Nobody feels addressed? Hm, then I start with the information on our protocol:

Basic decision: Replant or not.

Basic answer: Does a replantation do harm to the surrounding tissues? Can this result in massive tissue loss, thus complicating follow-up therapies?

1. infection related complications might result in considerable loss of bone and other tissues, thereby causing massive problems for a consecutive therapy. This has to be prevented. Thus, in every instance we do an extraoral endo to prevent any contamination of the dead endodontic tissues, thus also preventing any infection related complication (infection related resorption, apical periodonitits).

2. ankylosis/replacement resorption

2a. In adults the progression is slow, and there is not any problem with infraposition. Thus, all avulsed teeth are replanted, allowing an immediate rehabilitation of the patient, with the same tooth appearance (colour, shape) as before, at very low costs. Prognosis: many years/decades/througout life.

2b growing patient/ankylosis predicatable:

consequence: stop of alveolar growth, development of infraposition, vertical bone deficiency.

I: If alternative therapy (transplantation of primary canines or premolars, orthodontic space closure) is immediately available AND a decision towards this treatment can immediately drawn (together with patient, parents, orthodontist) then we don't replant.

II: If such alternatives are not (yet) available or a decision can't be achieved then we replant the tooth for these reasons:

IIA: immediate rehabilitation (function, aesthetics) - while knowing that this is timely limited

IIB: gain of time for information/discussion/decision

IIC: keeps tissues (bone & - important - gingiva) for a much easier transplantation

IID: if transplantation or orthodontic space closure are not possible or rejected, the tooth will be subjected to a decoronation which allows keeping the witdh of the bone and allows a vertical bone growth: Thus is can be considered as an optimization for a later implantation or prosthetic treatment.

In conclusion we replant every tooth with the exception that alternative treatments are available and can be done immediately/within short time.

Technical note:

We take off all PDL tissues, since dead tissues seem to be a strong trigger for resorptions.

I'm really interested in different strategies/methods/ideas.

Yango

I prefer to make a reimplantation . even tough several factor that can be affect the treatment plan like

A) the patient's age

b) the patient's health

c) the conservation conditions of the ant tooth reimplantation.

Dear Tony,

that is what I do; however we also need a strategy for complications. Our implantologists (implantology is also one of my duties) mainly reject reimplantation in growing persons if an ankylosis is predictable, and for good reasons: the expected vertical bone deficit is still one of the biggest challenges in implantology. However they don't know decoronation...

Even if an implant is not considered, and the tooth is kept as long as possible: the increasing infraposition somewhen leeds to aesthetic compromises. How much infraposition is acceptable? When does an acceptable - or sometimes even attractive - deviation turns into an ugly appearance? Can the final result be predicted, and how?

--

I just notice that I don't have en face-photos from my patients, we always concentrate too much on teeth... Furthermore, as we try to avoid any infraposition, we don't have many patients with this complication, at least more severe cases are rare. Thus we are limited in studying these topics. Anyone interested in such a study?

just opened a new question for that which is better describing the problem...

https://www.researchgate.net/post/Ankylosis_related_infraposition_of_front_teeth_in_the_upper_jaw_and_aesthetic_appearance_What_is_acceptable_what_is_not#share

I tried this and was a good result...

Article Reimplante dentario después de 72 horas avulsionado

Hi, Alain,

nice case in a more or less grown-up person, thank you for sharing, would be category 2a. I would have done reimplantation as well. We are just preparing a publication on a 12-y case in similar conditions, yet with a one-step-endo according to the method described in our publications...

Unfortunately my Spanish is restricted to "Hasta la vista, baby" [from Terminator] plus some words to survive ["una cerveza, por favor"], but it is not as good as it is needed in a professional environment.

Therefore, could you please tell in some words when you started and completed endo (I understand that there was one week between the two appointments), whether and how you treated the root surface (removal of necrotic PDL, application of medicaments) and whether you tried to desinfect/sterilize the tooth, and how?

Like I said in the article, 8 days later of feruled the tooth and LASER treatment I finish the endodontic treatment in only one session.

When the patient arrived to the consult I clean the root surface with physiologic solution and phosphoric acid to remove necrotic pulp persistent. There are a controversial solution on this part, but how a priori the prognostic was very bad, I tried to use all that I could read still this moment.

That’s all my friend….. Maybe someday you could come to Cuba and learn more Spanish.

Regards