Cho Sin-Yeon, Lee Yoon, Shin Su-Jung, Kim Euiseong, Jung Il-Young, Friedman Shimon, Lee Seung-Jong
Department of Dentistry and Institute for Translational and Clinical Research, International St Mary's Hospital, Catholic Kwandong University, Incheon, Korea.
Department of Conservative Dentistry, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University, Wonju, Korea.
J Endod. 2016 Jun;42(6):909-15. doi: 10.1016/j.joen.2016.03.006. Epub 2016 Apr 14.
Intentional replantation is an alternative to tooth extraction and prosthetic replacement when conventional endodontic treatment modalities are unfeasible or contraindicated. This study assessed tooth retention and healing after intentional replantation and explored predictors of these outcomes.
Data of intentional replantation procedures performed between March 2000 and December 2010 were collected prospectively, excluding teeth with preoperative periodontal and root defects. A cohort of 159 teeth was followed up for 0.5-12 years. Retention and healed status without complications (periapical radiolucency, external root resorption, ankylosis, signs/symptoms, probing ≥6 mm) was recorded and analyzed with Kaplan-Meier survival analysis and Cox proportional hazard regression model (P < .05).
Complications leading to extraction occurred in 8 of 159 teeth (5%). Kaplan-Meier survival function suggested 93% cumulative 12-year retention. Cumulative healed rates declined from 91% at 6 months to 77% at 3 years. The healed rate was significantly lower for maxillary teeth without preoperative periapical radiolucency, replanted in more than 15 minutes, and root-end filled with ProRoot MTA. Cox regression identified extraoral time ≤15 minutes as predictor of complication-free healing (P < .04; hazard ratio, 2.767; 95% confidence interval, 1.053-7.272).
This prospective cohort study of contemporary intentional replantation suggested a cumulative 12-year retention rate of 93% and healed rate of 77% after 3 years. Healing occurred 1.7 times more frequently in teeth replanted within 15 minutes. Although most complications occurred within 1 year after replantation, follow-up should extend for at least 3 years to capture late complications.
当传统牙髓治疗方法不可行或禁忌时，意向性再植是拔牙和修复替代治疗的一种选择。本研究评估了意向性再植后的牙齿保留情况和愈合情况，并探讨了这些结果的预测因素。
前瞻性收集2000年3月至2010年12月期间进行的意向性再植手术数据，排除术前存在牙周和牙根缺陷的牙齿。对159颗牙齿进行了0.5至12年的随访。记录并分析了无并发症（根尖透影、牙根外吸收、牙根粘连、体征/症状、探诊深度≥6mm）的保留和愈合情况，采用Kaplan-Meier生存分析和Cox比例风险回归模型（P <.05）。
159颗牙齿中有8颗（5%）出现导致拔牙的并发症。Kaplan-Meier生存函数显示12年累积保留率为93%。累积愈合率从6个月时的91%下降到3年时的77%。对于术前无根尖透影、再植时间超过15分钟且根尖用ProRoot MTA充填的上颌牙齿，愈合率显著较低。Cox回归确定口外时间≤15分钟是无并发症愈合的预测因素（P <.04；风险比，2.767；95%置信区间，1.053 - 7.272）。
这项当代意向性再植的前瞻性队列研究表明，12年累积保留率为93%，3年后愈合率为77%。在15分钟内再植的牙齿愈合频率高出1.7倍。尽管大多数并发症发生在再植后1年内，但随访应至少延长3年以发现晚期并发症。
