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Title Transplanting Teeth with An Apical Foramen Size of 1mm Allows Revascularization
Clinical Question In patients undergoing tooth transplantation, does a diameter of 1mm of the apical foramen, compared to a smaller diameter, result in a regeneration of the pulp?
Clinical Bottom Line For patients undergoing tooth transplantation, an apical foramen of a diameter of 1mm does not prevent the revascularization of the pulp. This is supported by an in vivo animal study and a prospective cohort study.
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) 23683275Laureys/201315 single-rooted mature teeth from 3 beagle dogsIn vivo animal study
Key results15 single rooted teeth from beagle dogs were extracted, and the apices were removed with wire cutters. Photographs of the apical base of the teeth were taken to determine the size of the foramen before the teeth were re-implanted. The diameter of the apical foramen did not seem to be the main factor for successful revascularization and tissue growth into the pulp after transplantation, as a diameter smaller than 1 mm did not prevent revascularization and ingrowth of vital tissue. The evidence in this in vivo study demonstrated that 80% of the teeth with an apical foramen of 0.31-1.09mm experienced 1/3 pulp chamber ingrowth 3 months after transplantation.
#2) 2318259Andreasen/1990370 premolar transplantsProspective Cohort Study
Key resultsIn 370 autotransplanted teeth, the frequency of pulpal healing was closely related to root development. Incomplete root formation showed 96 per cent pulpal healing, while those teeth with completely formed roots only exhibited 15 per cent pulpal healing. In those teeth with complete root formation, the chance for pulpal healing increased when the apices were cut with internal cooling burs, increasing the diameter of the apical foramen.
Evidence Search ("transplantation, autologous"[MeSH Terms] OR ("transplantation"[All Fields] AND "autologous"[All Fields]) OR "autologous transplantation"[All Fields] OR "autotransplantation"[All Fields]) AND ("dental pulp"[MeSH Terms] OR ("dental"[All Fields] AND "pulp"[All Fields]) OR "dental pulp"[All Fields] OR "pulp"[All Fields]) AND ("mortality"[Subheading] OR "mortality"[All Fields] OR "survival"[All Fields] OR "survival"[MeSH Terms])
Comments on
The Evidence
An in vivo animal study is low level evidence due to questions of external validity. There was also no control used in this study. Previous authors have indicated a need to perform apicoectomy on transplanted teeth to increase the apical foramen size. However, the findings of this study are interesting because there may be no need for apicoectomy (to create a larger apical opening) prior to tooth transplantation in humans. Further clinical studies in humans would be necessary to ascertain its clinical applicability. There is a consensus among various in vitro and clinical studies regarding the revascularization of the pulp with an apical foramen wider than 1mm in diameter. However, in the first study Laureys et al. (PMID 23683275) emphasize that in the results based on studies of beagle dog teeth, the diameter of the apical foramen before transplantation is not the decisive factor for successful revascularization and ingrowth of new tissue in the pulp chamber. A radiographic study of 370 cases by Andreasen et al. (PMID 2318259) shows that the ingrowth of vascular pulp tissue is unpredictable if the apical foramen is smaller than 1mm. While the available evidence supports the theory of a possible revascularization in transplanted teeth with an apical foramen diameter of 1mm, there may be more important variables to consider like an atraumatic extraction and replantation and infraocclusal placement of the transplanted tooth, or possibly the use of stem cells placed in the empty canal space (Iohara K. et al. 2011; PMID 21417716) to ensure a successful ingrowth of vascular tissue.
Applicability Clinicians should be aware that tooth transplantation is a highly successful and reliable treatment modality. The success rate of revascularization and ingrowth of new vital pulp tissue is not only dependent on the apical foramen diameter in a transplanted tooth. The transplanted tooth requires an atraumatic surgery, an apicoectomy of the root tip of mature teeth (Laureys W et al. 2001;PMID 23683275) and an infraocclusal placement (Andreasen et al. 1990; PMID 2318259).
Specialty/Discipline (Endodontics) (Oral Surgery)
Keywords Autotransplantation; regeneration; pulp tissue; tooth survival; transplantation; pulpal healing
ID# 2919
Date of submission: 10/28/2015spacer
E-mail michael.schulte@ucdenver.edu
Author Michael Schulte
Co-author(s) e-mail
Faculty mentor/Co-author Ethelyn Thomason, DMD
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