Center for Innovation and Research in Oral Sciences (CIROS), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal.
Published: August 2022
AI Article Synopsis
Article Abstract
Intentional replantation (IR) may offer a solution for persistent periapical lesions associated with endodontically treated teeth. A 35-year-old male patient presented with pain associated with the left mandibular second molar and hypoesthesia. Upon clinical examination, increased probing pocket depth in the mid-buccal surface was detected. Cone beam computed tomography revealed a previous non-surgical root canal treatment, with root canal filling material extrusion adjacent to the inferior alveolar nerve, a fractured instrument in the mesial root, and a large periapical radiolucency involving both teeth 37 and 36. A diagnosis of symptomatic post-treatment apical periodontitis was established. After discussing treatment options with the patient, an IR of tooth 37 was performed. Extra-oral procedures were completed in 17 min. At 9 months, hypoesthesia resolution was reported, and apical healing was radiographically observed. After 2.5 years, the replanted tooth showed extensive root resorption. An extraction with alveolar ridge preservation, using leukocyte-platelet rich fibrin (L-PRF), was performed. Six months after tooth extraction and regeneration, implant placement surgery was carried out. IR presents a valid treatment modality for the management of post-treatment apical periodontitis. When orthograde retreatment or apical microsurgery prove to be unfeasible, IR is a unique procedure with the potential to promote tooth preservation in properly selected cases. Although unsuccessful after 2.5 years, the IR of tooth 37 allowed for bone regeneration, the maintenance of tooth 36 vitality, and hypoesthesia resolution.
Aim And Background: The management of crown-root fractures poses significant uncertainty and involves meticulous evaluation of the tooth and supporting structures. The uncertain prognosis associated with crown-root fractures necessitates periodic evaluation.
Case Description: A 15-year-old female presenting with crown-root fracture of the permanent left maxillary incisors was treated by surgical extrusion with rotation for the central incisor, while the lateral incisor was coronally extruded by 2 mm.
Intentional reimplantation has long been supported by many clinicians as a last resort before tooth extraction. With the accumulation of data and the development of techniques, the survival rate of reimplantation has increased. However, although there have been many reports and studies on replantation for common causes such as root fracture, root resorption, inadequate root canal treatment, perforation, and apical periodontitis, the method of replantation in unusual cases is not yet clear, and many cases result in tooth extraction.
Invasive cervical resorption (ICR) is an aggressive pathological condition that can affect any permanent tooth. This process is characterized by replacement of the tooth structure with granulomatous fibrovascular or fibro-osseous tissue. Despite its asymptomatic nature, ICR can lead to tooth loss.
- The case discusses a young patient with type 1 diabetes who has multiple oral cavity issues, including an impacted canine and cervical root resorption of an incisor, highlighting the link between genetic variants and oral diseases.
- Genetic testing identified pathogenic variants in specific interleukin and VDR receptor genes, along with the presence of harmful periodontal bacteria, which guided treatment options.
- Treatment involved intentional replantation of the affected incisor, orthodontic methods to address the impacted canine, and ongoing non-invasive periodontal care, demonstrating the importance of genetic analysis in creating a multidisciplinary treatment plan.
