Immediate tooth replantation: root canal filling for delayed initiation of endodontic treatment

Abstract

The aim of this study is to evaluate the action of paramonochlorophenol associated with Furacin followed by calcium hydroxide (CH) dressing in the control of inflammatory root resorption in cases of immediate tooth replantation with delayed endodontic treatment. A total of 28 incisors of 3 male dogs were extracted and replanted after 15 minutes, and randomly divided into 3 groups: Group I (n = 8) - endodontic treatment was performed before the extraction and replantation; Group II (n = 10) - endodontic treatment was performed 30 days after replantation and the root canal was filled with CH dressing; Group III (n = 10) - endodontic treatment was performed 30 days after replantation and root canals received temporary medication of paramonochlorophenol-Furacin followed by CH dressing. The animals were euthanized 90 days after replantation. The histomorphological events analyzed at the epithelial reattachment site were the intensity and extent of acute and chronic inflammatory processes, periodontal ligament (PDL) organization, the intensity and extent of acute and chronic inflammatory processes in the PDL space, root resorption, bone tissue, and ankylosis. Data were submitted to the Wilcoxon Signed Ranks Test for group comparison (α = 5%). In Groups I, II and III the periodontal ligament was regenerated and most of the resorption areas were repaired by newly formed cementum. The depth and extent of root resorption were significantly higher in Group II than in Group III. The use of paramonochlorophenol-furacin followed by CH dressing was more effective in controlling inflammatory root resorption after immediate tooth replantation.

Anti‐inflammatory and anti‐resorptive efficacy of adrenergic blockers on late replanted rat incisors

“…Calcium hydroxide is the most commonly used root canal dressing for late replantation, and it is considered to be the medication of choice due to its alkaline pH and bactericidal effects, which may slow or limit inflammatory and replacement resorption . To observe these effects, a long application time with successive changes is required, which has been associated with a detrimental effect on the fracture resistance of root dentin . Additionally, as observed in this research, studies in animal models have demonstrated that calcium hydroxide is ineffective in preventing inflammatory and replacement resorption following tooth replantation .…”

“…It is estimated that 60 to 85% of replanted teeth are resorbed and lost 4‐6 years after injury . Such poor success rates have led to attempts to place temporary dressings in the root canal with the aim of preserving the root structure after replantation because immediate root canal filling is not effective for the control of inflammatory resorption …”

“…Osteoclast recruitment is under the control of a system of receptors within the tumor necrosis factor (TNF) superfamily, including osteoprotegerin (OPG) and receptor activator of nuclear factor kappa‐B ligand (RANKL), which are both expressed on the surfaces of osteoblasts . Several treatment strategies have already been studied with the aim of preventing or delaying osteoclast‐mediated root resorption after replantation, such as the use of fluoride, zoledronic acid, acetazolamide, local or systemic antibiotics, Ledermix, indomethacin, bisphosphonates, and laser therapy . Although some drugs may make the root surface more resistant to resorption and slow down resorptive processes, to date, none have been able to completely inhibit these complications.…”

Manejo endodôntico de dentes reimplantados: revisão de literatura

“…Sabe-se que quando o reimplante é realizado, uma das consequências esperadas é a anquilose, devido ao dano do ligamento periodontal (LP) (1,(6)(7)(8)(9). Entretanto, após o reimplante, outras situações podem ocorrer, tais como reabsorção substitutiva e reabsorção externa inflamatória (9)(10)(11)(12)(13). Contudo, essas consequências podem ser evitadas ou simplesmente controladas se algumas medidas de preservação e uma adequada terapia endodôntica for realizada (4,5,(13)(14)(15).…”

“…Destaca-se que além das manobras de limpeza e desinfecção relacionadas com a técnica endodôntica utilizada, o uso de medicações se faz necessário, especialmente para controlar as reabsorções inflamatórias. A medicação mais utilizada com esse intuito é o hidróxido de cálcio (HC) (13,14,(16)(17)(18). Relata-se que a elevação do pH promovida pela referida medicação intracanal é responsável pela morte das bactérias presentes na luz do canal e túbulos dentinários, sendo capaz de remover os estímulos que mantêm a reabsorção inflamatória ativa (19).…”