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Title Applying Fluoride to Root Surfaces of Delayed Replanted Teeth May Reduce Resorption
Clinical Question For avulsed teeth, does applying fluoride to the root prior to delayed replantation lead to improved healing outcomes?
Clinical Bottom Line Studies suggest that applying fluoride to root surfaces of delayed replanted teeth could reduce resorption. Application of basic fibroblast growth factors may be a better alternative by resulting in an increase of PDL cells, thus preventing ankylosis and resorption.
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) 18721196Gulinelli/200830 Wistar ratsLaboratory study
Key resultsThe maxillary right incisor was extracted, kept dry for 60 min, and immersed in either saline, propolis, or acidulated phosphate sodium fluoride. The root canals were dried, filled with CaOH, and replanted. After 60 days, the rats were euthanized. The teeth treated with saline had more inflammatory root resorption than teeth treated with propolis or fluoride. However, the difference was not statistically significant.
#2) 17227379Poi/200724 Wistar RatsLaboratory study
Key resultsCentral incisors were extracted and left for 6 hours on benchtop. Canals were irrigated with 1% sodium hypochlorite. For Group 1 the root surfaces were treated with sodium hypochlorite, rinsed with saline, and immersed in acidulated phosphate sodium fluoride. Group 2 teeth were immersed in Emdogain instead of fluoride. Teeth were filled with CaOH and replanted. Rats received antibiotics. Rats were sacrificed at 10 days or 60 days. H&E stains were performed on the teeth. Sodium fluoride had replacement resorption. Emdogain had more areas of ankylosis. Neither was able to completely prevent root resorption. At 60 days, the groups did not show statistically significant differences (P>0.05).
#3) 25290558Tuna/2015Beagle dogsLaboratory study
Key results18 incisors and premolars were extracted and placed in cow's milk for 45 and 60 min. Teeth were treated with bFGF or EMD (enamel matrix derivative), then replanted. 8 weeks later, teeth were sectioned and underwent histologic studies. EMD-treated teeth had more replacement resorption while bFGF favored new PDL formation (preventing ankylosis and resorption).
#4) 18721196Chalakkal/201110 year old boyCase report
Key resultsTooth #8 was avulsed with 10 hour dry time. Extraoral nonsurgical root canal treatment was completed and the root treated with 1.23% acidulated phosphate sodium fluoride for 15 minutes. THe socket was flushed with saline and the tooth replanted and splinted. A 6-month follow-up radiograph displayed narrowing of PDL space. 5-year postoperative follow-up displayed no abnormal mobility and the radiograph displayed no external root resorption.
Evidence Search ("fractures, avulsion"[MeSH Terms] OR ("fractures"[All Fields] AND "avulsion"[All Fields]) OR "avulsion fractures"[All Fields] OR "avulsion"[All Fields]) AND ("replantation"[MeSH Terms] OR "replantation"[All Fields]) AND (("plant roots"[MeSH Terms] OR ("plant"[All Fields] AND "roots"[All Fields]) OR "plant roots"[All Fields] OR "root"[All Fields]) AND surface[All Fields] AND ("therapy"[Subheading] OR "therapy"[All Fields] OR "treatment"[All Fields] OR "therapeutics"[MeSH Terms] OR "therapeutics"[All Fields])) AND ("fluorides"[MeSH Terms] OR "fluorides"[All Fields] OR "fluoride"[All Fields])
Comments on
The Evidence
Many in vivo animal studies have been completed, but a similar level of evidence using studies in humans was difficult to find. Randomized controlled trials and systematic reviews to increase the level of evidence with human subjects is needed.
Applicability Good healing outcomes after trauma are desired by both patients and clinicians. Striving to find the optimal intervention to improve healing success is of upmost importance.
Specialty/Discipline (Pediatric Dentistry)
Keywords Avulsion, replantation, root surface treatment, fluoride
ID# 3376
Date of submission: 02/26/2019spacer
E-mail amie.heim@childrenscolorado.org
Author Amie Heim
Co-author(s) e-mail
Faculty mentor/Co-author Anne Wilson
Faculty mentor/Co-author e-mail anne.wilson@childrenscolorado.org
Basic Science Rationale
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