Surgical Re-entry of an Intentionally Replanted Periodontally Compromised Tooth Treated with Platelet Rich Fibrin (PRF): Hopeless to Hopeful.

Intentional replantation is generally contraindicated in periodontally compromised teeth however, there are reports suggesting that it can be a successful treatment alternative for periodontally involved hopeless teeth. Currently there is dearth of evidence regarding the success of this therapy, especially evidence for the effectiveness of autologous platelet rich fibrin is lacking. We present a case report of a 23-year-old male patient with periodontally hopeless left maxillary central incisor having bone loss extending beyond root apex. The tooth was gently extracted and replanted utilizing root conditioning and combined regenerative therapy (Xenograft, PRF and Type I Collagen Membrane). Surgical re-entry at nine months revealed bone formation in the apical third of the tooth. At one year, 87% radiographic bone gain was accomplished. The improvement in the clinical and radiographic parameters reinforced by the re-entry surgery findings strongly suggest that intentional replantation may be a cost-effective substitute to implants and tooth supported prosthesis in situations where conventional periodontal therapy would yield compromised outcomes.

Salivary and gingival crevicular fluid melatonin in periodontal health and disease.

BACKGROUND: Melatonin, with its antioxidant properties, plays a pertinent role in influencing the pathogenesis of periodontal disease. This study aims to detect the presence of melatonin in gingival crevicular fluid (GCF) and to assess the levels of salivary and GCF melatonin in periodontal disease and show the correlation between salivary and GCF melatonin. METHODS: Forty-five subjects, based on the gingival and Russell periodontal indexes, were grouped as 15 healthy subjects (group 1), 15 subjects with gingivitis (group 2), and 15 subjects with periodontitis (group 3). Saliva and GCF samples were collected from all subjects. Melatonin levels were assessed using an enzyme-linked immunosorbent assay. The paired-sample test was used to correlate between saliva and GCF. RESULTS: Melatonin was present in GCF (mean: 1.54 pg/ml) with significantly less concentration compared to that of saliva (mean: 2.17 pg/ml). Salivary and GCF melatonin levels were reduced to the lowest concentrations in patients with chronic periodontitis (salivary melatonin: 0.07 pg/ml; GCF melatonin: 0.06 pg/ml; P <0.05), which were inversely proportional to the clinical indices. There was no significant correlation between salivary and GCF melatonin levels (P >0.05). CONCLUSIONS: Melatonin was expressed in GCF. Salivary and GCF melatonin levels varied from clinically healthy subjects (group 1) to subjects with periodontitis (group 3). Both salivary and GCF melatonin levels decreased in group 3 subjects compared to group 1 subjects, indicating that melatonin may have a protective role against periodontal disease, although further research is required to validate this hypothesis.