ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Survival of Implant Supported Crowns is Significantly Higher Than That of Intentionally Replanted Teeth
Clinical Question Among patients with periapical pathosis after conventional RCT, how does the survival rate of intentional replantation compare with the success of implant supported crowns?
Clinical Bottom Line A systematic review and meta-analysis found that the mean survival of ISCs (97%) was significantly higher than that of IR teeth (88%). Orthodontic extrusion of a tooth before intentional replantation decreased the risk of resorption and increased the survival rate.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 25742795Torabinejad/20158 articles (838 teeth) for intentional replantation, 27 articles (4130 implants) for implant supported crownsMeta-Analysis
Key resultsImplant supported crowns (ISC) have a significantly higher mean survival rate than intentionally replanted (IR) teeth. The mean survival rate for IR teeth is 88% (95% CI, 81%–94%) and for ISC teeth is 97% (95% CI, 96%–98%). Root resorption, which was reported in all included studies with an overall prevalence of 11%, was the main reason for failure. Orthodontic extrusion prior to intentional replantation significantly increases the survival rate (91% survival rate of IR alone as compared to 98% survival rate of IR with preoperative orthodontic extrusion; N=287). No root resorption was documented in any of 162 cases that had orthodontic extrusion prior to IR.
Evidence Search intentionally[All Fields] AND replanted[All Fields] AND ("tooth"[MeSH Terms] OR "tooth"[All Fields] OR "teeth"[All Fields]) AND ("mortality"[Subheading] OR "mortality"[All Fields] OR "survival"[All Fields] OR "survival"[MeSH Terms])
Comments on
The Evidence
A systematic review with meta-analysis is a level 1 evidence study. Strict inclusion and exclusion criteria were employed. However, the quality of the evidence analyzed in the systematic review was rated as moderate (4 clinical trials were included, all others were cohort studies or case series). Also, the articles were analyzed for survival rates, not success rates. It is unknown what the outcome difference may be if specific success criteria were employed. Only one ISC study reported a survival rate lower than the mean rate for IR, while all of the IR studies reported lower survival rates than the mean rate for ISC. In papers evaluating intentional replantation, the larger the sample size, the lower the prevalence of resorption, which suggests that increased experience with the procedure may improve survival. It has also been suggested that orthodontic extrusion of the tooth prior to intentional replantation may significantly increase the survival. Further research is necessary to establish a treatment protocol for intentional replantation and to establish success criteria for future investigations.
Applicability Apical surgery or implant placement may be contraindicated because of anatomic factors such as the mental foramen, mandibular canal location or thick buccal bone, maxillary sinus, and periodontal attachment loss. Intentional replantation has been shown to be a reasonable treatment alternative when the correct conditions exist, and it is important for general practitioners to be aware of treatment options available for patients with failing RCTs. Determination of the best and most appropriate treatment must be determined on a case-by-case basis.
Specialty/Discipline (Endodontics) (General Dentistry) (Oral Surgery) (Periodontics)
Keywords Intentional replantation, intentionally replanted teeth, implant-supported single crowns
ID# 2965
Date of submission: 12/08/2015spacer
E-mail hayrapet.sahakyants@ucdenver.edu
Author Hayrapet Sahakyants
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Ethelyn Thomason, DMD
Faculty mentor/Co-author e-mail ethelyn.thomasonlarsen@ucdenver.edu
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