Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.
Department of Dentistry, University Rey Juan Carlos, Madrid, Spain.
Dent Traumatol. 2021 Dec;37(6):758-771. doi: 10.1111/edt.12698. Epub 2021 Jul 1.
BACKGROUND/AIM: The high rate of root resorption resulting from tooth replantation represents a serious clinical problem. In order to prevent ankylosis and replacement resorption, the contemporary literature highlights the importance of using a flexible stabilization for traumatized teeth. For this purpose, orthodontic devices may be promising for obtaining a better prognosis and periodontal repair. The aim of this study was to evaluate the effect of an active splinting protocol with controlled force in dog's teeth following replantation.
Sixty premolar roots from three dogs were used. They were submitted to endodontic treatment, hemisected, atraumatically extracted and subsequently replanted. They were divided into four groups: Passive Stabilization (n = 20)-after 20 min in a dry medium; Active Stabilization (n = 20)-after 20 min in a dry medium; Negative control (n = 10)-immediate replantation and passive Stabilization; and Positive control (n = 10)-90 min of extra-alveolar time and passive Stabilization. The samples were collected and submitted to histologic processing. They were then evaluated for the count of inflammatory cells, expression of neurotrophin 4, osteoclasts, apoptotic cells and collagen fibres. The results were submitted to ANOVA or Kruskal-Wallis statistical tests followed by Tukey or Dunn post-tests (α = 5%).
Passive Stabilization with orthodontic brackets without traction used after replantation had the highest number of inflammatory cells (p = .0122), osteoclasts (p = .0013) and percentage of collagen fibres in the periodontal ligament (p < .0001) when compared to Active Stabilization with orthodontic brackets applying amild tensile force. Neurotrophin 4 had no statistically significant difference (p = .05), regardless of the treatment. The apoptotic cells count revealed statistical differences (p < .0001) between Active Stabilization (189.70 ± 47.99) and Positive Control (198.90 ± 88.92) when compared to Passive Stabilization (21.19 ± 32.94).
The active splinting protocol using orthodontic appliances generating a light and controlled force favoured periodontal ligament repair of replanted teeth.
背景/目的：牙再植后导致的高根吸收率是一个严重的临床问题。为了防止粘连和替代性吸收，当代文献强调使用弹性固定物固定外伤性牙齿的重要性。为此，正畸器械在获得更好的预后和牙周修复方面可能具有很大的潜力。本研究的目的是评估再植后应用主动夹板固定并施加可控力对犬牙的效果。
从 3 只狗中取出 60 颗前磨牙牙根。对它们进行根管治疗、半切、微创拔出，然后再植。将它们分为 4 组：被动固定组（n=20）-干燥环境中放置 20 分钟；主动固定组（n=20）-干燥环境中放置 20 分钟；阴性对照组（n=10）-立即再植和被动固定；阳性对照组（n=10）-牙槽外放置 90 分钟和被动固定。采集样本并进行组织学处理。然后对炎症细胞计数、神经营养因子 4、破骨细胞、凋亡细胞和胶原纤维的表达进行评估。结果采用方差分析或 Kruskal-Wallis 检验，然后进行 Tukey 或 Dunn 检验（α=5%）。
再植后使用正畸托槽但不施加牵引力的被动固定组炎症细胞数量最多（p=0.0122），破骨细胞数量最多（p=0.0013），牙周膜中胶原纤维的百分比最高（p<0.0001）与施加轻微张力的正畸托槽的主动固定组相比。神经营养因子 4 无统计学差异（p=0.05），与治疗无关。与被动固定组（21.19±32.94）相比，主动固定组（189.70±47.99）和阳性对照组（198.90±88.92）的凋亡细胞计数有统计学差异（p<0.0001）。
应用正畸器械产生轻力和可控力的主动夹板固定有利于再植牙牙周韧带的修复。
