Tooth transplant. Intentional replantation of an upper molar.
Acute periapical abscess in the upper second molar of a patient with special needs, difficulty in opening, inclination that made isolation and access difficult, and initial indication for extraction.
After analyzing the possible options, we opted for intentional replantation after endodontic treatment and apicectomy outside the patient's mouth, under sedation.
The hyperplastic gingiva was removed and then the tooth was removed from the socket and kept under constant irrigation with saline solution while delicate cleaning was carried out, removing granulation tissue and avoiding any scraping of periodontal tissue, followed by preparation and filling with cones and Bio C Sealer.
The tooth was then re-implanted and fixed by suture for 1 week.
Control after 1 year shows no change, and the patient is awaited for radiographic and tomographic follow-up.
A case carried out with colleague and friend Prof. Dr. Carlos Augusto das Neves, an oral and maxillofacial surgeon.
Intentional replantation in:Miranda, Andressa de Fátima Araújo, Rejane Santos Quintino, and Rafael José Santos Rodrigues. "SUCCESS RATE AND LONGEVITY RATE IN INTENTIONAL REPLANTATION (DENTISTRY)." Institutional Repository 3.1 (2024).
Introduction
Within dental practice, it is estimated
much the conservative philosophy, involving not
only the maintenance of tooth structure, but
also the preservation of surrounding tissues
(LLERENA et al., 2015; OLIVEIRA et al., 2021).
Intentional replantation (IR) is a
procedure that has existed since the 11th century, when
Albucasis reported the first replantation and the use of
splints on the replanted tooth (LLERENA et al.,
2015; PORTILLA et al., 2021). In 1712, Pierre
Fauchard reported the performance of an intentional
replantation in fifteen minutes after the extraction of the
tooth. The importance of the periodontal ligament in the
prognosis of reimplanted teeth was discussed
by Scheff in 1890 (LLERENA et al., 2015).
According to some authors, it is a technique that has been used
since 1950, in which the risk of resorption is
minimized if contamination is avoided during
the surgery and the procedure is carried out with
extra-oral time of fifteen minutes or less.
The risk of ankylosis can be reduced or prevented if the
tooth is kept in physiological occlusion
(PEREIRA et al., 2024), 2024).
Endodontic treatment has a
significant potential success rate, but
there is still a considerable failure rate,
which can fail in between 16% and 65% of cases, and its
failure is mainly related to
recolonization or new colonization of bacteria
due to errors during the procedure (ALVES et
al., 2020; PORTILLA et al., 2021; KUMAR et al.,
2023; PEREIRA et al., 2024).
When endodontic
treatment fails, there are a number of
treatment options that complement conventional
endodontics. Treatments such as: non-surgical endodontic
retreatment, apicectomy, parendodontic
surgeries, but when there is an
unfavorable prognosis for surgical or non-surgical
retreatment, or when treatment
may pose a risk to the patient, an alternative
is to opt for tooth extraction and replacement with
implant or IR treatment (ESTEVES et al.,
2019; ALVES et al., 2020; PEREIRA et al., 2024).
IR treatment has emerged as an
alternative to prevent the loss of natural teeth,
with a view to conserving natural teeth. It is a
procedure consisting of atraumatic extraction
of the tooth, with
an extra-oral treatment and, when there is tissue
apical lesion, curettage of the alveolus
and subsequent reimplantation of the tooth in the
alveolus (KUMAR et al., 2023; PEREIRA et al.,
2024).
Case selection and pre-surgery works
in the same way as endodontic treatment
surgical, a correct anamnesis
of the patient and tooth involved, clinical examination and
radiographic and tomographic examination involving an
adequate general oral diagnosis, sensitivity
test, percussion, palpation and probing
periodontal should be carried out. The patient should be shown
all the treatment options, as well as the
pros and cons of the procedure and have the
informed consent form (ICF) signed
by the patient (PORTILLA et al., 2021).
The choice of the most suitable treatment for
the patient depends on a number of factors such as the
patient's general health, the type of adjacent lesion,
how long and what the state of the filling of the
root canal is, after which check which treatment
best fits the
patient's diagnosis and complaint (PEREIRA et al., 2024).
In view of the data mentioned above, the
literature review is of particular importance to
dental students, dental surgeons and
health professionals, enabling
them to understand intentional replantation, its
social character, not just its clinical nature, and to
use it as a more conservative
alternative to tooth extraction.
This is because the aim is to demonstrate that the
technique of intentional replantation can have a high
success rate and a favorable prognosis,
as well as being a viable
treatment alternative.
Tooth transplantation.
