Intentional Replantation: Indications, Contraindications, and Pathways

Posted on Mar 8, 2025 in Biology

Intentional Replantation

Intentional replantation is indicated when there is no other treatment alternative to maintain a strategic tooth.

Indications

RCT cannot be performed conventionally:

  1. Calcifications
  2. Blockages
  3. The patient cannot open his/or her mouth sufficiently.

Treatment failures that cannot be retreated by conventional methods:

  1. Unusual anatomy.
  2. Canals that are blocked with broken instruments, crowns, ledges, or restorative materials such as posts; areas that are inaccessible.

Roots that have unmanageable perforations


Contra-Indications

Patients who have a major commination or fracture of the jaws or alveolus or an extensive medical history resulting in poor healing capacity.

Tooth with advanced periodontal disease with mobility or furcation involvement.

Evaluation

Recall evaluations are performed to search for

Signs of mobility

Periodontal defects

Root resorption

Persistent periradicular pathosis

Evidence of healing

(Surgery would be indicated but cannot be performed owing to anatomic restraints such as the external oblique ridge or nerve bundle proximity (inferior alveolar, lingual, or mental nerves).

Intentional replantation is not a substitute for endodontic surgery if that procedure can be successfully performed.)


Primary Endo, Secondary Perio

1–Caries, Restoration, Trauma–Pulpal inflammation–Clinical signs (Acute pain

Swelling May/not be present)–Sinus tract Gingival Sulcus–Crestal bone level normal–Pulp vitality:

EPT; negative

2–Endodontic involvement– Failure of host defense Virulence of Microorganisms–Destruction of periodontal ligament,Break down of supporting hard and soft tissues–Drainage Thru the gingival sulcus

–Presence of Bacteria and plaque in the sulcus– Apical migration of Junctional epithelium

–Angular bone loss,Periradicular bone loss —Pulp vitality:EPT; negative


Pathways of Communications

  1. Developmental origin;

    1. Apical foramen

    2. Accessory / lateral canals

    3. Dentinal tubules exposure / congenital absence of cementum…

    4. Developmental groove / lingual groove

    5. Permeability of cementum

    6. Enamel projection and enamel pearls

  1. Pathologic origin;

  1. Caries

  2. Empty space created by destroyed sharpey’s fibre

  3. Vertical root fracture caused by trauma

  4. Idiopathic resorption- Internal/External

  5. Loss of cementum due to external irritants

  1. Iatrogenic origin;

  1. Exposure of dentinal tubules following root planing

  2. Accidental lateral perforation during endodontic therapy

  3. Root fractures due to endodontic procedures


‘Walking Bleach’ or Non-Vital Bleaching

Steps:

1-Prepare the tooth – polishing, remove surface debris

2-Apply petroleum jelly to gingival tissues

3-Adapt the rubber dam

4-Re-establish the access cavity

5-Remove any GP that extends into the pulp chamber to the level of alveolar bone.

6-Seal the orifice of the root canal with at least 1mm glass ionomer cement to prevent percolation of the bleaching agent into the apical area

7-Mix sodium per borate and superoxol and carry the thick paste into pulp chamber.

8-Place a cotton pledget over the bleaching paste.

9-Seal the cavity with IRM.

Image