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Azerbaycan Saytlari

 »  Home  »  Endodontic Articles 4  »  Monitoring pulp vitality after transplantation of teeth with mature roots
Monitoring pulp vitality after transplantation of teeth with mature roots
Introduction - Case report.



M. L. Siers, W. L. Willemsen & K. Gulabivala
Department of Cariology and Endodontology, Faculty of Dental Science, University of Nijmegen, Nijmegen, the Netherlands.
Department of Conservative Dentistry, Eastman Dental Institute for Oral Health Care Sciences, University of London, London, UK.

Introduction.
Autotransplantation is a valid treatment option to replace missing teeth (Ahlberg et al . 1983, Paulsen et al . 1995). Careful manipulation of the root and socket under favourable preoperative, surgical and postoperative conditions ensures survival of the cells of the periodontal ligament and promotes the reformation of a normal supporting apparatus. However root resorption can be a major complication that can be exacerbated by pulp necrosis and infection.
The occurrence of pulp necrosis is influenced by a number of factors, including most crucially the maturity of the roots at the time of transplantation. As far as the pulp is concerned, revascularization is more likely in teeth with open apices than in those with closed apices (Andreasen et al . 1970, Altonen et al . 1978, Andreasen 1986), where an 85% chance of pulp necrosis is reported (Andreasen et al . 1990). On this basis, some clinicians have adopted a clinical protocol that indicates routine root canal treatment for transplanted teeth with mature root apices (Lownie et al . 1986). On the other hand, some clinicians may adopt a more conservative policy preferring to wait and see even in cases involving transplanted teeth with mature roots. But as yet this practice remains unsupported by the published literature.
This paper describes a case of pulp revascularization after transplantation of a tooth with closed apices and aims to initiate a discussion on the value of a conservative approach for the management of transplanted teeth.

Report.
An 18-year-old female patient was referred to an endodontist by an oral surgeon for root canal treatment of tooth 38, which had been transplanted to the site of tooth 16, that had been lost as a result of trauma. Figure 1 shows the radiographic appearance immediately after transplantation. It was not until 5 months after transplantation and referral that the patient made an appearance at the endodontist; she reported no problems. The intraoral investigation showed a sound transplanted tooth with no discolouration and painless on percussion. It did not react to electric pulp testing or cold. The probing depths around the tooth were in the range of 2–3 mm, whereas on the mesial aspect of the tooth it was 4 mm, but without bleeding on probing. The bone levels were similar to that of the neighbouring teeth with no pathological radiolucencies discernible. Figure 2 shows the tooth 5 months after transplantation. No record of root maturity was available, but radiographically when seen by the endodontist they appeard (nearly) closed. In view of the period since transplantation and the absence of pathological signs, it was decided to reschedule the patient for follow-up after 6 months, before considering root canal treatment.

Figure 1. Situation immediately after transplanting the 38 to the position of the 16. Radiograph by oral surgeon.

Situation immediately after transplanting the 38 to the position of the 16. Radiograph by oral surgeon



Figure 2.
Situation 5 months after autotransplantation. First visit of patient to endodontist.

Situation 5 months after autotransplantation. First visit of patient to endodontist



Figure 3.
Second visit: situation 14 months after autotransplantation. Partial obliteration of the pulp space is visible.

Second visit: situation 14 months after autotransplantation. Partial obliteration of the pulp space is visible



Figure 4.
Third visit: situation 26 months after autotransplantation. Almost total obliteration of the pulp space is visible.

Third visit: situation 26 months after autotransplantation. Almost total obliteration of the pulp space is visible

However, it was 9 months before the patient reported again. There were no symptoms and no clinical changes were observed; the tooth still gave no response to sensitivity tests. The radiographic appearance at this time (Fig. 3), 14 months after transplantation, showed no pathological bone changes and no evidence of root resorption. However, the pulp space of the transplanted tooth showed partial obliteration. Since this may be considered a sign of vital pulp tissue, and since there were no pathological conditions present, the patient was given another follow-up appointment 1 year later.
Twenty-six months after transplantation no pathological signs were detected clinically or radiographically. The pulp space at this time was completely obliterated, without a widening of the periodontal ligament space. The accompanying radiograph is shown in Fig. 4. Thus, 26 months after transplantation, the transplanted tooth 38 functioned without discernible problems or discomfort.