Written by: Marieke Zaffron
What adjustments we’ve had to make over the last few months. Replacing waiting rooms with parking lots, screening everyone with questions and temperature checks, having patients sanitize their hands and mouths before treatment. We’ve all had to adapt, and hopefully it’s been a positive experience that’s allowed patients access to the treatment they need as safely as possible.
Now that we’re reopening the world with these new safety measures, maybe it’s time to start thinking about other new techniques and procedures to start implementing. Meetings and seminars may have been postponed until next year, but that doesn’t mean you can’t learn something new! How does a technique for preserving severely compromised teeth sound?
When faced with a tooth that has suffered periodontal damage, the clinician has an important decision to make—extract the tooth or try to save the tooth. While there are certainly cases where extraction is the best or only option, Andreas Filippi, DDS, PhD, coeditor of Tooth-Preserving Surgery, warns against overzealous extraction. There are now so many methods of treating teeth, and these options should be explored before the irreversible action of extraction is taken.
Regardless of your specialty in dentistry, you’re likely already familiar with some of these options. Others may be brand new. Dr Filippi’s new book provides an in-depth discussion of six different treatment options to save teeth that might otherwise have required removal, including the surgical procedure for each one with case examples. Of these procedures, the newest and least widely known is transreplantation, an alternative method often used as a last resort to save teeth with a hopeless prognosis.
Transreplantation involves removing a tooth whole, treating it extraorally, and replanting it in a different position in the same socket with the goal of ankylosis. This treatment can be chosen for adult patients when a single tooth is affected by advanced periodontal disease and symptoms such as probing depths > 10 mm, mobility, and elongation or malpositioning. It is an ideal solution in the esthetic zone because it prevents ridge resorption that would occur if extraction were chosen instead.
Before and after transreplantation. Ankylosis has been achieved with minimal bone remodeling.
Another advantage of transreplantation is that it can be used in unusual circumstances such as when a tooth is recovered after trauma but is no longer vital. The tooth and socket are both cleaned of epithelial cells, and the bone in the socket is exposed. An extraoral root canal is performed, along with apicoectomy for teeth that have been outside the mouth for an extended period of time. The root surface is then prepared and treated with enamel matrix derivative, and the tooth is replaced in the socket and splinted.
This tooth was found outside weeks after the trauma that caused its loss, but it was still able to cleaned and replanted with successful ankylosis.
Transreplantation has had a very high success rate clinically in both the short and long term. It is a newer treatment method and more research should be done, but it is still an excellent alternative for severely compromised teeth.
As Dr Filippi explains, there are many reasons an option to preserve the tooth, such as transreplantation, might be favored over extraction and implant treatment. “Natural teeth,” he says, “have far better long-term prognoses than implants.” In addition, it may be the patient’s desire to keep their natural teeth for as long as possible. Though transreplantation is contraindicated for young patients who are still growing, other methods of tooth preservation may be better suited for children and adolescents than would implant treatment. Other considerations include medical contraindications to implants as well as the financial cost of implants, which is not achievable for all patients.
Rather than giving up on working during a pandemic, our society has explored all its options and found ways to make it work, from increased teleconferencing and telecommuting to increased PPE. Make sure you’re exploring all available options before giving up on saving a tooth. Your patients will thank you!
Preview the first chapter of Tooth-Preserving Surgery here.
Tooth-Preserving Surgery
Edited by Andreas Filippi and Sebastian Kühl
Despite all of the advances that have been made in implantology, many patients still want or need to keep their natural teeth for as long as possible. Tooth-preserving surgery has been performed for hundreds of years, but the last 10 to 15 years have shown a resurgence and a great increase in knowledge regarding these techniques. The aim of this book is to present modern methods of tooth-preserving surgery so clinicians can expand the range of treatments offered in daily practice or to bring them up to date. This volume is not intended as a textbook, but rather as an illustrated atlas and reference work. Each surgical technique is systematically described with indications and contraindications, step-by-step surgical procedure featuring case examples, as well as prognosis and potential complications. Armed with knowledge of methods old and new, clinicians can evaluate whether their patients’ teeth—even potentially hopeless teeth—might still be preserved.
136 pp; 428 illus; ©2020; ISBN 978-0-86715-958-5 (B9585); US $110
Contents
1. Introduction
2. History of Tooth-Preserving Surgery
3. Exposure and Alignment
4. Apicoectomy
5. Intentional Replantation and Transreplantation
6. Resective Furcation Therapy, Hemisection, and Root Amputation
7. Transplantation
8. Success with Tooth-Preserving Surgery