Surgical repositioning , replantation and transplantation of teeth Dr. Rafik Al Kowafi BDS, MSc, German board of Oral and Maxillofacial Surgery ( Berlin- Germany), Doctoral degree by LBMS 1-Surgical repositioning of impacted or malposed teeth • It is the surgical up righting and repositioning of impacted or malposed teeth in one stage with or without bone removal and maintaining the vitality of these teeth. 3 May 2014 LIMU Dr. Rafik Al Kowafi 2 1
2- Replantation • Replantation of tooth is the re-insertion of this tooth into its socket after it has been removed either intentionally or accidentally • Types of replantation a. Replantation of fully formed tooth. b. Replantation of tooth germ or developing tooth. 3 May 2014 LIMU Dr. Rafik Al Kowafi 3 a- Replantation of fully formed tooth • Indications 1. Tooth intentionally removed for treatment of periapical infection when RCT & apicectomy is impossible for inaccessibility or approximation of vital structures. 2. Tooth accidentally luxated or extracted while extracting the adjacent one or through the use of mouth gag during general anesthesia. 3 May 2014 LIMU Dr. Rafik Al Kowafi 4 2
a- Replantation of fully formed tooth • Contraindications 1. Patients with systemic diseases that contraindicate the surgery. 2. Non-restorable tooth. 3. Fracture of the roots. 4. Poorly motivated patients. 3 May 2014 LIMU Dr. Rafik Al Kowafi 5 a- Replantation of fully formed tooth • Operative procedure 1. Asepsis & pre-operative antibiotics. 2. Control of salivation. 3. RCT of the tooth with or without retrograde filling. 4. Replantation of the tooth as far as possible in the socket. 5. Freeing from occlusion. 6. Suturing. 7. Splinting (fixation) of the tooth for 1-2 weeks. 3 May 2014 LIMU Dr. Rafik Al Kowafi 6 3
a- Replantation of fully formed tooth • Post-operative care and treatment 1. Broad spectrum antibiotics (controversial). 2. Mouth wash (Chlorohexidine 0.2%). 3. Soft diet for 2 weeks. 4. Sutures should be removed on the 7 th post- operative day. 5. Fixation should be removed after 1-2 weeks. 3 May 2014 LIMU Dr. Rafik Al Kowafi 7 a- Replantation of fully formed tooth • Criteria of success 1. Asymptomatic non mobile tooth for 3 years. 2. No root resorption and normal periodontal ligament space are evident radiographically. 3. Normal marginal gingiva and absence of periodontal pocketing. 3 May 2014 LIMU Dr. Rafik Al Kowafi 8 4
b- Replantation of tooth germ or developing tooth • Indication – Replantation of accidentally extracted developing tooth during extraction of their predecessor or during extraction of an adjacent tooth. • Operative procedure: 1. Do not use disinfectant on the tissues. 2. If contaminated , wash with saline and place the tooth in a penicillin solution. 3. Stimulation of bleeding in the socket by curettage 4. Implant the tooth 5. Intraoperative X-ray 6. Suturing 7. Fixation 3 May 2014 LIMU Dr. Rafik Al Kowafi 9 b- Replantation of tooth germ or developing tooth • Post-operative care and treatment 1. Broad spectrum antibiotics (controversial). 2. Mouth wash (Chlorohexidine 0.2%). 3. Soft diet for 2 weeks. Sutures should be removed on the 7 th post-operative 4. day. 5. Fixation should be removed after 4-6 weeks. 3 May 2014 LIMU Dr. Rafik Al Kowafi 10 5
3. Transplantation of teeth • Transplantation of a tooth is the transfer of that tooth from one place in the mouth to another ( Autotransplantation ) or from one individual to another ( Homotransplantation ). 3 May 2014 LIMU Dr. Rafik Al Kowafi 11 3. Transplantation of teeth • Indication – Malposed teeth or impacted teeth when orthodontic treatment is not applicable. • Basic requirements 1. Good oral hygiene 2. Firmly attached gingival tissue 3. The transplanted tooth should be free of periapical and peridontal infections. 4. The tooth should be in a good vertical position when transplanted 5. Protection of the dental follicle in developing tooth. 6. While preparation of the socket the tooth should be kept in the patient's own serum , normal saline or solution of penicillin 3 May 2014 LIMU Dr. Rafik Al Kowafi 12 6
3. Transplantation of teeth • Operative procedure 1. Pre-operative administration of antibiotics. 2. Disinfection and anesthesia of the surgical sites. 3. Extraction of the tooth at the recipient site. 4. Extraction of the donor tooth without disturbing the PDL or dental follicle. 5. Preservation of the tooth in a storage medium like Hank’s balanced salt solution while preparing the socket. 6. Preparation of the socket by bone burs and adequate cooling. 7. Freeing the transplanted tooth from occlusion. 8. Suturing. 9. Adequate fixation for at least 4 weeks. 10. RCT after 2 weeks for the fully formed tooth. 3 May 2014 LIMU Dr. Rafik Al Kowafi 13 3 May 2014 LIMU Dr. Rafik Al Kowafi 14 7
3 May 2014 LIMU Dr. Rafik Al Kowafi 15 3 May 2014 LIMU Dr. Rafik Al Kowafi 16 8
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Methods of fixation of replanted or transplanted tooth • Direct wiring to the adjacent teeth. • Fixation by using an arch-bar. • Acrylic splints. • Fiber splints. • Acid – etch composite (with wire). • Transosseous wiring of the tooth to the investing alveolar bone. 3 May 2014 LIMU Dr. Rafik Al Kowafi 19 Prognosis • Replanted or transplanted partially formed teeth have higher success rates than fully formed teeth because of the revascularization that can be easily established. 3 May 2014 LIMU Dr. Rafik Al Kowafi 20 10
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