Clinical

Outcome of Intentional Replantation With

Preoperative Orthodontic Extrusion: A Retrospective Study

Author: Choi et al Year: 2014 Journal: IEJ

Aim
- To evaluate the clinical outcomes of intentional replantation (IR) of teeth and to investigate their
prognostic factors

Materials & Methods
- 287 teeth (285 patients) that received IR were included in this retrospective study.
Inclusion criteria
1. Failed non surgical RCT
2. Fractured instrument could not be removed or bypassed
3. Un-negotiable calcified canal with persistent symptomatic apical periodontitis
4. Failed periapical surgery or when surgery was not feasible
- Teeth with perio disease, cracks, perforations or divergent roots hampering safe extraction were excluded
- Teeth received either:
Orthodontic extrusion 2-3 wks. before IR (162 teeth)
No orthodontic extrusion before IR (125 teeth)
- All procedures were performed by one endodontist and received the following:
1. Atraumatic extraction followed by examination for cracks or fractures.
2. Resection of the apical 2-3 mm, root end preparation, and retro-filling with MTA
3. Repositioning of the tooth back into the socket
- A full coverage restoration was placed 23 months after surgery, if clinical symptoms and radiographic
findings did not reveal any abnormalities.
- The outcome was assessed by 2 endodontists as survival (periradicular healing & functional success) or
failure (Functional failure & extraction failure).
Functional success: teeth with minimal and arrested root resorption, normal lamina dura and PDL space
and no definite clinical symptoms
Functional failure: Teeth with inflammatory/ replacement root resorption or increased PAR or no signs of
healing in 6 months post-op
- Statistical analysis was performed to compare between the 2 extraction methods (with/without extrusion)
in terms of success, survival and time of extraction.

Results
- The success rate (periradicular healing) was 89.5% while the survival rate was 95.1%.
- The success rate of the IR without extrusion was 83.2% and that with orthodontic extrusion was 94.4%.
- No significantly difference in the extraction times with or without orthodontic extrusion.
- The survival of IR was not significantly affected by patients age, gender, tooth type or location.
- Survival of IR with orthodontic extrusion was significantly higher than that of the IR without extrusion.
- The risk ratio of IR performed without extrusion was almost 5 times higher than IR with extrusion.

Conclusion
- Intentional replantation (IR) is a reliable surgical treatment option with a high clinical survival rate.
- Extraction with pre-op orthodontic extrusion significantly affected the success & survival rates of IR.

Authors
Y. Choi, J. Bae, Y. Kim, H. Kim, S. Kim & Byeong-Hoon Cho



Reference: Choi YH, Bae JH, Kim YK, Kim HY, Kim SK, Cho BH. Clinical outcome of intentional replantation with
preoperative orthodontic extrusion: a retrospective study. Int Endod J. 2014 Dec;47(12):1168-76.