J Korean Acad Conserv Dent.  2011 Jan;36(1):12-18. 10.5395/JKACD.2011.36.1.12.

Short-term clinical outcome of intentionally replanted posterior molars

• Choi YH

• KMID: 1446079
• DOI: http://doi.org/10.5395/JKACD.2011.36.1.12

Abstract

OBJECTIVES
This retrospective study evaluated the therapeutic effects of the intentional replantation (IR) procedure performed on the maxillary and mandibular molars of 35 patients.
MATERIALS AND METHODS
For the subjects, IR was performed due to difficulties in anatomically accessing the lesions and/or close proximity to the thick cortical bone, inferior alveolar nerve, or maxillary sinus, which rendered the ordinary periradicular surgery impossible. The patients' progress was followed for a year and up to 2 years and 4 months. The success of the procedure was evaluated in terms of clinical and radiographic success (%).
RESULTS
The results revealed the following: (a) 1 case (3%) of failed tooth extraction during IR; (b) 2 cases (6%) of extraction due to periodontal diseases and inflammatory root resorption; (c) 3 cases (9%) of normally functioning teeth in the oral cavity with minor mobility and apical root resorption, and; (d) 29 cases (82%) of normally functioning teeth without obvious problems.
CONCLUSIONS
IR was confirmed to be a reliably repeatable, predictable treatment option for those who cannot receive conventional periradicular surgery because of anatomic limitations or patient factors.

Keyword

Clinical evaluation; Extraction; Intentional replantation; Success rate

MeSH Terms

Humans
Intention
Mandibular Nerve
Maxillary Sinus
Molar
Mouth
Periodontal Diseases
Replantation
Retrospective Studies
Root Resorption
Tooth
Tooth Extraction

Figure

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  Figure 1 (a) Periapical radiograph of a second mandibular molar with a large periapical lesion. Patient (28-year-male) refused non-surgical retreatment and just wanted simple extraction of second molar then implant therapy. (b) Extracted mandibular second molar. Apical 3 mm was resected using diamond high speed bur. Calcification was observed in the mesiobuccal canal connected with mesiolingual canal via an isthmus. Retrograde filling was performed using MTA. Extracting the tooth took 1 minute and 23 seconds, with the extra oral root end treatment taking 9 minutes and 56 seconds. (c) 1.5 years after intentional replantation, the radiograph shows complete healing and no evidence of external root resorption.

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  Figure 2 (a) Periapical radiograph of a first mandibular molar showing brocken root canal instrument and long canal post. (b) GP cone tracing through buccal fistula showed the origin was periapical lesion of the first mandibular molar. Non-surgical retreatment was the first choice of treatment but failed to remove or bypass the brocken instrument. Intentional replantation was indicated because of accessibility to the disto-lingual canal and thick buccal cortical bone. Extraction time was 58 seconds and extra-alveolar time was 14 minutes and 40 seconds. (c) 1 year after intentional replantation: The buccal fistula disappeared. No mobility of the tooth or formation of the periodontal pocket was observed. 80 days after the procedure, preliminary resin build up was performed to ensure the tooth's contact with opposing teeth. After clinical and radiological examinations confirmed the absence of problems, permanent cast gold crown was cemented 112 days after the procedure.

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  Figure 3 (a) The mandibular second molar treated for deep subgingival caries on the distal root surface: Despite the endodontic therapy provided, the patient complained of discomfort during mastication. The leakage in the distal end was not resolved, either. Thus, root end treatment and distal decay treatment were decided via intentional replantation. (b) 1 year after intentional replantation: The molar was mobile, showing unsatisfactory healing. Nonetheless, it was still functional, causing no obvious problems. Periodontal pockets were not observed, although mobility was found to have increased slightly; root absorption was detected.

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