Methodology for tooth replantation surgery and instruments. Replantation - is it possible to return a fallen or extracted tooth to its place? Cost of tooth replantation

Replantation means transplanting an extracted tooth into its own alveolus.

There are immediate and delayed replantation.

Indications and contraindications for direct replantation are the same as for resection of the apex of the tooth root. Replantation of mainly multi-rooted teeth is performed.

Operation technique:

The tooth is carefully removed, trying not to injure the walls of the alveoli and adjacent soft tissues. The extracted tooth is immersed in a warm (+ 37 degrees) isotonic sodium chloride solution with the addition of an antibiotic. Granulation growths or granuloma are removed, trying to preserve periodontal tissue, the lateral walls of the alveoli and the circular ligament, and the socket is washed with an antibiotic solution. Under aseptic conditions, the canals and carious cavity of the tooth are mechanically cleaned, filled with phosphate cement or quick-hardening plastic, and the apexes of the roots are resected. After toileting the socket, the tooth is placed in the socket and fixed with a wire splint made of quick-hardening plastic for 2-3 weeks and removed from occlusion. Multi-rooted teeth may not require fixation.

There are three types of fusion of the transplanted tooth with the alveolus: periodontal - occurs with complete preservation of the alveolar periosteum and periodontal remnants on the roots of the tooth; periodontal fibrous - with partial preservation of the alveolar periosteum and periodontal remnants on the tooth root; osteoid - with complete destruction or death of the alveolar periosteum and periodontal tooth root. The prognosis for the viability of a replanted tooth is most favorable with periodontal and least favorable with osteoid type of engraftment. In acute inflammatory processes (acute and aggravated chronic periodontitis, periostitis, osteomyelitis), delayed replantation is performed. The extracted tooth is placed in an isotonic solution.

5. Materials for student activation during lecture presentation
1. A 31-year-old patient has chronic granulomatous periodontitis of the 11th tooth. On the radiograph, there is a granuloma up to 4.5 mm at the apex of the 11th tooth. in diameter. The filling mass is not brought to the root apex by 2-3 cm. What type of treatment should be carried out for this patient?
2. A 42-year-old patient consulted a dentist about a defect in the crown of the 46th tooth. There is a large carious cavity on the distal approximal surface of the 46th tooth. On the radiograph, the medial root is filled to the apex, there are no periapical changes.

The crown defect reaches the bifurcation. At the distal root there is a rounded bone tissue resorption with clear boundaries with a diameter of up to 4 mm. with a sclerotic rim along the periphery. Choose the most appropriate type of treatment.

Tooth replantation- a procedure that represents the return of an extracted tooth to its own alveolar bed.

It is possible only if the tooth does not have an overly branched root. The operation will be more successful if there are teeth adjacent to the replanted tooth. In this case, the use of conduction anesthesia is indicated. The use of local is fraught with vasoconstriction, which prevents the normal filling of the alveolar bed with blood.

Tooth replantation: indications

Indications for dental replantation are the following situations:

chronic periodontitis, not amenable to conservative treatment methods;
chronic periodontitis, in which resection of the root apex cannot be performed;
perforation of the tooth root;
odontogenic periostitis of the jaw in acute form;
preservation of a healthy accidentally removed (for example, during complex procedures with neighboring teeth affected by disease) or dislocated teeth.

Tooth replantation: stages of surgery

The first stage of the procedure is tooth extraction. It should be carried out as carefully as possible; in no case should hard or soft tissues be damaged.

The extracted tooth is placed in a saline solution of sodium chloride, the temperature of which should correspond to body temperature. The solution also contains antibiotics, usually streptomycin or penicillin.

Then it is necessary to clean the alveoli from granulations characteristic of chronic periodontitis. To do this, use a special sharp spoon. After cleansing, the alveolus should be rinsed with warm saline from the syringe from which the needle has been removed. After this, mechanical and chemical treatment of the replanned tooth begins, and the alveolus is first covered with sterile tampons, however, avoiding dense tamponing. The root canals are cleaned, and then, after wrapping the tooth in sterile gauze soaked in saline solution, they begin filling the roots and crown. In this case, a quick-hardening mass is used, less often cement.

Having done this work, you can begin resection of the root tips. This step is required because the apexes are deltoid branches of the canals. The latter contain necrotic tissue. If you neglect the resection procedure, the likelihood of relapse of periodontitis increases. Such replantation is called devital.

Vital view of dental replantation

There is another type of replantation - vital, which does not involve filling the canal. With this operation, the pulp of the tooth is preserved, and the indication for it is the replantation of a healthy tooth, for example, after a dislocation.

After carrying out these procedures, you can place the tooth in the alveolus. This process is fraught with difficulties, especially if the tooth has complex multi-channel branches or the alveolar walls are not mobile. The best effect can be achieved by using wire or styracrylic tires.

If there is an acute inflammatory process in the alveolus, then placing the tooth in it is postponed for 1-2 weeks. The alveolus itself is covered with a bandage soaked in an antibiotic solution. The tooth is stored in a solution of sodium chloride and antibiotics, the temperature of which is 40 degrees.

When replanting an accidentally pulled out or dislocated tooth, it must be cleaned of scraps of gum and periodontal tissue. After placing the tooth in warm milk, you should rush to the doctor. If a tooth is not susceptible to caries and does not have other non-carious pathologies, then there is a high probability that it is ready for replantation. However, the final decision is made by the doctor. Otherwise, the replantation procedure is performed in the same way as replantation for periodontitis.

Healing of the tooth takes 3-4 weeks. To ensure rest, the cusps of the replanted tooth or its antagonist can be ground. In the first 5-7 days, a special diet is indicated, including liquid food at room temperature.

The healing process is painful. This syndrome is relieved by taking analgesics.

Even with an impeccably performed operation and strict adherence to the doctor’s instructions in the postoperative period, the average service life of a transplanted tooth is 5 years. Then it will begin to loosen and the question of removal and further prosthetics will arise. However, in some cases replantation is justified.

A tooth whose transplant was caused by dislocation or accidental removal can cope with its functions a little longer, up to 10 years.

Replantation: types of fusions

There are 3 types of fusion of the transplanted tooth:

periodontal (the most favorable, possible when the alveolar periosteum is preserved in full and part of the periodontium on the roots of the tooth);
periodontal fibrous (in which there is partial preservation of the alveolar periosteum and periodontium);
osteoid (the least favorable type, characterized by complete removal of the periosteum and the absence of periodontal particles on the roots).

Replantation: contraindications

Like any treatment, replantation has contraindications:

diseases of the heart and blood vessels;
homologous diseases;
psychical deviations;
acute infectious diseases;
malignant and benign neoplasms;
radiation sickness.

A decaying tooth that cannot be restored (significant damage to the crown) and expanding, curved roots does not undergo replantation.

REPLANTATION(lat. replantare to replant, replant) - surgical engraftment of an organ or its segment temporarily separated from the body. The term “replantation” was proposed at the beginning of the 20th century. Hepfner (E. Hopfner) and A. Carrel, and in Russia N.A. Bogoraz.

R. has the greatest practical importance of the extremities (Fig. 1) and their segments: hand, foot and fingers (see Microsurgery). R. are also produced on the scalp (Fig. 2), auricle, nose, teeth, penis, testicles, etc. Replantation of the kidney, liver, lungs, heart and some other organs is performed by hl, arr. in animal experiments.

Story

R. became possible only after the development of methods for suture of blood vessels (see Vascular suture), and especially after introduction into the wedge. practice of an operating microscope, microsurgical instruments, microsurgical equipment and the finest suture material (see Microsurgery). For the first time in 1902, E. Ullmann and A. Carrel, independently of each other, using a vascular suture, performed R. kidneys in a dog. The first R. of the limb using a vascular suture in an experiment on a dog was performed in 1907 by Hepfner.

In 1962, R. A. Malt successfully replanted the right arm of a 12-year-old boy for the first time after a traumatic amputation at the level of the upper third of the shoulder. In 1963, Ch'en Chung Wei et al. carried out successful R. brushes from a worker. The first successful R. of the thumb was performed in 1965 by Komatsu and Tamai (S. Komatsu, S. Tarnai). Currently, R. of fingers, hands, limbs and other amputated organs is performed in microsurgery centers in our country and abroad.

A great contribution to the development of the problem of R. of the limb in the experiment and preparation for its implementation in the wedge, practice was made by domestic researchers A. G. Lapchinsky, N. P. Petrova, A. D. Khristich, G. S. Lipovetsky, I. D. Kirpatovsky, T. M. Oksman, L. M. Saburova, V. A. Bukov, Yu. V. Novikov and others.

Theory

R. in a theoretical sense is based primarily on the results of studying the viability of tissues and organs, the edges depend on the anatomical structure of the organ, the degree of its damage, the duration of thermal and cold anoxia, and the method of preservation. The possibility of R. of a separated organ that has a large mass (for example, a limb) also depends on the general condition of the body, which is determined by the amount of blood loss, the severity of shock, the presence of combined injuries, water and electrolyte disorders, as well as concomitant diseases ( diabetes mellitus, obliterating endarteritis, atherosclerosis, etc.).

Cells of the brain and spinal cord, peripheral nerves react extremely quickly to thermal anoxia, while the skin, subcutaneous tissue, tendons and bones tolerate it within several hours and even days. According to experimental data, the duration of thermal anoxia of internal organs should not exceed 30-90 minutes. Thus, it has been proven that 30-minute thermal anoxia leads to destruction of lung tissue, and for the small intestine the maximum permissible period of thermal anoxia, according to morphol. studies are 60 minutes, after which intra- and extracellular changes occur in the nerve plexuses. Extending the period of organ anoxia is possible only with hypothermia (t°4°), perfusion of a separated organ and other measures (see Artificial hypothermia, Oxygenators, Perfusion).

Adequate restoration of cardiac function at a temperature of 37° is possible with anoxia within 30 minutes. When preserving the heart using complex means, according to D. K. Cooper, this period can be increased to 24 hours. The cardiopulmonary complex can be replanted 1 hour after the cessation of blood circulation in it, perfusing it with oxygenated blood.

The permissible period of thermal anoxia for the kidney is 30-90 minutes, but in some cases tubular necrosis can occur after 15-30 minutes. Hypothermia of the kidney during this period is of great importance for its subsequent replantation, since when the temperature drops to 10°, the tissue's oxygen demand is halved and remains at the level of 5% of the initial level when cooled to 5°.

Determining the viability of a limb separated from the body is still very difficult. According to M.P. Vilyansky and I.V. Vedeneeva, thermal anoxia of the limb for up to 12 hours. is not a contraindication to restoring the main blood flow if the viability of the muscles according to electromyography is not in doubt.

The changes that occur in the body during R. of the limb are diverse and develop not only in the replanted organ, but also in other organs and systems. The totality of these changes constitutes limb replantation syndrome, including disturbances of central hemodynamics, kidney and liver functions, biochemical changes and characteristic changes in the replanted limb - denervation, edema, dystrophic changes.

The pathogenesis of replantation syndrome is based on a complex of influences, of which the main ones are: trauma (see) and blood loss (see), as well as multiple small hemorrhages and plasma loss in the postoperative period, toxicosis as a result of toxins entering the bloodstream after R., products of perverted metabolism and destruction of ischemic tissue (see Traumatic toxicosis, Shock).

Initially, in the wedge, the picture is often dominated by signs of traumatic shock, later by the phenomena of ischemic toxicosis and plasma loss, which can reach varying degrees of severity. Often, after R. of the limb, severe changes in the function of the liver and kidneys are observed, which are regarded as manifestations of hepato-renal syndrome (see). These disorders can be so significant that there is a need for special treatment. events.

The main importance in R. is given to the level of amputation: the more distal the level of amputation, the smaller the mass of tissues and muscles deprived of blood circulation, the less the risk of toxicosis, and with R. of the finger, toxicosis is not noted at all.

There are “macroreplantation” for traumatic amputation of a limb proximal to the wrist and ankle joints and “microreplantation” for amputation of a limb distal to these joints. In addition, micro-replantation includes surgical engraftment during amputation of the auricle, penis, and scalp.

Indications

When developing indications for macroreplantation, the viability of the limb is of paramount importance due to the limited time of anoxia (no more than 6 hours of permissible thermal anoxia). This is explained by the threat of developing a severe general condition of the patient, due to the extent of the injury and the occurrence of intoxication in the postoperative period. Toxicosis is most pronounced in R. of the lower extremities amputated at the level of the hip, and of the upper extremities - at the level of the shoulder.

With micro-replantation, the patient’s condition almost never causes concern, but to restore blood supply it is necessary to use microsurgical techniques (see Microsurgery). During microreplantation, the duration of thermal anoxia can be St. 6 hours, which is associated with the absence or minimal amount of muscle tissue (for example, in a finger). In all cases of amputation of an organ or its segment, cold preservation is required at t° 4° in special plastic bags with ice. Amputation of the thumb is the most common indication for R. due to the great importance of this finger for the function of the hand. When amputating fingers II-V, which are not of primary importance for the function of the hand, R.’s operation can be discussed with the patient. The profession of the victim is of no small importance. When developing indications for R. and determining the viability of the separated organ, it is necessary to take into account the type of amputation (see) and the degree of tissue damage.

Replantation technique

Replantation involves the complete restoration of the anatomical and functional integrity of a separated organ or its segment. In the preparatory stage, the stump is processed, all non-viable tissue is excised, and perfusion of the separated organ is ensured. At the next stage (for the limbs and their segments), shortening and removal of loose bone fragments, osteosynthesis (see), tendon suture (see Tendon suture) are necessary. The vascular stage - the main one for any R. - consists of anastomosing arteries, veins (see Vascular suture) and nerves (see Nervous suture).

Complications

The most common and serious complication after R. is thrombosis of blood vessels, most often veins, which can be suspected by changes in the temperature and color of the replanted organ, and the absence of pulsation of peripheral arteries. With arterial thrombosis (see), the replanted organ is pale, not filled with blood, and there is no venous pattern. With phlebothrombosis (see), cyanosis, swelling and tissue tension are noted. In case of vascular thrombosis in the anastomotic area, a repeat operation is indicated - thrombectomy (see) or resection of the anastomosis followed by autoplasty of the vessel.

After macroreplantation of a limb, the main attention should be paid to detoxification therapy, correction of protein and water-electrolyte metabolism, and careful monitoring of liver and kidney function. If necessary, hemodialysis (see) and hemosorption (see Hemosorption) should be used. Hyperbaric oxygenation sessions are also shown (see). In case of a life-threatening condition and increasing intoxication, emergency removal of the replanted organ is indicated.

Forecast

The prognosis depends on the timely hospitalization of the victim in a specialized department, the duration of anoxia and the method of preservation, the type of amputation. Reducing the period of anoxia, especially thermal, during R. of the limb significantly affects the outcome of R. The shorter the period of time before surgery and the earlier hypothermia of the amputated organ is started, the greater the chances of a favorable outcome. The most favorable outcome of replantation of any organ or its segment during guillotine amputations is when there is a smooth section and damage to all anatomical structures in the amputation area is minimal. R. of fingers or hands during guillotine amputations gives up to 95% favorable results, provided that R. is performed in a specialized center. When crushed, torn off, or scalped in the amputation area, R.'s outcome is less favorable.

Replantation of teeth

Dental replantation is the surgical implantation of an extracted tooth into the same dental alveolus. Currently, transplantation and implantation of teeth, as well as transplantation of tooth germs, are also used. However, these methods are less reliable due to the manifestation of tissue incompatibility reactions (see Immunological incompatibility). The first attempts to develop a technique for dental rhinoplasty date back to the first half of the 19th century. Gradually, this operation became quite widespread as one of the types of bone grafting (see), but frequent complications (inflammation around the transplanted tooth) forced many doctors to abandon it. Introduction into medicine the practice of antibiotics opened up new prospects for R. teeth.

Experimental and morphological studies indicate that the success of dental restoration directly depends on the preservation of the periodontium on the root of the transplanted tooth. When it is well preserved, a fibrous fusion is formed between it and the bone alveolus due to the regeneration of bundles of collagen fibers. With partial preservation of the periodontium, a fibrous fusion also forms between the transplanted tooth and the bone of the dental alveolus. In the complete absence of periodontium, fusion occurs between the root cement and the bone of the dental alveolus, but subsequently resorption of the root cement and death of the replant occurs. A favorable outcome of the operation is impossible without good blood circulation in the surrounding tissues. Replanted teeth are firmly strengthened in the alveoli after 3-4 weeks. after surgery and can be used as support in the manufacture of fixed dentures.

Indications for R. of teeth are the impossibility of preserving the tooth using conservative or surgical methods of treatment due to hron. periodontitis or its exacerbation, when the root canals, especially of large molars, are impassable and are close to the maxillary (maxillary, T.) sinus or the canal of the lower jaw; dislocation of the tooth or fracture of its root at the apex; the location of the tooth root in a small peri-radicular cyst, in the area of large or small molars, as well as with epulis emanating from the periodontium of the tooth; abnormalities of tooth eruption (dystopia). That. Tooth replantation is possible in cases where its removal can be carried out without damaging the walls of the dental alveoli and while preserving the tooth crown.

Contraindications to dental R. are significant destruction of the bone walls of the dental alveoli, fracture of tooth roots during its removal, severe disturbances in metabolic processes in the body (diabetes mellitus, hypovitaminosis, etc.).

Before R., the degree of destruction of the tooth crown, the preservation of the gum mucosa, and, according to radiography, the relationship of the tooth to neighboring formations are visually determined. The need for immobilization and its nature are also determined. If immobilization with double parallel aluminum splints is intended, they are made before R.

Local anesthesia). The circular ligament of the tooth is carefully peeled off without tearing and the tooth to be replanted is removed, trying to minimally injure the walls of the dental alveolus. The extracted tooth is placed in an isotonic sodium chloride solution containing streptomycin. Granulation tissue is removed from the dental alveolus with a sharp spoon, and the alveolus is tamponed with a gauze cloth. Then the replant is processed: the tops of the roots are resected, for which, holding the tooth with forceps, they are sawed off with a separation disc (Fig. 3, a), the carious cavities are processed and filled. The canals of the tooth roots are widened (Fig. 3, b), decay is removed from them and filled with phosphate cement (Fig. 3, c), and the expanded cone-shaped part is filled with amalgam (in children only with phosphate cement). The neck of the tooth is cleaned of periodontal remains and dental deposits. After treatment, the tooth is placed in an isotonic solution of sodium chloride with antibiotics. After removing the gauze pad from the dental alveolus, the alveolus is washed with isotonic sodium chloride solution and covered with streptomycin powder. The tooth prepared for R. is placed in the dental alveolus and fixed with an aluminum splint to the adjacent teeth for 3-4 weeks (Fig. 4). Fixation with a fast-hardening plastic splint is possible.

Bibliography: Ermolov V.F. Transplantation of dental follicles in children, Dentistry, No. 1, p. 100, 1967; Konchun V.P. Reimplantation of teeth in chronic periodontitis, ibid., No. 3, p. 91, 1966; Kozlov V.A. Autotransplantation of teeth (experimental study), ibid., No. 1, p. 100, 1967; aka, Odontoplaetics, L., 1974; Lapchinsky A. G. Autoplastic transplants of preserved limbs in experiments on dogs, in the book: Organization of traumatology. and orthop. help, ed. N. N. Priorova, p. 268, M., 1959; aka, Methods of preservation and transplantation of fingers and hands during primary surgical treatment after injury, in the book: Issues. injury and orthop., ed. 3. V. Bazilevskoy et al., p. 86, Irkutsk, 1968; Maksudov M. M. Homotransplantation of tooth germs. M., 1970; Petrovsky B.V. and Krylov V.S. Microsurgery, M., 1976; Petrovsky B.V. et al. Replantation of the thumb of the left hand using microsurgical techniques, Surgery, No. 2, p. 111, 1977; In i e m e g E. Replantation von Fingern im& Extremitat-enteilen, Chirurg, S. 353, 1977; Cooper D. K. The donor heart. The present position with regard to resuscitation, storage and assessment of viabilitv, J. Surg. Res., v. 21, p. 363, 1976; Malt R.A.a. McKhann C. F. Replantation of severely damaged arms, J. Amer. med. Ass., v. 189, p. 716, 1964; Northway W. M. a. KonigsbergS. Autogenic tooth trans-* plantation, Amer. J. Orthodont., v. 77, p. 146, 1980; O' Brien V. M. Replantation and reconstructive microvascular surgery, Ann. roy. Coll. Surg. Engl., v. 58, p. 171, 1976, bibliogr.; T a m a i S. a. o. Traumatic amputation of digits, the fate of remaining blood, J. Hand Surg., v. 2, p. 13, 1977.

G. A. Stepanov; V. I. Zausaev (ostomy).

Throughout life, people receive various injuries to the dental system.

The problem occurs when a tooth is dislocated, fractured or the root system is damaged.

Replantation, which is carried out under the supervision of an experienced doctor, allows you to get rid of the pathology.

The essence of the operation

During replantation, the damaged element returns to its own alveolus. In practice, this type of intervention is used quite rarely. For example, if traditional treatment does not produce visible results.

The basis for replantation may be complete dislocation of an element or chronic periodontitis.

The procedure is most often performed on the front teeth. This is due to the fact that they have one root and are more easily damaged by injuries.

Indications

Replantation is indicated for people whose dental pathologies cannot be eliminated surgically.

For example, if a cyst on a tooth is located in a hard-to-reach place, and it is not possible to remove it using known methods.

In such a situation, the problematic element is removed from the hole and then placed back.

There are several situations to note in which replantation is recommended:

tooth dislocation due to injury;
perforation of the root wall of the element;
impossibility of resection of the apex;
impossibility of sealing the problem area along the entire length of the dentinal tubules.
removal of adjacent teeth when access to the problem area is difficult.

Contraindications

To perform the procedure, the basic rule must be observed - the tooth should not have any damage.

Replantation is prohibited for patients who have health problems. In general, the list of contraindications is as follows:

the presence of a large carious cavity in the element being treated (in this case, the likelihood of engraftment decreases);
inflammatory diseases in the oral cavity (in this case, delayed replantation is prescribed);
cracks in the enamel;
incorrect structure of the root system;
neurological abnormalities;
disturbances in the functioning of the cardiovascular system;
malignant tumors;
radiation sickness occurring in acute form;
viral and infectious pathologies during exacerbation.

Before carrying out manipulations, the doctor must take into account all contraindications for replantation.

Methods of intervention

There are several ways to install a tooth in the alveolus - vital and devital. In the first case, the canal is not filled.

During the intervention, the pulp of the element is preserved. The main indication for vital replantation is dislocation of a healthy tooth.

You should know! Restoring the tooth into its original position is a difficult task, especially when dealing with multi-channel holes. For better fixation of the element in the alveolus, a styracrylic or wire splint is used.

If acute inflammation is observed at the site of damage, then replantation is postponed for several weeks.

The resulting wound is treated with antiseptic solutions and covered with a bandage. The lost segment is stored at 40 degrees in a special solution.

With the devital method intervention, the problematic element is first removed. The doctor fills all the canals present in it and cuts down the roots. Only after treatment the tooth returns to its original place.

Preparation

Preparation for replantation is necessary for both the specialist and the patient. The patient must prepare for the procedure mentally and physically, and the doctor must collect all the information about the problem and possible contraindications for replantation.

After the initial examination, the specialist examines the patient’s oral cavity for the presence of inflammatory processes and dental diseases. Next, the patient is given directions for tests and x-rays.

Preparation for the event includes the following diagnostic procedures:

Anamnesis collection. The doctor collects dental and medical information about the patient to exclude possible contraindications to the procedure.
Instrumental examination of the dental system– X-ray or computed tomography, giving an image in three planes.
Using instrumental techniques, pathologies of the dentofacial system are identified. It is important that the bone structures are in a healthy state at the time of replantation.
Sanitation of the oral cavity. All carious elements are removed or treated.

Patients must adhere to the following recommendations before surgery:

give up bad habits for a while;
stop taking medications that thin the blood;
avoid physical activity.

Order of conduct

The operation is performed in several stages:

First, the causal element is removed using surgery. The doctor peels off the tissues of the neck of the tooth in such a way as not to destroy the circular ligament.
After this, the periodontal pocket is cleaned. The extracted segment is placed in a solution of antibiotics and sodium chloride for better preservation. The hole is covered with a sterile swab. After this, the patient closes his jaws.
The doctor processes the element removed from the socket. At this stage, filling of cavities affected by caries, resection of the root apex and expansion of the canals are carried out.
Then the dentinal tubules are treated with antiseptic solutions and filled with composite.

The neck of the element is carefully freed from soft and hard deposits and scraps of mucosal tissue. The replantant is stored in isotonic liquid before the procedure.
The last stage is the direct implantation of the replantant. In case of periodontitis, a specialist cuts down the tops of the roots until visible pathologies disappear.
Before implanting the element into place, the scab is removed from the socket. Additional fixation of the tooth is usually not performed. The engraftment period takes 20 days.

The success of the procedure largely depends on the safety of the surrounding tissue. The likelihood of engraftment decreases when the tooth wall is injured or its root is damaged.

If after the intervention the patient experiences pain, he should consult a doctor again to adjust the therapy regimen. To eliminate the symptoms of pain and inflammation, a specialist may prescribe antibacterial agents.

Interesting! Recently, there have been many cases of tooth engraftment after long-term storage in a dry environment. The success of the operation depends on the physiological properties of the periodontal ligament, and not on the time the element remains outside the oral cavity.

With a sufficient level of qualification, the doctor will be able to implant a tooth into the alveolus that has been outside the oral cavity for more than 48 hours.

The video shows a diagram of the replantation of an injured tooth.

Recovery period

The recovery period after surgery lasts no more than 2 weeks. If there are unpleasant symptoms, the patient is prescribed the following in the postoperative period:

painkillers;
anti-inflammatory drugs;
antibiotics.

To reduce bleeding after the procedure, apply a cold compress to the cheek. Within 1 week After the intervention, you should avoid overheating the body - do not take a hot bath, do not visit saunas.

First 3 days Do not consume hot food or drinks. It is recommended to chew food on the healthy side. All food is crushed before consumption. The diet includes foods rich in fiber - fresh vegetables and fruits.

During the recovery period, physical activity is limited. During the first 3 weeks give up drinking alcohol and smoking. Nicotine contained in cigarettes and aggressive substances in alcoholic beverages contribute to irritation of the mucous membranes of the mouth. This negatively affects the tissue healing process after surgery.

During the recovery period, careful oral care is important. Daily hygiene is carried out without the use of hard-bristled brushes and pastes with an aggressive composition.

This minimizes the risk of damage to the operated tissues. Plaque on the teeth is removed with a cotton swab, and the mouth is rinsed with antimicrobial agents.

Advantages and disadvantages

The tooth replantation procedure has its advantages and disadvantages. The advantages of the procedure include:

the possibility of saving a tooth extracted by mistake;
performing manipulations in one visit to the dentist;
the possibility of implanting an element that has been outside the oral cavity for a long time;
preservation of the aesthetic and functional properties of the element for a long time.

Among the shortcomings are noted:

the risk of tissue rejection of the element;
the need to follow a diet in the postoperative period;
taking antibacterial drugs if complications develop;
impossibility of intervention even with minor damage to the crown of the tooth.

Price

The price of replantation is quite affordable, and depends on the number of roots of a dental unit.

The average cost of the necessary manipulations is presented in the table.

With various injuries to the jaw, a healthy tooth can fall out. In modern dentistry, this problem can be solved by a unique technique - tooth replantation, which involves implanting the lost incisor into its own alveolar bed. This operation is mainly performed on single-rooted front teeth, since they are more susceptible to accidental loss due to injury.

A unique method of dental restoration shows successful results under the following conditions:

the fallen tooth is not seriously damaged (the degree of integrity of the crown is assessed);
no serious damage to the socket was detected.

Also, the result of the treatment procedure depends on the period that has passed since the tooth fell out. The sooner the patient contacts a specialist, the greater the likelihood of a successful result.

Indications for dental replantation

Replantation is carried out for various indications:

chronic periodontitis of single-rooted teeth with severe destruction of the socket in the presence of contraindications to resection of the root apex;
odontogenic jaw periostitis in acute form;
retraction of the incisor into the gap of the jaw bone fracture;
tooth loss due to maxillofacial trauma;
perforation of the root system and other complications of periodontitis of multi-rooted teeth.

Contraindications for replantation

Dental restoration using the replantation method is performed only if the patient has no contraindications, which include the following pathologies:

extensive caries;
acute inflammatory processes in periodontal tissues;
numerous cracking of tooth enamel;
serious curvature of the root system of the teeth;
poor blood clotting and other diseases of the circulatory system;
diabetes;
acute viral and bacterial diseases;
cancerous tumors in the patient's body;
cardiovascular diseases;
alcoholism, drug addiction;
active phase of psychoneurological diseases.

Preparation for replantation

Before the surgical procedure, minor preparation of the patient's mouth is performed. The specialist conducts a diagnostic examination, identifies all existing pathologies, and then begins to eliminate them. It is very important to improve the health of the entire dentition and eliminate inflammatory processes in the gums, which will eliminate the risks of complications in the postoperative period.

At the preparatory stage, the following treatment procedures can be carried out (according to indications):

elimination of caries and various deposits from tooth enamel;
removal of defects on incisor crowns;
teeth that cannot be restored must be surgically removed;
Anti-inflammatory therapy and antiseptic treatment are also carried out.

After carrying out the preparatory work, the doctor begins to directly implant the lost tooth into the prepared hole.

Stages of the dental replantation procedure

First, the patient is given local anesthesia. As soon as the drug begins to act, the doctor begins extraction, after which the following manipulations are performed:

The tooth for implantation is placed in a special solution, which includes an antibacterial drug, which helps prevent infection of the root system.
The hole for tooth implantation is being prepared. Antiseptic treatment using Chlorhexidine solution is mandatory.
Using a curettage spoon, the surgeon cleans the socket from small bone fragments and granulations, after which the cavity is treated with sodium chloride. A sterile swab is placed on top.
Next, the tooth is processed, which involves cleaning large and small deposits. Holding the tooth by the coronal part with tweezers, the doctor opens the cavity and removes the pulp.
At the next stage, the root canals and tooth cavity are filled with a special filling material. If for certain reasons such manipulation cannot be performed, the doctor performs retrograde filling using silver amalgam. The root apex is also resected with a bur.
The prepared tooth is technically inserted into the alveolar cavity, after which it is strengthened with a reliable splint for up to 4 weeks.

At this stage, the tooth replantation procedure ends. The patient will need to follow some of the doctor's recommendations during the postoperative period, which will increase the chances of successful healing of the incisor.

Rehabilitation period

During the rehabilitation period, analgesics are prescribed to relieve pain symptoms detected in the first days after surgery. Antibacterial therapy drugs are also added to the prescriptions. Some experts recommend physiotherapeutic treatment sessions to speed up the process of tooth healing.

After replantation, it is necessary to exclude any stress on the implanted tooth. When brushing your teeth, do not press on the operated area. It is better to include liquid food into your diet. It is unacceptable to loosen or press on the installed tooth with your tongue. The use of an irrigator and rinsing the mouth with various solutions is also prohibited.

The duration of the rehabilitation period is 4-6 weeks. The average service life of a replanted tooth is 10 years or more.