PAEDIATRIC DENTISTRY - 3rd Ed. (2005)

(John Hannent) #1

with the root surface. Damage to the root surface will lead to resorption or ankylosis.
Thus when removing an erupted tooth for transplantation the usual rules concerning
the application of forceps beaks to the root surface do not apply. The beaks are
positioned on the crown. Prior to the application of the forceps a scalpel should be run
around the gingival margin to the crest of the ridge to sever gingival attachments.


When an unerupted tooth is being used as a donor great care must be exercised during
its removal. The entire crown must be exposed. As mentioned earlier, bone removal
with hand chisels is less likely to damage the donor than the use of a bur. Once the
crown has been exposed elevators or forceps (again confined to the crown) are used to
extract the tooth as gently as possible. When the tooth has been extracted it should be
gently replaced into its socket and maintained there until the recipient site is prepared.
This is to ensure that a satisfactory tooth is obtained before recipient site surgery is
performed.


Preparation of the recipient site


The recipient site may or may not contain a tooth. Following extraction of the tooth at
the recipient site the socket is enlarged, if necessary, using either a chisel or a bur (an
implant bur is ideal). Some operators recommend that the socket is enlarged following
flap raising by removing the buccal plate of bone, which is stored in saline prior to
being replaced with the cortical surface against the root. It is thought that this might
decrease the incidence of ankylosis.


Transplantation


Once the socket has been prepared the donor tooth is gently placed in its new position.
The occlusion is assessed to ensure that it is not traumatic to the transplanted tooth,
and the gingival margin is held around the tooth with a horizontal mattress suture.


Splinting the transplanted tooth


The donor tooth should be splinted at the time of transplantation. It is important to
stress that rigid splinting should not be employed as this may lead to ankylosis. A
simple splint using orthodontic wire bonded to the tooth and its neighbours with
composite resin is sufficient. It is essential that splinting is not maintained for too long
a period as this may also lead to ankylosis⎯3 weeks is the maximum length of time,
indeed in some cases the splint can be removed in 1 week.


Root treatment of transplanted tooth


The pulp of the transplanted tooth is extirpated after 2-3 weeks and the root canal
filled with non-setting calcium hydroxide. The calcium hydroxide is replaced with
gutta percha at around 6-12 months' post-transplant as long as there is no evidence of
root resorption.


Follow-up of transplanted teeth


At the time of discharge the patient should be given an antiseptic mouthwash to
maintain good hygiene in the surgical site. The first review is in 1 week, at which

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