ABSTRACT
OBJECTIVE: To evaluate matrix metalloproteinase (MMP) expression in replanted permanent teeth with external root resorption (ERR). DESIGN: The present cross-sectional study included 42 patients with replanted permanent teeth, presenting with progressive forms of ERR, and referred for extraction according to the rehabilitation treatment plan or due to root fractures. The control group consisted of 12 healthy premolars, from 5 patients with good periodontal health and no radiographic evidence of root resorption, referred for extraction for orthodontic reasons. Root fragments were processed soon after extraction, and the supernatant was collected to measure matrix metalloproteinase 2/tissue inhibitor of metalloproteinase 2 (MMP-2/TIMP-2) and matrix metalloproteinase 9/tissue inhibitor of metalloproteinases 2 (MMP-9/TIMP-2) complexes through a double-ligand enzyme-linked immunosorbent assay (ELISA). RESULTS: Case groups with external inflammatory root resorption (EIRR) or external replacement root resorption (ERRR) showed significantly higher levels of MMP-2/TIMP-2 and MMP-9/TIMP-2 complexes than the control group. Additionally, comparisons between the case groups demonstrated that the MMP-2/TIMP-2 complex also had significantly higher levels in the ERRR group (pâ¯<â¯0.001). CONCLUSIONS: Our results suggest that MMP-2 and MMP-9 participate in the pathobiology of both types of ERR. In addition, the higher levels of MMP-2/TIMP-2 complex in the ERRR group support common modulation mechanisms with physiological bone turnover.
Subject(s)
Matrix Metalloproteinase 2 , Matrix Metalloproteinase 9/metabolism , Root Resorption , Tooth Replantation , Cross-Sectional Studies , Humans , Matrix Metalloproteinase 2/metabolism , Tissue Inhibitor of Metalloproteinase-2ABSTRACT
BACKGROUND/AIM: Tooth displacement during avulsion causes total rupture of the pulp's neurovascular supply. Revascularization and pulp healing may occur in immature teeth, which gives rise to the recommendation that root canal treatment may not be required. The aim of this study was to evaluate the prognostic factors for the pulp's response after replantation of young permanent teeth. METHODS: Records from 117 patients with 133 replanted permanent immature teeth were reviewed, and pulp outcomes were classified as healing (hard tissue deposition on the dentinal walls followed by narrowing of the pulp lumen or ingrowth of bone-like tissue inside the pulp canal) or non-healing (pulp necrosis with infection). The effect of clinical and demographic co-variates on the hazards of both outcomes was assessed performing a competing risk model. RESULTS: Pulp necrosis with infection was diagnosed in 78.2% of the teeth, and healing was observed in 12.8% of the teeth. A total of 12 teeth (9.0%) were censored due to prophylactic removal of the pulp or severe external root resorption caused by eruption of adjacent canines. The cs-Cox model demonstrated that the hazards of pulp healing increased in teeth with extra-alveolar periods <15 min (csHR: 7.83, 95% CI 1.76-34.80, p = .01), while the hazards of pulp necrosis with infection decreased (csHR: 0.31, 95% CI: 0.10-0.92, p = .04). Teeth replanted with Moorrees' stages 4 and 5 of root development had higher hazards of pulp necrosis with infection than teeth with stage 2 of root development (csHR: 2.23, 95% CI 1.11-4.50, p = .03; csHR: 2.89, 95% CI: 1.40-5.95; p = .01). CONCLUSIONS: Pulp healing rarely occurred after replantation of young permanent teeth being associated with short extra-alveolar periods <15 min. Early stages of root development decreased the hazards of pulp necrosis with infection.
Subject(s)
Root Resorption , Tooth Avulsion , Dental Pulp , Dental Pulp Necrosis/etiology , Dentition, Permanent , Humans , Risk Assessment , Root Resorption/etiology , Tooth ReplantationABSTRACT
A avulsão dentária é definida como o completo deslocamento do elemento dental do alvéolo ocasionando o rompimento total das fibras do ligamento periodontal bem como do feixe vásculo-nervoso apical. O reimplante é o tratamento de escolha, embora seu prognóstico no longo prazo seja imprevisível, pois enquanto alguns dentes reimplantados permanecem em boca por anos, outros são perdidos rapidamente promovendo sérios prejuízos psicológicos, estéticos, funcionais e financeiros. Poucos estudos clínicos longitudinais avaliaram o prognóstico pulpar de dentes permanentes reimplantados. Este estudo consistiu numa coorte histórica para avaliar o prognóstico pulpar de 133 dentes permanentes com rizogênese incompleta reimplantados após avulsão traumática em 117 pacientes atendidos na Clínica de Traumatismos Dentários da Faculdade de Odontologia da Universidade Federal de Minas Gerais no período de 1994 a 2018. A partir da análise de prontuários clínicos foram coletados dados como: sexo, idade do paciente no momento do trauma, grau de rizogênese, duração do período extra-alveolar, meio de armazenamento do dente avulsionado, prescrição de antibioticoterapia sistêmica, tempo de imobilização, ocorrência de fraturas da coroa concomitantes com a avulsão. O padrão de resposta pulpar foi determinado com base nos dados clínicos e radiográficos e classificado como cicatrização quando observada a manutenção da vitalidade pulpar, obliteração do canal radicular e invaginação de tecido mineralizado semelhante ao osso na cavidade pulpar. A ausência de cicatrização foi classificada como necrose pulpar. Os dados foram analisados utilizando-se o programa estatístico R (versão 3.5.3, Viena, Áustria, 2018). Foi feita a análise descritiva das variáveis pesquisadas e uma regressão logística para estudo de associação entre as co-variáveis estudadas e a ocorrência ou não de cicatrização. A necrose pulpar representou o achado mais frequente (82,7%) seguida da invaginação de tecido mineralizado com aspecto ósseo na cavidade pulpar (9,77%), manutenção da vitalidade pulpar (5,26%) e obliteração do canal radicular (2,25%). O modelo multivariado final demonstrou que as chances de cicatrização pulpar foram maiores para dentes com estágios de rizogênese 2 (RC 17.4, IC 95% 2.8-106.6, p= 0.003) e 3 (RC 6.9, IC 95% 1.4 -3.9, p= 0.019), dentes armazenados no leite (RC 5.5, IC 95% 1.1 26.5, p= 0.038) e dentes reimplantados dentro de 15 minutos (RC 25.9, IC 95% 3.7 183.3, p= 0.001). Os resultados obtidos no presente estudo nos permitem concluir que a cicatrização pulpar representou um evento raro tendo ocorrido principalmente em dentes reimplantados com estágios precoces de desenvolvimento radicular após armazenamento em meios fisiológicos como o leite por curtos períodos de tempo.
Tooth avulsion implies total displacement of the tooth out its soket leading to rupture of all fibers of the periodontal ligament as well as the apical vascular-nervous bundle. Replantation is the treatment of choice, although its long-term prognosis is unpredictable. While some reimplanted teeth remain in the mouth for years, others are lost quickly causing serious psychological, aesthetic, functional and financial damage. Few longitudinal clinical studies have evaluated the pulp prognosis of reimplanted permanent teeth. This study consisted of a historical cohort to assess the pulp prognosis of 133 permanent teeth with incomplete rhizogenesis replanted after traumatic avulsion in 117 patients treated at the Dental Trauma Clinic of the Faculty of Dentistry at Federal University of Minas Gerais, from 1994 to 2018. Dental records were evaluated to collect data such as: gender, age of the patient at the time of trauma, stage of root development, storage medium and length of extra-alveolar period of the avulsed tooth, prescription of systemic antibiotic therapy, immobilization time, presence of concomitant uncomplicated crown fractures in the avulsed tooth. The pulp response pattern was determined based on clinical and radiographic data and classified as healing as follows: pulp survival without radiographic changes, pulp canal obliteration and invagination of bone-like mineralized tissue in the pulp cavity. Pulp necrosis was classified as non healing. Statistical analysis was done using the program R (version 3.5.3, Vienna, Austria, 2018). A logistic regression was performed to explore possible associations between the studied co-variables and the occurrence of healing inside the pulp cavity. Pulp necrosis represented the most frequent finding (82.7%) followed by bone-like tissue invagination into root canal space (9.77%), maintenance of pulp vitality (5.26%) and root canal obliteration (2.25%). The final multivariate model demonstrated that the chances of pulp healing were greater for teeth with stages of rhizogenesis 2 (OR 17.4, 95% CI 2.8-106.6, p = 0.003) and 3 (OR 6.9, 95% CI 1.4 - 3.9, p = 0.019), teeth stored in milk (OR 5.5, 95% CI 1.1 - 26.5, p = 0.038) and teeth reimplanted within 15 minutes (OR 25.9, 95% CI 3.7 - 183.3, p = 0.001). The present results demonstrated that healing represented a rare event, occurring mainly in teeth reimplanted with early stages of root development after storage in physiological media such as milk for short periods of time.
