Intentional replantation of periodontally compromised hopeless tooth
Systemically healthy 24-year-old male patient came to Department of Periodontics, with the complaint of unaesthetic appearance of upper central teeth because of forwardly placed maxillary left central incisor since 6 months. Patient gave history of extraction of supernumerary tooth, which was placed palatal to 11 and 21, 3 months back. 21 had gradually come to the present position over 6 months []. Patient was also complaining about functional problems of the upper central teeth because of loss of biting ability due to forwardly placed and mobile tooth. During the clinical examination, approximately 6 mm of periodontal pocket were observed with 21. Radiographic examination was revealed moderate alveolar bone resorption reaching to the middle third of the tooth []. Mobility of the tooth was Grade II.\nPatient demanded not to loose any teeth because of psychological reasons during the treatment plan phase. Considering patient's demands and the clinical situation, the treatment plan of upper anterior teeth (21) decided as Phase I periodontal therapy and intentional replantation and relocation of maxillary left central incisor followed by periodontal splint. Oral hygiene motivation, scaling and root were as the initial periodontal therapy. At the 4th week after the initial therapy, a considerable improvement in oral hygiene and gingival health and slight reduction in periodontal pocket depths were observed during the clinical examination. Endodontic treatment was performed prior to intentional replantation in three visits.\nAfter giving local, gingival attachments of central teeth were removed by periotome and sulcular incisions. Left upper central tooth was gently and atraumatically extracted []. Granulation tissues in the extraction sockets were removed by gentle curettage and the sockets were rinsed with sterile saline []. All irritants and necrotic cementum were removed from the root surfaces with periodontal curettes carefully. Extruded tooth was put into position by preparing the reimplantation site [], at the apical end of the socket to accommodate the tooth in the new position. Tooth was then placed into the socket in an adequate position contacting their roots directly to the alveolar bone []. The replanted tooth was then splinted with composite splint [].\nPatient was advised not to eat stiff foods using maxillary anterior teeth at least for 3 months. Patient was prescribed amoxicillin 1 g. Bid for 5 days along with an analgesic and also recommended to use interdental brush at the replantation site, in addition to the routine oral hygiene attempts. Chlorhexidine mouthwash 0.2% was prescribed twice daily for 14 days. Regenerative therapy was carried out 3 months later. Patient was placed in a maintenance recall program every month for the first 3 months and every 3 months thereafter [] 6 months post-operative showing bone fill [] following regenerative therapy. The necessary oral prophylaxis was done, oral hygiene instructions were reinforced and splint integrity was checked along with clinical parameters at every recall visit.\nPatient is under continued supportive periodontal therapy and has not shown any untoward effects of root resorption or mobility other than slight papillary recession at 14 months follow-up as per clinical and radiographic evaluation [Figures and ].