital method involves preserving the nerves; canal filling is not performed. With this type of transplantation, the replantant will be able to function normally for another 10-12 years.

This procedure has a number of advantages:

• Possibility of complete restoration of a lost tooth;
• Preservation of functionality and aesthetics for up to 20 years;
• Carrying out the manipulation in one session with a doctor;
• The ability to implant a tooth that has been outside the mouth for about a day.

In order for the replantant to take root well, certain conditions must be met. He must be completely healthy. Immediately after it falls out, it must be placed in milk or in a solution of table salt. In this way, the life of cells can be briefly extended. After the operation, you must take a course of antibiotics.

The replanted tooth can be subjected to the usual chewing load only six months after the operation. To monitor the implanted tooth, it is recommended to undergo an X-ray examination every 3-4 years.

Despite the advantages, replantation has a number of disadvantages:

• High probability of non-engraftment;
• The presence of a large number of contraindications to the procedure;
• Inability to predict the outcome of the manipulation.

Operation stages

Replantation is performed under local anesthesia. The first stage involves carefully removing the tooth. First, the ligament peels off from the neck, and then the entire tooth. Movements must be as precise as possible to prevent major damage.

The step-by-step procedure in the photo looks like this:

After removal, the periodontal pocket is thoroughly cleaned. This is necessary in order to remove granuloma or granulations. The replantant is placed in a warm sodium chloride solution. To avoid infection, antibacterial agents are added to the solution. The hole is closed with a sterile gauze swab.

The second stage of the operation consists of processing the replantant itself. The doctor must fill all carious lesions, perform resection of the root tips and widen the canals. All deposits and parts of the mucous membrane are removed from the dental neck. The replantant should remain in sodium chloride solution immediately until transplantation.

The third stage is the implantation of the replantant. To do this, the upper part of the root system is cut down. Before placing the tooth in the socket, the doctor must completely remove any blood clots that may be present in it. The tooth is placed directly into the alveolus. No additional fixation is required. Engraftment with proper restoration takes about 20 days.

Rehabilitation period

After the manipulation, there is a high risk that the replantant will not take root, and various kinds of complications will arise. To prevent this from happening, you need to follow simple rules.

You can eat food for the first time only after 2 hours. At the same time, it should be soft and semi-liquid. To avoid seams coming apart, it is recommended to eat on one side. During the entire rehabilitation period, before eating, the area where the sutures are placed is treated with Solcoseryl dental paste.

For the first few weeks after the procedure, it is recommended to take medications containing large amounts of calcium. After the manipulation, the patient may experience swelling, bruising, or bleeding of the tissue. To reduce the severity of these symptoms, it is recommended to apply cold to the operated area during the first days.

You should avoid physical activity and avoid severe temperature changes. In the first few weeks after surgery, smoking and drinking alcohol are prohibited. It is necessary to avoid hot and spicy foods.

After surgery, the doctor may prescribe a course of analgesics and antibiotics. For a quick recovery, it is recommended to attend physiotherapeutic procedures.

Features of engraftment

The duration of engraftment of the replantant depends on the characteristics of the patient’s body, the correctness of the manipulation and the implementation of all recommendations for restoration. In total, there are 3 types of fusion of the replantant with the alveolus:

• Periodontal - preservation of the periosteum of the alveoli and parts of the periodontium on the roots;
• Permodontal-fibrous - partial preservation of the periodontium and periosteum;
• Osteoid - complete removal of the periosteum and periodontium.

The most favorable prognosis for engraftment is with the periodontal type; frequent complications are observed with the osteoid type. If the operation is performed correctly, the replantant can retain its functions from 2 to 10 years. A tooth that was removed accidentally and is completely healthy can last much longer.

It is quite difficult to predict the result of dental replantation, since even with proper engraftment and following all the doctor’s recommendations, the roots may begin to dissolve.