Methodology for tooth replantation surgery and instruments. Replantation or an effective method of returning a tooth to its place. Materials and research methods

People of different ages may encounter in life such a concept as tooth replantation. What is it, indications and contraindications, price, reviews - this will be discussed below. This term and procedure are usually familiar to those who suffer injuries to the dental system.

If, as a result of damage, a tooth falls out or was removed for medical reasons, then you cannot do without the help of a qualified dentist. To return the element to its place, the patient is offered replantation at the clinic.

What is tooth replantation?

During the operation, the doctor performs manipulations to return the dropped unit to its alveolar bed. This procedure is used most often on the front teeth, as they are more susceptible to injury due to the presence of only one root. A positive result of replantation depends on several factors:

• integrity of the damaged tooth;
• degree of injury to the hole;
• time interval from the moment of loss.

In order for the engraftment to be successful, you should place the element in saline solution and immediately go to the doctor. The shorter the period of time between injury and surgery, the higher the likelihood of its complete healing, restoration of functionality and beauty of the smile.

Indications and contraindications

In practice, replantation is rarely used. Carrying out such a manipulation is advisable only in cases where it is not possible to return a unit removed from the socket to its place by surgical or other conservative means.

Indications for tooth replantation surgery:

• dislocation as a result of injury;
• which cannot be cured using traditional methods, and it is not possible to perform root resection in the upper part;
• in acute form;
• the development of complications that arise during the treatment of periodontitis of a tooth with several roots, during which their perforation occurs;
• , as a result of which the tooth fell into the resulting gap;
• if there is a need to remove nearby units to access a hard-to-reach or affected area.

It is worth noting that the operation is performed only when the element is not affected by caries, its crown part has no defects, and the roots are not curved.

Contraindications include:

• severe carious process;
• presence of cracks in tooth enamel;
• inflammation in the oral cavity;
• pathologies of the cardiovascular system;
• radiation sickness;
• neurological abnormalities;
• the presence of malignant tumors;
• damage to the blood and circulatory system;
• viral infections;
• mental illness;
• curvature of roots;
• diabetes.

Advantages and disadvantages

Replantation has positive and negative sides.

Advantages:

• allows you to save and restore teeth extracted for various reasons;
• carrying out manipulations during one visit to the doctor;
• in the presence of special equipment, there is a high probability of complete survival, even if the prolapsed unit was outside the oral cavity for 24 hours;
• restoration of functionality and beauty of the smile;
• safety for the client in the absence of contraindications.

The disadvantages of the operation include such characteristics as:

• there is a risk of rejection of the replanted element;
• the likelihood of refusal to carry out the procedure if the coronal part is damaged;
• the need to adhere to a special diet, combining it with taking analgesics and antibiotics, for a period of time determined by the doctor;
• the presence of diseases or restrictions according to which manipulations are prohibited;
• there is no guarantee that if all rules and instructions are followed, the tooth will fully take root.

Types of interventions

There are two methods of replantation: vital and devital.

Vital method

The technique is used when it is necessary to preserve the nerve of a tooth without using canal fillings in case of severe damage. During manipulation, the pulp is preserved; the doctor treats the hole and the prolapsed segment with an antiseptic, and then installs it in its original place. The main indication for this technique is tooth dislocation, and the result is restoration of functionality for 10-20 years.

Devital method

It is used when the patient has a pathological condition such as exacerbation of periostitis or chronic periodontitis, and conventional treatment methods do not provide the desired effect. During the operation, the doctor removes the damaged unit, being careful not to damage or stretch nearby tissues.

The canals are filled and the roots are treated. After this, the hole is cleaned, deposits are removed, and treatment is carried out with antiseptic agents. Only after these steps the dentist is able to install the tooth into the alveolus.

Whatever replantation method is used, its success and effectiveness depend on the qualifications and professionalism of the attending physician.

Preparation

Before replantation, a preparatory process begins, in which not only the patient, but also the attending physician participates. The client will have to get ready for the operation both mentally and physically, and the dentist will have to collect information about the problem that has arisen in order to eliminate all possible contraindications.

It all starts with an initial examination of the patient, during which the doctor examines the oral cavity. This allows us to draw conclusions about the presence or absence of inflammatory processes or any dental diseases. The extracted tooth and socket are examined, as well as plaque and tartar are removed. The client must undergo the necessary tests and take x-rays.

The preparatory process usually looks like this:

• collection of comprehensive information about the client’s condition;
• examination of the damaged area and the entire dental system using computed tomography or x-rays;
• , as a result of which teeth are treated for caries or removed according to doctor’s indications.

A prerequisite for replantation is the healthy state of the bone structure. Before the operation, the client needs to avoid physical activity and also give up bad habits. Taking blood thinning medications during the period of preparation for manipulation is prohibited.

How is the procedure carried out?

The first step in the replantation process is anesthesia. To do this, conduction anesthesia is used, after which the dentist has the opportunity to begin extraction. The doctor performs all actions in such a way that trauma to the tissue in the alveoli is minimal. Further steps of the operation:

1. The extracted element is placed in a saline solution for a certain time, the temperature of which does not exceed 37 degrees. Gentamicin or Penicillin is added to it, which eliminates the possibility of developing infections and also eliminates unfavorable microflora.
2. The process of preparing the hole. Includes treatment of the oral cavity and alveolar area with an antiseptic. Then, with a special tool, the hole is cleaned from the remaining smallest bone elements and granulations. It is treated with Furacilin, after which it is closed with a sterile swab.
3. Stage of tooth processing. It consists in the fact that the dentist cleans the crown of small and large deposits, and also removes the pulp after opening the cavity.
4. Filling canals and dental cavities.
5. Replantation of a dental unit into the socket and restoration of its original physiological position.
6. Fixation. For this purpose, a splint is used, which the patient usually needs to wear for a month.

After the manipulations, the client is prescribed a diet that prohibits the consumption of solid food. If the preparatory stage was carried out correctly and all the dentist’s recommendations were followed, then the likelihood of a positive outcome of replantation is very high.

Recovery stage

Typically, the recovery period lasts 4-5 weeks and takes place under the supervision of a doctor. If the patient develops symptoms that cause discomfort, he is prescribed anti-inflammatory and painkillers, as well as antibiotics.

During the first days, it is necessary to avoid taking high-temperature drinks and foods. Food should be crushed and chewed only on the healthy side of the mouth. During the recovery period, it is advisable to increase your intake of fruits and vegetables, which contain large amounts of fiber.

To reduce the risk of poor tooth survival, the patient is prohibited from smoking or drinking alcoholic beverages. Daily treatment of the oral cavity should be carried out carefully and carefully, namely:

• For cleaning, you can use brushes with soft bristles, but you should not press them on the area where the replantation was performed;
• Gently rinse your mouth with drugs that have antimicrobial properties;
• Do not loosen the tooth with your tongue.

Video: wisdom tooth replantation.

Price

The main factor influencing the cost of the operation is the number of roots of the damaged element. Despite the fact that new technologies are used for replantation, this procedure is not particularly expensive. The exact prices for services related to the restoration of dental units can only be found in the clinic where the manipulations will be performed. The average data is presented in the table below.

Tooth replantation refers to the transplantation of an extracted tooth into its own alveolus. This operation is performed for chronic periodontitis in cases where conservative treatment does not lead to a cure, and resection of the root apex cannot be performed for one reason or another. Tooth replantation can be undertaken when the root is perforated. Finally, replantation is a way to preserve a tooth when it is completely dislocated or accidentally removed. Replantation is indicated if the tooth does not have strongly divergent roots, and the crown is strong enough and is not damaged during removal. Strengthening the replanted tooth requires the presence of adjacent teeth; tooth replantation in their absence is less successful. It is better to perform the operation under general anesthesia, since when anesthetizing the dental plexus, the adrenaline contained in the anesthetic solution can cause a sharp narrowing of blood vessels and disrupt the normal filling of the socket with a blood clot.

The tooth replantation operation begins with its removal, which must be done especially carefully, with minimal trauma to the soft and hard tissues of the alveolar process. The extracted tooth is immersed in a warm (body temperature) physiological solution of sodium chloride with the addition of antibiotics (penicillin, streptomycin). The alveolus of the extracted tooth is carefully cleaned from granulations with a sharp spoon (for chronic periodontitis) and washed from a syringe with a warm physiological solution of sodium chloride with antibiotics. While the tooth is being treated, the alveolus is loosely packed with sterile gauze. Treatment of the replanted tooth consists of mechanical and chemical cleaning of the root canals and filling of the crown and roots. During treatment, the tooth is kept in sterile gauze soaked in saline solution of sodium chloride with antibiotics. The canals are filled with cement or quick-hardening plastic, after which the root tips are resected.

The apexes of the roots of the replanted tooth should be removed, since this area is rich in deltoid branches of the canal with necrotic content, which can lead to relapse of chronic periodontitis. At the end of the treatment, the tooth is inserted into the alveolus, and this stage of replantation sometimes presents great difficulties when transplanting multi-rooted teeth with divergent roots, as well as in cases where the bone walls of the alveolus are not sufficiently pliable. The best effect is obtained when fixing the tooth after replantation for 2-3 weeks using a wire or pre-prepared splint made of styracrylic or other material.

The replanted tooth must first be placed in conditions of complete rest and turned off from articulation, for which it is sometimes advisable to grind off the cusps of the transplanted tooth or the cusps of the antagonist. During the first days, the patient should eat liquid food. Pain that occurs quite often after replantation is eliminated with the help of conventional analgesics. The healing of the replanted tooth lasts 3-4 weeks.

However, even with the most impeccable technique of this operation, the roots of the replanted tooth dissolve after some time, the tooth becomes mobile and has to be removed. The average lifespan of a replanted tooth is 5 years. And yet, in some cases, such an operation is justified. The longest periods of preservation of a replanted tooth are observed when a healthy tooth is transplanted, accidentally dislocated from its socket or accidentally removed. When transplanting such a tooth, it should be thoroughly cleaned of periodontal debris and gum remnants.

Tooth transplantation, i.e. transplanting it into another alveolus, is rarely used. This operation can take place when a healthy supernumerary or impacted tooth can be transplanted into the alveolus of a tooth removed due to chronic periodontitis or due to crown destruction. The surgical technique is the same as for replantation, but favorable outcomes are observed much less frequently. Particular difficulties with this operation lie in the formation of the alveoli for tooth transplantation. Great complexity is also created as a result of the difference in the size of the crown and roots of the extracted and replanted teeth. Therefore, sometimes it is necessary to expand the alveoli and reduce the length of the root, which affects the engraftment process. The same considerations make it difficult to transplant a tooth from one person to another (homoplasty).

Observations of intraosseous implantation of artificial roots made of metal or other material show that in most cases the implant takes root; inflammatory processes and suppuration are observed less often, which lead to loosening and loss of the implant. However, implanted intraosseous artificial roots after implantation do not withstand heavy loads and are therefore unsuitable for fixing individual crowns or abutment crowns of a bridge prosthesis on them.

Our observations of dental implantation from artificial material give reason to evaluate this operation generally negatively, since stratified squamous epithelium, growing from the oral mucosa into the periodontium, quickly leads to implant rejection. Therefore, dental implantation, and even more so metal or plastic frames, should be treated with caution.

TEETH REPLANTATION. Indications and contraindications, methodology Associate Professor of the Department of Pediatric Dentistry, Pediatric Maxillofacial Surgery and Implantology Grechko N.B.K. med. n.

The focus of the development of modern dentistry on the use of low-traumatic treatment methods determines the need for wider use of various types of tooth-preserving operations. This type of operation includes resection of the root apex, hemisection and replantation. Advances achieved in the field of therapeutic, surgical and orthopedic dentistry allow a new approach to the technique of dental replantation.

Despite the fact that many authors recommend wider use of this procedure, dental replantation should be carried out according to strict indications. It should be taken into account that after replantation, ankylosis of the root part of the tooth may occur, which leads to disruption of the function of the supporting apparatus of the tooth; usually such teeth are not recommended for use as supporting teeth for prosthetics.

Ø However, despite all the above disadvantages, this procedure is one of the effective methods for treating some forms of chronic periodontitis, traumatic dislocation of teeth, and is also applicable for the mistaken removal of intact teeth.

Ø The main positive aspect of dental replantation is that this procedure is an organ-preserving operation that prevents bone tissue atrophy, displacement of adjacent teeth, and also eliminates cosmetic defects in the dentition. With the correct use of this technique in the long term, the majority of patients were able to obtain quite satisfactory results.

The operation of tooth replantation is usually understood as the transplantation of a tooth into the jaw socket in which it was previously located. It is carried out more often in case of: 1. Chronic periodontitis of single-rooted teeth, if the compact plate of the socket is destroyed by more than 1/3 and, thus, resection of the apex of the tooth root is contraindicated; 2. Complications of treatment of multi-rooted teeth in chronic periodontitis (root perforation, breakage of an endodontic instrument, impassable canals), and resection of the root apex is impossible; 3. Trauma accompanied by complete dislocation of the tooth; 4. Accidental tooth extraction; 5. Fracture of the jaws, when the tooth located in the fracture gap cannot be filled to the apex; 6. Acute odontogenic periostitis of the jaws, exacerbation of chronic periodontitis, not subject to conservative treatment (delayed replantation).

TRANSPLANTATION - transplantation of a tooth into another alveolus, used extremely rarely. IMPLANTATION - intraosseous introduction of artificial roots made of metal or other material. It is carried out in specialized clinics.

Conditions for replantation Contraindications: Ø Ø Ø Pathological conditions that inhibit regeneration processes (diabetes, alcoholism, etc.) Tooth destruction during its removal or treatment. Acute inflammatory periodontal diseases and periodontal disease. Requirements for the tooth to be replanted: Ø Ø Ø The tooth must have a well-preserved crown. The roots of the tooth should not be severely curved or excessively divergent. Good fixation of the replanted tooth

TERMS OF REPLANTATION If 12-24 hours have passed since the injury, then successful replantation is noted in 90-100%. Ø if 36-48 hours have passed since the injury, then successful replantation is noted in 65-70%. Ø if 48 - 72 hours have passed since the injury, then successful replantation is noted in only 50%. Ø

Stages of the operation: 1. Perform anesthesia. 2. Carefully peel off the circular ligament. 3. Remove the tooth with minimal trauma to surrounding tissues. 4. Immerse the extracted tooth in a warm (37ºC) solution of sodium chloride (isotonic), milk, your own saliva with the addition of antibiotics. 5. Carefully clean the socket of the extracted tooth from granulations, rinse with an isotonic solution of sodium chloride with antibiotics or furatsilin and cover with a sterile gauze swab. The patient is asked to bite the tampon. 6. Processing of the replant. Mechanical cleaning of carious cavities and root canals is carried out in compliance with aseptic rules. The tooth is held in a sterile gauze moistened with an isotonic solution of sodium chloride with antibiotics. The drill tip must be sterile. The remains of the ligamentous apparatus on the tooth root are not removed. The root canal of the teeth is filled, the apex of the tooth root is resected. The prepared tooth is immersed in an isotonic sodium chloride solution.

7. Processing the hole. Remove the tampon and blood clot, wash the hole (carefully) with a solution or fill it with antibiotic powder. 8. Place the tooth in the socket and secure it with a splint for 3 - 4 weeks. 9. Give recommendations to the patient, prescribe a gentle diet, analgesics, sulfonamides. Prescribe physiotherapy from the 4th - 6th day (3 - 4 sessions of UHF therapy). In case of delayed tooth replantation, the operation is carried out in two stages. The first stage consists of removing the tooth and preserving it in an antibiotic solution at a temperature of 4ºC. The second stage is carried out when acute inflammation is eliminated, after about 2 weeks. The tooth is treated according to the method described above and replanted. The function of the transplanted tooth is preserved from 2 to 10 years or more; the longest periods are observed when transplanting a healthy tooth that was accidentally dislocated from its socket.

Another replantation technique Gentle tooth extraction is performed under local anesthesia. The tooth socket is covered with a gauze swab moistened with a 5% solution of aminocaproic acid. The tooth canal is expanded with a drill or a special thin drill, and a tooth cavity is formed for the filling. Antiseptic treatment of the tooth canal is performed. The tooth is filled, and the entire length of the tooth canal is filled with a thin titanium pin fixed with liquid phosphate cement, and the formed carious cavity of the tooth is filled with modern filling material. The tooth root is cleaned of fragments of the cystogranuloma shell and dental deposits. Then a thorough curettage of the hole is performed in the area of ​​its bottom if there is a defect in the jaw bone tissue. The latter is filled with demineralized bone graft strictly to the size of the defect.

The tooth socket and tooth root are treated with a 0.05% solution of chlorhexidine biglucanate using low-frequency ultrasound. The tooth is placed in the socket and composite-wire fixation is performed. The proposed method allows you to reliably and quickly seal the tooth canals and achieve effective sterilization of the root canals of the tooth and the tooth socket. The physiological method of fixing the replanted tooth does not disrupt the process of osteogenesis.

Replantation is a surgical procedure. It is based on the return of a removed or dislocated tooth to the hole where it grew.

What are the indications for replantation?

• when treatment of apical periodontitis in a chronic form (granulomatous or granulating) cannot be carried out using conservative or other surgical methods;
• dislocated as a result of injury;
• removal of teeth that are next to the one being removed due to the complexity of the operation;
• if during the treatment of a multi-rooted tooth diagnosed with chronic periodontitis, perforation of the root wall occurs or an endodontic instrument breaks off, and it is not possible to perform resection of the apex;
• when a fracture of the jaw bone occurs and the tooth ends up in the fracture line, and it is not possible to fill it along the entire length of the root canal;
• accidental tooth extraction.

What are the contraindications for replantation?

• destruction of the incisor during its removal or filling;
• inflammatory processes of periodontium in the acute phase;
• diabetes;
• bad habits (alcohol and drug use);
• neoplasms.

There are two types of replantation:

• vital;
• devital.

The vital method is based on the fact that the pulp remains alive, that is, the canal filling procedure is not carried out.

During devital replantation, first the causative tooth is removed, all existing canals are filled, then the tops of the roots are cut off and only after that it returns to its place.

How is replantation done?

First, the causative tooth is removed (sometimes the patient brings it in his hands). The removal procedure is carried out extremely carefully, since the tissues around this incisor should not be damaged. After this, the replantant is placed in a warm sodium chloride solution with antibiotics.

If it happens that the incisor is completely dislocated and the patient brings it himself, he needs, before coming to the doctor, to put it in saline or milk, or better yet, by the cheek. If this is not done, then the fibers located on the roots will not retain their viability.

After the removal procedure, the dentist examines the hole for granulomas and granulations. If there are any, they are scraped off with a special surgical spoon and the hole is washed with an antibacterial solution.

If devital replantation is performed, then all canals are filled.

Then the apical parts of the replantant roots are resected.

After this, the cutter is placed in its own hole and fixed with a splint. For these purposes, special plates are also used, which are made of quick-hardening plastic or special mouthguards. Splinting is usually carried out for a period of 1-1.5 months. During this period of time, the replantant should not be in contact with the contact group of teeth of the opposite jaw, so the cusps are ground off either on them or on the replanted tooth itself.

After the operation, the patient is prescribed a gentle diet, it is recommended to take analgesics, since the postoperative period occurs with severe pain, and antibiotics to prevent inflammation. After four days, a course of physiotherapy is prescribed.

If acute inflammation is observed in the causative tooth (periodontitis in the acute phase or its aggravated form), then delayed replantation is performed. The essence of the operating process is the same, only immediately after removal a gauze swab soaked with an antibiotic is placed in the socket, and the tooth itself is placed in a sodium chloride solution with an antibiotic for a week. After seven days, when the inflammatory process subsides, the tampon is removed from the hole. All other manipulations are the same as described above.

What are the requirements for a future replantant?

• the coronal part of the future replantant should be well preserved;
• the root system should be smooth, the roots should not diverge;
• The replantant should not develop a deep carious process.

But in any specific case, replantation is possible or not, the dentist decides. Everything depends not only on dental tissues, but also on the individual characteristics of the body.

Types of replant fusion

• periodontal;
• fibro-periodontal;
• osteoid.

The first case is the most favorable. Such fusion is possible only if the periodontal tissues on the roots are partially preserved, and the periosteum in the socket is completely preserved.

Fibrous-periodontal fusion is noted if periodontal tissues and periosteum are partially preserved.

The osteoid type is observed when the periosteum of the socket and the periodontium on the roots are completely lost. This is the most unfavorable type of fusion.

The forecast for such manipulation

Although such an operation is performed extremely rarely, its prognosis is positive. As a rule, replantants remain in the jaw for about five years without any signs of inflammation. After five years they begin to loosen and sooner or later they are removed. Sometimes, of course, the replantant can last longer, but this is typical for dislocated teeth. In general, everything depends on the individual characteristics of the body.

Cost of tooth replantation

These studies are devoted to the study of factors influencing the prognosis of replantation of permanent teeth in children with complete traumatic dislocations. One of the main problems of replantation is external (inflammatory) resorption of tooth roots, which develops 2–6 weeks after replantation and leads to tooth loss. A comparative analysis of the indicators of dental, immune status and salivary microcrystallization (SMC) was carried out in 46 children with a normal type of engraftment (28) and with the development of inflammatory root resorption. In children who developed complications, a decrease in secretory immunoglobulin (sIgA) = 0.235 ± 0.015 mg/ml was recorded, a high degree of caries activity and low hygiene indicators of 2.63 ± 0.023 compared to the first group: sIgA = 0.37 ± 0.01 mg /ml, IG=2.16±0.27. A decrease in salivary microcrystallization (SMC) indicators was also found. In the first group, type I–II of the pattern predominated, the average score was 3.92 ± 0.23 compared to the second group, which had type III–IV crystallization, 2.58 ± 0.21. Therefore, to solve the problem of replantation, when prescribing therapeutic measures, it is necessary to take into account the degree of caries activity. In children with decompensated forms, a decrease in local immunity in the oral cavity dictates the need to prescribe drugs to increase immune reactivity, as well as to carry out a set of hygienic measures during the period of tooth splinting.

tooth dislocation

replantation

resorption

immunity

dental status

microcrystallization of saliva

1.Belovolova R.A. Features of the immune status and the possibility of immunocorrection in post-traumatic inflammatory complications of patients with open fractures of the lower jaw // Immunology. – 2003. – No. 3. – P. 287–293.

2.Belyakov I.M. Immune system of mucous membranes // Immunology. – 1997. – No. 4. – P. 7–13.

3.Moskovsky A.V. Assessment of the immune status of patients with scaries and its complications combined with periodontitis // Dentistry. – 2008. – No. 4. –

4. Pitaeva A.N. Physico-chemical methods for studying mixed saliva in clinical and experimental dentistry: a textbook. – Omsk, 2001. – 40 p.

5.Andreasen FM. Transient root resorption after dental trauma: the clinician’s dilemma // J. Esthet Rest Dent. – 2002. – Vol. 14, No. 6. – P. 80–92.

6.Andreasen J.O. Replantation of 400 avulsed permanent incisors. Factors related to periodontal ligament healing // Endodontics & Dental Traumatology. – 1995. – Vol. 26, No. 11. – P. 76–89.

7.Marino T.G. Determination of periodontal ligament cell viability in long shelf-life milk // J. Endod. – 2000. – Vol. 26, No. 14. – P. 699–702.

8.Pacheco L.F. Evaluation of the knowledge of the treatment of avulsions in elementary school teachers in Rio de Janeiro // Brazil, Dent. Traumatol. – 2003. – Vol.19. – P. 76–78.

Complete dislocation is one of the most serious types of dental injuries in children. The most preferred method for treating dislocated teeth is replantation (returning the tooth back into the socket followed by fixation in the dentition). The authors noted that most replanted teeth sooner or later undergo resorption. Researchers have identified the main factors influencing the outcome of replantations: the time the tooth remains outside the oral cavity and the conditions for storing the tooth. In 20-40% of cases, inflammatory resorption develops at 1-6 weeks, which, if left untreated, leads to tooth decay. Therefore, the problem of replantation is to predict the development of resorption using preventive corrective measures in children, taking into account the condition of the oral cavity and the degree of caries activity.

Purpose of the study: assessment of the influence of dental and immunological parameters on the results of replantation of children with traumatic dislocations of teeth.

Materials and research methods

Dispensary observation was carried out for 46 children aged 8 to 15 years with complete traumatic dislocations who applied to the children's dental clinic in Blagoveshchensk and odontological clinic No. 22 in Khabarovsk. A comprehensive examination was carried out: clinical determination of the intensity of the dental caries process (KPU, KPU+kp), the level of oral hygiene according to the Green-Vermillion index (J.Green, J.Vermillion, 1960), RMA modified Parma %. The state of local immunity in the oral cavity was assessed by the content of saliva IgG, IgA, secretory sIgA using the radial immunodiffusion method in a gel according to G. Manchini.

To assess the level of general resistance of the children's body, microstructural crystallization of mixed saliva was studied according to Leus P.A. modified by microphotography. The MCS was assessed on a five-point scale. B5 and 4 points were assessed for preparations that have a characteristic clear pattern in the form of elongated fern-like crystalloprismatic structures extending from the center of the drop. The more organic matter and the more chaotic the arrangement of structures, the lower the number of points corresponding to the drug. Scores of 2 and 3 points were assigned to preparations that had scattered and fractured structures forming crystals.

Clinical follow-up was carried out every week during the splinting period and every two weeks after the splints were removed. Control radiographs were performed on patients at 8-10 weeks of the postoperative period. According to radiography, the presence of foci of rarefaction of bone tissue around the root was regarded as a complication. The research results were processed using the Statistics 6 program using nonparametric methods using the Mann-Whitney test.

Research results and discussion

As a result of the clinical examination, 2 groups were formed. The grouping feature was the presence of early complications - the development of lateral tooth root resorption. When examining children of group 1 - 28 children, physiological mobility of the tooth and the absence of inflammatory changes in the tissues surrounding the tooth were noted. Radiographs revealed an unchanged root contour, sometimes with small areas of resorption, and no loss of surrounding bone tissue (Fig. 1, 2).
In children of group 2 (18 children), complications developed in the form of inflammatory resorption in the period from 1 to 6 weeks, pathological mobility of the tooth, edematous, hyperemic gum tissue, and control radiographs showed areas of rarefaction of bone tissue adjacent to the lateral surfaces of the tooth root (Fig. .3).

Rice. 1. Patient B., 7 years old. Replantation of 21 teeth. Splinting stage

Rice. 2. Patient B., 8 years old. Condition after replantation. Control after 6 months

Rice. 3. Patient Sh. Replantation of the 21st tooth. Splinting stage. Inflammatory tooth root resorption

According to the results of a dental examination in the group of children with postoperative resorption, the CP+CP indicators were 2 times higher: 5.62±2.09 compared to group 1 -2.68±1.67 (p‹0.01). Statistically significant differences were revealed in the study of the hygiene index (table). The oral hygiene of children in group 2 is worse - 2.63±0.23 compared to the hygiene of children in group 1 - 2.16±0.27 (P< 0,01).

Indicators of the dental and immunological status of children with complete traumatic dislocations of teeth

Statistically significant differences were also revealed in the RMA indicators: in children with developed resorption, the degree of inflammatory process in the periodontal tissues was 22.8±1.09 higher than in the group without complications - 16.25±0.87 ( R < 0,01), что соответствует гингивиту легкой степени тяжести. По показателям МКС слюны для детей 1 группы характерен более структурированный и четкий рисунок- 3,92 балла (I-II тип МКС), что свидетельствует о более высокой резистентности к кариесу, а также хорошей общей реактивности организма (рис. 4). У детей 2 группы преобладал III-IV тип, свойственный лицам с ослабленной иммунореактивностью, высокими показателями КПУ и низким уровнем гигиены, что соответствовало 2,58 балла (рис. 5).

Rice. 4. II type ISS - 4 points

Rice. 5. III type ISS - 2 points

When studying the level of immunoglobulins in the oral cavity, no significant difference in the IgA content of the two groups was revealed (table). The average IgG concentrations in children with developed root resorption turned out to be slightly higher than those in children of the first group: 0.055±0.002 and 0.029±0.002, respectively ( R < 0,01). Ведущим признаком специфической защиты в полости рта является sIgA . У детей с наружной резорбцией после реплантации обнаружен дефицит sIgA в ротовой жидкости 0,235 ± 0,015 в сравнении с пациентами первой группы, где показатель составляет 0,37 ± 0,02 (R < 0,01).

Conclusion

One of the serious problems of dental replantation is the lack of guarantee of a positive result. Despite the accompanying favorable anamnestic factors observed in children: a short extra-alveolar period, wet storage of the tooth during transportation, the state of the patient’s dental health has a great influence. In group 2 of children, external inflammatory root resorption revealed deviations in dental and immunological status. Research has revealed in this group high rates of activity of the carious process, a low level of hygiene, more pronounced periodontal inflammation, and a decrease in (sIgA) - the main factor of antimicrobial protection. Studies of microcrystallization of saliva, reflecting both the general somatic state of the body and the icary situation, showed a low degree of structure in the group of children with complications. Such changes in children of the second group indicate an imbalance of the protective systems in the oral cavity. After replantation of an injured tooth, the antigenic load increases, and an inadequate immune response provokes an inflammatory reaction with the participation of immunocompetent cells, connective tissue cells, and osteoclasts, which leads to progressive resorption of root tissue.

Consequently, the main way to solve the problems of dental replantation associated with the development of early root resorption is to prevent complications and improve the condition of the oral cavity during the period of engraftment of replants. It is necessary to include in conservative treatment:

1) prescription of drugs that increase local immunity;

2)carrying out controlled hygiene measures;

3) the appointment of physiotherapeutic procedures that stimulate the engraftment process.

This complex is a prevention of inflammatory-resorptive complications of replantation of permanent teeth in children and a solution to the problem of early loss of replanted teeth.

Reviewers:

Bobylev N.G., Doctor of Medical Sciences, Professor, Head. Department of Maxillofacial Surgery, Far Eastern State Medical University, Khabarovsk;

Danilova M.A., Doctor of Medical Sciences, Professor, Head. Department of Pediatric Dentistry and Orthodontics, Perm State Medical Academy named after. Academician E.A. Wagner, Perm.

The work was received by the editor on November 15, 2012.

Bibliographic link