The last resort to save "bad teeth" - intentional tooth replantation

Author: Huang Dingming, Chief Physician, West China Hospital of Stomatology, Sichuan University

Member of the Professional Committee of Endodontics of the Chinese Stomatological Association

Reviewer: Hou Benxiang, Chief Physician, Beijing Stomatological Hospital, Capital Medical University

Deputy Secretary General of the Chinese Stomatological Association

Intentional tooth replantation mainly refers to the minimally invasive extraction of the diseased tooth from the oral cavity, targeted treatment of the cause of the diseased tooth in vitro, and after the in vitro treatment is completed, the diseased tooth is implanted again in its original position.

The cells growing on the root surface of natural teeth are combined with the cells on the surface of the alveolar bone through the periodontal ligament to restore the periodontal ligament structure and physiological function of natural teeth. The main purpose is to retain natural teeth in the oral cavity and preserve them healthily.

Intentional tooth replantation is mainly to eliminate the cause of pulpal periapical disease, while repairing and reconstructing the periapical tissue of the diseased tooth, curing the disease, and maintaining the chewing function of the tooth. It is the last resort to preserve teeth with pulpal periapical disease.

1. Under what circumstances should intentional tooth reimplantation be used?

Clinically, if the problem of the affected tooth can be solved by root canal therapy, root canal retreatment, microapical surgery and other treatment methods, intentional tooth replantation is not recommended.

If the above treatment methods cannot solve the disease of the affected tooth, intentional tooth replantation is recommended as the last line of defense for difficult and complicated diseases that cannot be solved by general clinical treatment methods.

Figure 1 Original copyright image, no permission to reprint

2. What preparations and assessments does the doctor need to make before intentional tooth replantation?

Preoperative preparation plays a key role in the success of the operation.

Preoperative preparation first includes preoperative examination, to understand the patient's overall health status, such as whether there are systemic diseases such as hypertension, heart disease, diabetes, etc. Only when the patient's overall condition is good, the success rate of intentional tooth replantation can be guaranteed, so before the operation, a comprehensive understanding of the patient's overall condition is required.

Secondly, we need to understand the patient's oral health status. If the patient has poor oral hygiene and severe periodontal disease, the success rate and long-term efficacy of intentional tooth replantation will be greatly affected.

Figure 2 Original copyright image, no permission to reprint

In addition, you should also understand the condition of the tooth that will undergo the intended tooth replantation:

First, evaluate the function of the affected tooth after the intended tooth replantation. If the affected tooth can perform less function after surgery, then there is little point in replanting it.

Second, evaluate the crown of the affected tooth. If there is too little crown tissue left, the crown of the affected tooth is likely to break during the extraction process, and replantation will be impossible.

Third, evaluate the periodontal condition of the affected tooth. If the periodontal condition of the affected tooth is not good, it will be difficult for it to survive after replantation.

In addition, an X-ray examination or even a three-dimensional cone beam CT examination (CBCT) is required before the operation, so as to have a comprehensive and clear understanding and assessment of the root canal anatomy, root morphology, number of roots, and the relationship between the important and adjacent anatomical structures around the affected tooth before treatment, so that the doctor can have a clear idea during treatment.

On the other hand, intentional tooth replantation surgery has very high requirements on the doctor's operating skills, corresponding equipment and the entire medical team.

First of all, the anesthetic prepared for the intentional tooth replantation surgery must be in place to ensure that the patient is in a painless state during the treatment, especially during the tooth extraction process, so that the patient can better cooperate with the doctor for treatment.

The second is the preparation during tooth extraction. The tooth extraction of intentional tooth replantation is different from ordinary tooth extraction. It is not just to extract the tooth and then discard it. Instead, the affected tooth is extracted minimally invasively and then put back. Therefore, the integrity of the affected tooth needs to be preserved.

In addition, the trauma to the surface cells of the affected tooth root should be minimized as much as possible. At the same time, the trauma to the tissues around the root of the affected tooth, such as the alveolar bone, should also be minimized. Therefore, for the preparation of tooth extraction instruments, corresponding special tooth extraction instruments suitable for intentional tooth replantation should be used.

Application of microscopes. To achieve a good treatment effect, it is often necessary to use the magnification and illumination functions of a microscope to clearly observe, evaluate and treat the root surface and the fine structure of the root apex of the affected tooth, and fully ensure that during the treatment process, the microorganisms in the root canal and the tissues around the root apex will no longer interfere with each other.

In addition to the preparation of the microscope, the corresponding instruments for microscopic periapical surgery and nano-bioceramic materials with good compatibility with human tissue to seal the end of the root canal must also be prepared.

Finally, the medical staff must be well prepared. Since the intentional tooth replantation has strict restrictions on the treatment time of the affected tooth in vitro after extraction, it requires the medical team to be able to cooperate well to ensure that the affected tooth is treated satisfactorily in vitro in the shortest possible time. This is also the key to the success of the intentional tooth replantation.

It can be seen from this that intentional tooth replantation has very high requirements on the medical conditions, medical equipment of medical institutions, medical skills and coordination ability of medical staff.

3. What preparations should patients make before intentional tooth replantation?

First of all, patients should go to the periodontal specialist clinic for full-mouth oral care before treatment, thoroughly clean the bacteria and plaque colonized in the oral cavity, and create a good ecological environment for the success of intentional tooth replantation.

In the week before replantation, mouthwash can be used to control the oral microbial flora.

You must eat on the day of surgery. Because local anesthesia injection is required for intentional tooth replantation, hypoglycemia may occur after anesthesia, which may cause adverse reactions such as syncope, so patients should eat before treatment.

Although intentional tooth replantation has extremely high requirements on the medical conditions of medical institutions and the technical level of medical staff, it is actually a relatively small operation performed in the dental clinic, which is equivalent to a tooth extraction process. As long as the affected tooth can be completely extracted, the treatment can basically be guaranteed to proceed smoothly. Therefore, patients should relax psychologically and not add too much pressure to themselves invisibly.

Figure 3 Original copyright image, no permission to reprint