Psychosocial and Functional Impact of Successful Digital Replantation - a Cohort Study of 36 Patients with a Median Follow-up of 6 Years.

INTRODUCTION: This study aims to evaluate the long-term psychosocial and functional outcomes of successful digital replantation following traumatic amputation. METHODS: Patients that underwent successful replantation (i.e. no secondary amputation following replantation) of one or more traumatically amputated digits between January 2009 and April 2019 were invited to participate in this study. In addition to a custom questionnaire on psychosocial and socioeconomic aspects of life, various Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaires regarding global health, upper extremity function, and depressive symptoms were completed. Bivariate analyses were performed to identify significant associations between outcomes and explanatory variables. RESULTS: Thirty-six patients were successfully enrolled and completed the questionnaires at a median follow-up of 6.1 years. The median PROMIS score for Upper Extremity Function (40.6) was considerably different from the score that is typically found in the general population (all PROMIS instruments are calibrated with a control group score of 50.0), but the median PROMIS scores for Global Health - Physical (49.0), Global Health - Mental (50.7), and Depression (45.6) were comparable to those among the general population. Dominant hand injury, a greater number of injured digits, higher age at the time of injury, and the need for neuropathic pain medication were associated with lower Upper Extremity Function scores (all p < 0.05). Additionally, the presence of neuroma was associated with negative changes in both household finances and mental well-being (p < 0.05). CONCLUSIONS: At long-term follow-up, a majority of patients that underwent replantation of traumatically amputated digits seem to cope well based on psychosocial and functional outcomes. However, neuropathic pain and the presence of neuroma are strong negative factors. Specific attention to digital nerves at the time of surgery is crucial in the management of traumatic amputations.

Effect of Dental Implant System-Assisted Tooth Intentional Replantation in the Treatment of Anterior Teeth with Pathological Tooth Flaring, Drifting and Elongation in Patients with Stage III/IV Periodontitis: a Case Series.

OBJECTIVE: To investigate the clinical effect of implant-assisted dental intentional replantation (IR) for the treatment of "drifted" anterior periodontally hopeless teeth (PHT). METHODS: The present authors recruited 22 patients with stage III/IV periodontitis who suffered drifting of the maxillary anterior teeth, with a total of 25 teeth. The PHT were extracted for in vitro root canal treatment (RCT). The root surface was smoothed and the shape was trimmed, and the alveolar socket was scratched. The dental implant system was used to prepare the alveolar socket according to the direction, depth and shape of the tooth implantation. The PHT were reimplanted into the prepared alveolar socket. The periodontal indicators were analysed statistically before and after surgery. RESULT: Twenty-two patients who completed the full course of treatment, with a total of 25 PHT, had a successful retention rate of 88%. Mean periodontal probing depth (PPD) decreased by 2.880 ± 0.556 mm and 3.390 ± 0.634 mm at 6 months and 1 year, respectively, and clinical attachment loss (CAL) decreased by 2.600 ± 0.622 mm and 2.959 ± 0.731 mm at the same time points, respectively, showing significant improvement (P < 0.05). CONCLUSION: Dental implant system-assisted IR can effectively preserve "drifted" natural PHT in patients with stage III/IV periodontitis.

Self-inflicted penile and testicular amputation: A very rare case report and treatment dilemma in the absence of microsurgical service.

INTRODUCTION AND IMPORTANCE: Genital self-mutilation is a rare urologic surgical emergency that is usually encountered in patients with underlying psychiatric illness. Because of shortage of published data and variance in management schemes worldwide, these conditions can present a significant management dilemma. CASE PRESENTATION: In this case report we present this rare phenomenon, where a known schizophrenic patient presented after he amputated both of his testes and penis under the influence of command hallucination. After 15 h of the incident, macroscopic replantation of the severed genitalia was done and psychiatric evaluation and management initiated simultaneously. But the replantation failed after 9th post operative day. DISCUSSION: Initial management of patients presenting with genital amputation should be resuscitation. The severed organ has to be washed with sterile saline and placed in "double bag". There are multiple factors for the success of replantation, the major ones are cooling of the amputated organ and precise microsurgical replantation. CONCLUSION: Early intervention and microscopic replantation are crucial for the successful outcome.

Application of flow-through flaps for replantation after traumatic limb amputation according to the angiosome concept.

OBJECTIVE: This study was performed to explore the treatment of the injury caused by traumatic limb amputation. METHODS: From October 2002 to October 2021, 30 cases were enrolled in the present study. The reasons for injury were as follows: 8 cases with single hydraulic column crush injury, 12 cases with gear and wire rope stranding, 6 cases with belt avulsion injury, and 4 cases with carbon block smash injury. The present study application of a free or small saphenous vein bypass to reconstruct the injured artery and vein according to the concept of the angiosome model. The defective vessels were bridged with the axial vessels of a flow-through flap, such as a medial calf flap or anterolateral femoral flap, to construct an additional blood supply and drainage vein for the severed limb. The clinical data of 30 cases with traumatic limb amputation of the lower leg and ankle were retrospectively analyzed. RESULTS: In all 30 cases of traumatic limb amputation, the replantation via the adoption of a flow-through flap was successful, and 85.6% of the patients remained in good postoperative condition. There were no symptoms of ischemia in the marginal segment after blood supply reconstruction of the transected limb by axial vascular bridging within the flap. CONCLUSION: Via the adoption of microsurgical techniques, the blood supply to the transected limb can be reconstructed by bridging the defective vessels with the adoption of the axial vessels of the flow-through flap is a feasible and advanced treatment option.

Intentional Replantation in Combination with Fibroblast Growth Factor-2 Application and Orthodontic Tooth Extrusion for Periodontal Regeneration in the Treatment of Severe Endodontic-Periodontal Lesions.

Endodontic-periodontal lesions are characterized by the involvement of the pulp and periodontal disease in the same tooth. Despite successful root canal treatment, if the majority of bone support has been lost from periodontitis, the tooth may have a poor prognosis. In severe endodontic-periodontal lesions, the periodontal tissue regenerates poorly because of the significant loss of the periodontal ligament and cementum, poor tooth stability, and bone defect morphology unfavorable for bone regeneration. To overcome these difficult situations, in this case, osteotomy of the replantation bed and tooth replantation with horizontal rotation and deep placement were performed. To improve periodontal regeneration, fibroblast growth factor (FGF) 2 was applied to the artificially made periodontal defect. In addition, orthodontic extrusion of the deeply replaced tooth was performed for potential coronal migration of the periodontal tissue. This case presents a unique multidisciplinary method of treating severe endodontic-periodontal lesions using intentional replantation combined with FGF 2 application and orthodontic extrusion.

Pediatric Digit Replantation: A Nationwide Analysis of Failure Rate, Complications, and Potential Factors Affecting Failure.

Purpose: Function and cosmesis may be improved by replantation following digital amputation in pediatric patients. However, accurate failure and complication rate estimates may be limited as most pertinent studies reflect single center/surgeon experience and therefore are limited by small sample sizes. The primary aim of this study was to assess the rate of failure (amputation) following pediatric digital replantation. Secondary aims include evaluating the rate of complications and associated resource utilization (intensive care unit stays, readmission rate, and hospital length of stay). Methods: Digital replantation patients were identified from 47 pediatric hospitals using the 2004 to 2020 Pediatric Health Information System nationwide database. Using applicable International Classification of Disease 9/10 and Current Procedural Terminology codes, we identified complications after replantation, including revision amputation, infection, surgical complications, medical complications, admission to intensive care unit (ICU), and length of stay. Results: Of the 348 patients who underwent replantation the mean age was 8.3 ± 5.1 years, and 27% were female. Mean hospital length of stay was 5.8 ± 4.7 (range, 1-28) days. Of the 53% of patients who required ICU admission, the mean ICU length of stay was 2.4 ± 3.3 days. Failure/amputation after replantation occurred in 71 (20.4%) patients, at a mean of 9.7 ± 27.2 days postoperatively. Surgical complications occurred in 58 (17%) patients, 30-day hospital readmissions occurred in 5.7% of patients, and 90-day readmissions occurred in 6.3% patients. Conclusion: The estimated rate of failure following pediatric digit replantation was 20%. Our data on failure and complication rates and associated resource utilization may be useful in counseling pediatric replantation patients and their families and provide an update on prior literature. Level of Evidence: IV, Prognosis.

Dentin Collagen versus Er:YAG Laser as Surface Biomodifiers for Intact Root Slices Simulating Delayed Replanted Roots.

Objective: To evaluate effects of dentin collagen versus Er:YAG laser application through enhancing human periodontal ligament fibroblast (PDLF) cells to attach to intact root surfaces imitating delayed replanted roots. Background Data: Accidental traumatic injuries with teeth avulsion are managed by replantation. Root resorption, poor conditioning, and non-viable fibroblasts are factors responsible for failure. Methods: Thirty six human healthy single-rooted premolars were collected. Six teeth were used for PDLF, six teeth used for dentin collagen, whereas the remaining 24 teeth (48 root slices) were used for PDLF cell density and morphology. Each root was soaked in 5.25% NaOCl. Three groups (n = 16 slices/each) were planned as follows: I: Control (untreated); II: dentin collagen application; III: Er:YAG laser irradiation (4 mm distance, 40 mJ/pulse, under coolant). Following incubation, cell density and morphology of PDLF were investigated under SEM. Statistical analysis was performed using analysis of variance with Scheffé's test, and p < 0.05 was considered significant. Results: All groups showed increased cultured PDLF following incubation. Regarding cell density, attached PDLFs were significantly lower in untreated controls (36.5 ± 6.36) (p < 0.00001 i.e., <0.05) in negative empty and/or light cellular areas, compared with dentin collagen (65 ± 6) and laser-irradiated (66.75 ± 5.77) groups that did not show significant differences (p = 0.940 i.e., >0.05) and showed intermediate and/or heavy cellular areas. Regarding cell morphology, controls showed round and/or oval appearance with less lamellipodia, whereas dentin collagen and laser groups showed flat morphology with cytoplasmic processes. Conclusions: Both dentin collagen and Er:YAG laser showed comparable effectiveness as biomodification tools with good biocompatibility for human PDLF cell attachment on intact root slices imitating delayed replantation. Dentin collagen as a natural bioactive material is considered an alternative to Er:YAG laser to enhance the regenerative effects.

Intentional replantation for a Class 4/Stage C cemental tear: Etiology, choice and outcomes of treatment.

Cemental tears, root cracks, and associated periapical-periodontal lesions may occur simultaneously in one tooth, and can be effectively managed by intentional replantation and etiological control. A durable splint, along with occlusal and periodontal monitoring, is required as healing progresses slowly and may be insufficient.

A Simple Technique Ensuring Adequate Exposure During Primary Repair of Complex Thumb Injuries.

As the thumb is pronated, primary repair of complex injuries may be more difficult than the repair of other digits. We describe a simple technique that facilitates thumb repair. We insert a Kirschner wire perpendicular to the bone axis in the middle of the proximal phalanx, which ensures adequate exposure of the palmar aspect without the need for thumb position adjustment by an assistant. This technique is particularly useful when inexperienced surgeons perform thumb replantation and primary flexor tendon repair using a multistrand suture technique.

Analyzing attempt and success factors for amputated digit replantation in Japan using the diagnosis procedure combination database.

The number of amputated finger replantation has declined in the USA and Germany in recent years; however, there have been no reports on recent trends in Japan. We examined the current practices, attempts, and success factors of digit replantation in Japan. We hypothesized that the rates of digit replantation and success rates were consistently standardized in Japan. The diagnosis procedure combination database was used to analyze 14004 cases from April 2014 to March 2020, excluding multiple-digit amputations, thus focusing on 13484 patients. We evaluated replantation success rates and identified factors influencing replantation decisions using multiple logistic regression analysis. The key findings included a higher frequency of replantation in thumb cases and surgeries during overtime hours, on Sundays, and in educational institutions. Success rates were notably higher for thumb replantations and patients under 20 years of age. Patients over 65 years of age treated with urokinase showed higher failure rates, unrelated to regional or hospital case volumes. The number of amputated digit replantation surgeries in Japan was high during overtime hours, on Sundays, and in educational institutions. Region, hospital type, and hospital case volume were not associated with a low success rate across Japan.

Altered sensation following extrusion of an endodontic file treated by intentional replantation: case report and treatment recommendations.

OBJECTIVE: An altered sensation during endodontic treatment can occur due to the extrusion of endodontic materials. This study aims to discuss intentional replantation to address paresthesia resulting from an endodontic file penetrating the inferior alveolar nerve canal (IANC) and provide a protocol for managing nerve injuries in such incidents. CASE PRESENTATION: A 12-year-old girl developed paresthesia when an endodontic file separated and was inadvertently pushed through the apical foramen into IANC during root canal treatment of the mandibular left first molar. A CBCT scan revealed the file penetrating the canal towards the inferior border of the mandible. After considering the treatment options, intentional replantation was deemed suitable. The tooth was a-traumatically extracted and preserved in sterile saline. The surgeon then carefully cleaned and irrigated the socket. The radiographic assessment confirmed successful file removal from the socket. The Root ends were resected, and retrograde preparation and obturation were conducted using ultrasonic tips and MTA. The tooth was then replanted into the socket. Successful replantation was confirmed by tooth stability and an audible click. The patient was prescribed antibiotics and steroids. Subsequently, after completing the endodontic treatment. a stainless-steel crown was cemented. The successful intentional replantation procedure resulted in rapid improvement in the patient's condition. The normal sensation had been restored, indicating nerve recovery. At the 15-month follow-up, Periapical bone healing and the eruption of the adjacent second molar were observed, affirming the treatment protocol's overall success. CONCLUSION: Prompt intervention and immediate intentional replantation facilitated direct inspection of the separated file within the socket. Collaboration between an oral maxillofacial surgeon and an endodontist ensures expedited and targeted treatment, leading to favorable outcomes.

Bridging the Gap between Endodontic Failure and Success: A Case Report on Intentional Replantation.

This case report describes a case of intention replantation in a 15-year-old patient with a mandibular permanent right second molar that had undergone root canal treatment previously. The tooth was tender on percussion. Radiographic evaluation showed the presence of a separated instrument and periapical radiolucency. The surgical procedure was performed under local anesthesia, and the tooth was extracted. After cleaning and disinfecting the root canal system, the tooth was reimplanted, and the socket was filled with a mixture of bone graft material and a growth factor. A stainless steel crown was then placed to protect the tooth. A follow-up examination was performed after 12 months. The clinical and radiographic examinations revealed a well-healing periapical lesion with no signs of infection. The patient was asymptomatic, and the tooth was functional. The results of this case indicate that intentional replantation can lead to a favorable outcome.

Microsurgical replantation after forehead avulsion - success or failure? A case report.

In this article we would like to present, to our best knowledge, the very first published replantation of a forehead/part of a forehead as a single unit. The patient is a 57-year-old male smoker who sustained an avulsion forehead injury after a dog bite. Replantation was performed using microanastomosis of the supratrochlear vessels with restoration of good blood circulation after the procedure. Unfortunately, 5 days after the surgery, ischemia of the flap occurred followed by successful acute revision surgery. Nevertheless, the day after the ischemia reoccurred due to the time that passed, circumstances and unfavorable conditions affecting the sutured vessels, no further revision surgery was indicated. Observation continued and eventual wound necrosis after demarcation was left to be treated with skin grafting or per secundam intentionem. Only partial necrosis of the flap occurred, approximately 50%, which was subsequently treated with a full-thickness skin graft with very good results leading to the satisfaction of the patient.

Partial hand replantation using free microsurgical replantation with staged heterotopic banking of amputated parts: towards improving long term outcomes.

In hand trauma, the uninjured forearm has been touted as the ideal site for ectopic banking in digit/hand amputations. Here, we describe the temporary ectopic implantation and subsequent replantation of a partially amputated hand and highlight the "Three R's" - Recovery, Rehabilitation, and Revision over the first year of recovery.

Successful replantation of an avulsed frontal scalp through microvascular anastomoses of only one artery and one vein: a case report.

Scalp avulsion is a devastating injury. The best possible procedure is replantation. Several successful scalp replantations with anastomoses of several vessels in large defects have been reported. In this report, we present a case of replantation of a large scalp avulsion using revascularizing with only one artery and vein. Despite the initial signs of flap congestion, we could predict the survival of the replanted scalp and terminate the procedure after detecting good perfusion and washout with indocyanine green fluorescence imaging. The procedure was successful following the patient's recovery of sensory and sweating functions without complications such as flap necrosis or infection. Several important factors for successful scalp replantation with positive esthetic and functional outcomes were considered.

Management of traumatic dental injuries in a hemophiliac patient: A challenge! Case report with nine years follow-up.

Traumatic dental injuries (TDIs) are frequently associated with an injury pattern that requires accurate diagnosis for developing the appropriate treatment plan. When children with special healthcare needs, i.e., Hemophilia experience TDIs, managing the situation becomes a challenging task for pediatric dentists due to the requirement of a multidisciplinary approach in their care. This case report highlights the successful management of extrusive luxation injury of a young permanent tooth with an open apex in an eight-year-old male child with severe Hemophilia A. After a follow-up of nine years, the pulp showed significant healing with physiological closure of the apical foramen. The study further emphasizes that timely management of such injuries can lead to improved tooth prognosis.

Intentional Replantation as a Viable Option for Crown-Root Fracture in Maxillary Central Incisor: A Case Report.

Crown-root fractures are often challenging to treat and have a poor prognosis. The present case explains the successful management of a vertically fractured tooth treated by intentional replantation in a 12-year-old child. The patient underwent a successful 12-month follow-up, which included a mobility test and measurement of the gingival sulcus depth. Additionally, a radiological assessment was performed to evaluate the root resorption, the integrity of the alveolar cortex, and the periodontal space. We suggest that intentional replantation may be an effective therapeutic approach for the treatment of cases of vertical crown-root fractures.

Effects of Doxycycline-Loaded NO-Releasing Nanomatrix Gel on Delayed Replanted of Rat Molar.

BACKGROUND/AIM: Tooth avulsion and delayed replantation may cause inflammatory responses and root resorption of the tooth. The aim of this study is to investigate the effect of a doxycycline-loaded nitric oxide-releasing nanomatrix (DN) gel on the delayed replantation of avulsed rat teeth, with a focus on assessing the gel's potential to promote regeneration and inhibit complications associated with the replantation process. MATERIALS AND METHODS: Twenty-four right maxillary first molars from male Sprague-Dawley rats were atraumatically extracted using sterile extraction forceps. The molars were dried for 1 h at room temperature (approximately 23 °C) and divided into four groups according to the root conditioning methods after extra-alveolar 60-min drying: Group 1, no root conditioning treatment prior to replantation; Group 2, soaking in 2% NaF solution for 5 min before replantation; Group 3, 5-min soaking in NO gel and injection of the gel into the alveolar socket; Group 4, 5-min soaking in DN gel and injection of the gel into the alveolar socket before replantation. The animals were euthanized four weeks after the operation and the specimens were evaluated histologically. RESULTS: The use of NO gel alone showed better anti-inflammatory and periodontal effects than the control group, but it did not show a significant effect compared to the group using NaF. When using NO gel loaded with doxycycline, it showed a significant anti-inflammatory effect compared to the control group and showed a similar inhibitory effect to the group using NaF. CONCLUSIONS: Within the limits of this study, in delayed replantation situations, the control of inflammatory resorption and replacement resorption is an important factor for achieving a better prognosis of replanted teeth. Root surface treatment with DN gel decreased root resorption after delayed replantation.

A novel surgical treatment approach for the vertical root fracture of posterior teeth: a case report with 24-month review.

BACKGROUND: Up to 25% of the tooth extraction after root canal treatment could be attributed to the vertical root fracture (VRF). The treatment choice for teeth with VRF would mostly be the extraction despite some repairing methods were also reported. The repairing treatment result of VRF would mostly depend on the fixation strength and the bioactivity of the repairing materials, especially for the posterior teeth with high masticating stresses. This case report designed a novel surgical treatment approach for the VRF of posterior teeth. METHODS: a maxillary premolar with buccal-palatal complete VRF was treated with a new dual-layered repairing approach using adhesive resin + iRoot BP Plus bioceramic cement to fill the modified fracture line with retention forms through the intentional replantation. RESULTS: At the 24-month review, the tooth showed desirable periodontal healing and normal function. CONCLUSIONS: This case report indicated that the dual-layered repairing approach might be effective for saving the posterior teeth with VRF. Nevertheless, further clinical trials are needed for its long-term result.