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Replantation is defined as the intentional extraction and repositioning of teeth that have lost their periodontal support. The aim of this study is to evaluate the clinical and radiographic follow-up results of planned replantation treatment in cases with advanced periodontal destruction and to compare it with splinting alone.
Twenty-five patients with periodontal damage in the control group and 25 patients in the experimental group will be included in the study. The clinical parameters of both groups will be evaluated at baseline, 1, 3, and 6 months using periodontal indices and the Visual Analog Scale (VAS).
Fifty individuals aged 18-65 with severe clinical attachment loss (>3 mm) and alveolar bone loss (⅔ or more of the root) in their lower anterior incisors will participate in the study, taking into account the inclusion and exclusion criteria. All patients will undergo non-surgical periodontal treatment before being divided into groups. Patients who meet the inclusion criteria will be randomly selected for the experimental and control groups:
Control group (n=25): The group that will undergo conventional root canal treatment and be followed up with a splint Experimental group (n=25): The group that will undergo conventional root canal treatment followed by planned replantation treatment and splinting.
Infiltrative anesthesia is applied to the tooth planned for replantation. The tooth is extracted with care not to cause trauma to the surrounding tissues. Care is taken not to touch the root surface of the extracted tooth, especially in areas where it comes into contact with the bone apically, in order not to damage the cells that promote healing. If there are attachments on the root surface, they are removed with ultrasound. The tooth is placed in the prepared tetracycline solution and left for 5 minutes. During this time, the extraction socket is gently checked to ensure it is clean. Any granulation tissue that would prevent the tooth root from settling into the bone and making contact is removed. The tooth is removed from the tetracycline solution and placed in the socket. The tooth is stabilized and a temporary splint is applied. Contacts are removed during closure and intrusive movements. The patient is informed that they should not bite or tear with their front teeth and that they should protect the tooth. After 2 weeks, a permanent periodontal splint will be applied.
The clinical parameters of the patients participating in the study will be monitored for 6 months, and the success of the planned replantation treatment will be evaluated by comparing the data from the control group and the test group. It will be investigated whether there is a significant difference between the treatments applied to the control and test groups in terms of clinical and radiographic findings and patient satisfaction.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Replantation | Active Comparator | Replantation group (n=25): Group that underwent conventional canal treatment followed by planned replantation treatment and splinting. |
|
| Splint | Placebo Comparator | Splint group (n=25): The group that will undergo conventional canal treatment and splinting. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Replantation | Procedure | Root canal treatment Tooth extraction and replacement Splinting |
| |
| Measure | Description | Time Frame |
|---|---|---|
| Clinical attachment loss (CAL) | CAL is measured as the change in distance from the cementoenamel junction to the bottom of the gingival sulcus (the most coronal attachment) using a Williams periodontal probe. The changes in clinical attachment loss was measured for determining the severity of disease. | Baseline, 3rd and 6th months |
| Bone Loss,(BL) | The pre- and post-treatment tooth length/bone ratio around the tooth root will be determined using CBCT and periapical radiographs. The amount of bone loss (% bone loss, BL) will be determined using a millimeter scale from both the mesial and distal regions of the teeth, according to the method described by Schulte and colleagues (10) using periapical radiographs. To determine individual bone loss, intra-alveolar root length (hi) and total root length (hg) are measured. Hg, the total root length, is defined as the distance from the apex to the proximal enamel-cementum junction, parallel to the long axis of the teeth. Since the distance between the alveolar bone crest and the enamel-cementum junction varies between 0.75 and 1.49 mm, 1.5 mm is subtracted from the total root length during calculation. The intra-alveolar root length is defined as the distance from the apex to the highest point on the alveolar margin. The change in bone loss at baseline and at 6 months will be examined. | Baseline and 6th monts |
| Measure | Description | Time Frame |
|---|---|---|
| Probing pocket depth (PPD) | Probing pocket depth (PPD) measured as the change in distance from the gingival margin to the bottom of the gingival sulcus using a Williams periodontal probe. | Baseline, 3rd and 6th months |
| Bleeding on probing (BOP) |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Tuğçe PAKSOY associate professor | Contact | +90 553 449 04 52 | tugce.paksoy@sbu.edu.tr |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Health Sciences, Hamidiye Faculty of Dentistry. | Recruiting | Istanbul | Turkey (Türkiye) |
There is no need for such a sharing
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| ID | Term |
|---|---|
| D010518 | Periodontitis |
| D014086 | Tooth Mobility |
| ID | Term |
|---|---|
| D010510 | Periodontal Diseases |
| D009059 | Mouth Diseases |
| D009057 | Stomatognathic Diseases |
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| ID | Term |
|---|---|
| D012092 | Replantation |
| D013165 | Splints |
| ID | Term |
|---|---|
| D014180 | Transplantation |
| D013514 | Surgical Procedures, Operative |
| D016267 | External Fixators |
| D009984 | Orthopedic Fixation Devices |
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Fifty individuals aged 18-65 with severe clinical periodontal attachment loss (>3 mm) and alveolar bone loss (⅔ or more of the root) in the anterior incisors will participate in the study, taking into account the inclusion and exclusion criteria. All patients will undergo non-surgical periodontal treatment before being divided into groups. Patients who meet the inclusion criteria for the study will be randomly selected into the experimental and control groups: 1. Control group (n=25): The group that will undergo conventional root canal treatment and be followed up with a splint. 2. Experimental group (n=25): The group that will undergo conventional root canal treatment followed by planned replantation treatment and be followed up with a splint.
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| Splint |
| Procedure |
Root canal treatment Splinting |
|
All six sites of all teeth were probed to assess whether this elicited bleeding (+) or not (-). The severity of gingival inflammation was expressed as a percentage (BOP=number of bleeding sites×100/number of sites evaluated).
| Baseline, 3rd and 6th months |
| Mobility | Tooth mobility will be assessed using a 5N (500g) manual measurement. Changes in mobility will be examined with treatment. 0th degree: no mobility
| Baseline, 3rd and 6th months |
| Gingival index (GI) | To determine the gingival index (Löe & Silness), gingival bleeding caused by running a Williams periodontal probe inside the pocket on the mesial, distal, buccal, and palatal surfaces of all teeth was evaluated. The gingival index of an individual was obtained by summing the values determined for each tooth and calculating the averages. Scoring was as follows: 0: Healthy gums.
| Baseline, 3rd and 6th months |
| Plaque index (PI) | Patients' plaque indices will be recorded according to the Silness and Löe plaque index. After the teeth are dried with air, the amount of plaque near the gingival margin of each tooth is examined with an inspection and examination probe. Index values between 0 and 3 are given according to the amount of plaque on the tooth surface. According to this index: 0: No plaque.
| Baseline, 3rd and 6th months |
| VAS measurement values | VAS is the most commonly used scale for measuring pain intensity and tracking the degree of pain relief. VAS is a 10 cm line with the extremes of "no pain" and "worst possible pain," and the measurement is determined by the patient marking the line that best describes their pain intensity. The average of the values obtained for patients is calculated. | Baseline, 3rd and 6th months |
| D009983 | Orthopedic Equipment |
| D013523 | Surgical Equipment |
| D004864 | Equipment and Supplies |
| D053831 | Surgical Fixation Devices |