This position statement represents a consensus of an expert committee convened by the European Society of Endodontology (ESE) on revitalization procedures. The statement is based on current clinical and scientific evidence as well as the expertise of the committee. The goal is to provide suitably trained dentists with a protocol including procedural details for the treatment of immature teeth with pulp necrosis as well as a patient consent form. Revitalization is a biologically based treatment as an alternative to apexification in properly selected cases. Previously published review articles provide more detailed background information and the basis for this position statement (Journal of Endodontics, 39, 2013, S30; Journal of Endodontics, 39, 2013, 319; Journal of Endodontics, 40, 2014, 1045; Dental Traumatology, 31, 2015, 267; International Endodontic Journal, 2015, doi: 10.1111/iej.12606). As controlled clinical trials are lacking and new evidence is still emerging, this position statement will be updated at appropriate intervals. This might lead to changes to the protocol provided here.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/iej.12629

European Society of Endodontology position statement: Revitalization procedures.

Long-term prognosis of tooth autotransplantation: a systematic review and meta-analysis.

Autotransplantation can provide patients with all the benefits of a natural tooth, but is seldom considered as a treatment option, in large part because of a lack of knowledge about periodontal tissue or the anatomy of teeth. The authors conducted a literature search using the PubMed database. They searched for key words including "autotransplantation," "clinical indications," "sequence and treatment procedures," "healing factors and prognosis" and "treatment options". Autotransplantation demonstrates as a viable treatment alternative, especially in growing adolescents. It provides a biological and economical treatment option for tooth replacement.

Tooth autotransplantation as a treatment option: a review.

Osteogenesis imperfecta (OI) is a heterogeneous group of connective tissue diseases that mainly manifest as bone fragility and skeletal deformity In most families it segregates as a dominant trait and results from mutations in type I collagen genes In this study we analyzed the size and form of the bony structures in heads of 59 consecutive patients with OI types I, III, or IV (Sillence classification), using lateral radiographs Paired controls were matched for gender and age The purpose was to obtain baseline information of craniofacial development in OI patients that have not received bisphosphonate treatment In OI type I we found smaller than normal linear measurements, indicating a general growth deficiency, but no remarkable craniofacial deformity In OI types III and IV, the growth impairment was pronounced, and the craniofacial form was altered as a result of differential growth deficiency and bending of the skeletal head structures We found strong support both for an abnormally ventral position of the sella region due to bending of the cranial base, and for a closing mandibular growth rotation Vertical underdevelopment of the dentoalveolar structures and the condylar process were identified as the main reasons for the relative mandibular prognathism in OI Despite of the widespread intervention with bisphosphonates, the facial growth impairment will probably remain characteristic for many OI patients, and their orthodontic treatment should be further developed

Craniofacial features in osteogenesis imperfecta: a cephalometric study.

BACKGROUND/AIM: Tooth autotransplantation has been advocated for replacement of missing teeth, or teeth that are unsuitable for restoration. The aim of this study was to investigate the outcomes and prognostic factors that influenced the success of tooth transplantation in a paediatric population. MATERIALS AND METHODS: Data was extracted from the records of 75 patients (89 teeth). Demographic and prognostic factors were recorded and analyzed for the clinical and radiographic outcomes for periodontal ligament (PDL) and pulp healing of transplanted teeth. RESULTS: The mean age at transplant was 13.2 years and the mean follow-up observation period was 2.6±1.8 years with a range of 12.0 months-9.9 years. The main reason for transplantation was to replace upper central incisors lost or missing due to dental trauma, hypodontia and dilaceration. Of the 45 teeth that were monitored for pulp revascularization, 75.6% showed clinical and radiographic signs of pulp healing and 24.4% showed signs of pulp necrosis and infection. Pulp healing was significantly related to the stage of root development of the transplant. Favourable PDL healing was observed in 87.6% of the transplants, while 13.5% showed signs of replacement resorption. PDL healing was significantly related to the stage of root formation of the transplanted tooth at the time of the surgery, the ease of handling and placement of the tooth, and the status of the alveolar bone at the recipient site at the time of the surgery. Overall success of tooth transplantation was 87.6% and the survival rate was 94.4%. CONCLUSIONS: Tooth transplantation carried out in children and adolescents demonstrated high success and survival, with the stage of root development influencing both the pulp and PDL healing of the transplanted teeth.

/pdf/outcomes-and-prognostic-factors-that-influence-the-success-52lezlznwc.pdf

Outcomes and prognostic factors that influence the success of tooth autotransplantation in children and adolescents

This is the first of two papers discussing the implications of dental trauma for patients requiring orthodontic treatment. This paper will focus on the factors the orthodontic specialist should consider when contemplating movement of traumatized teeth. The prevalence of dental trauma and the recognition and prevention of traumatic injuries are discussed. The evidence available in the literature relating to orthodontic tooth movement in vital and endodontically treated traumatized teeth is explored. The interdisciplinary management of root fractured and intruded teeth receive special attention. The second paper will look at the role of the specialist team in the management of failing anterior teeth and will outline possible treatment options for children and adolescents encountering such situations. Avulsion injuries and tooth transplantation are considered in particular detail.

Dental trauma: an overview of its influence on the management of orthodontic treatment. Part 1

Part 1 concentrated on implications of dental trauma especially prior to and during orthodontic treatment. This paper examines the literature supporting various treatment options for poor prognosis anterior teeth and subsequent space generated when these teeth are lost. The role of an interdisciplinary team in managing this clinical situation is essential to obtain optimal results and an orthodontist is an essential member. Although some treatment options are not provided by orthodontists it is important that they have some knowledge of these and the latest research that support their use. Other techniques lie very much within the orthodontic remit. Treatment options can be split into maintaining the failing tooth or extraction and restoration of the edentulous gap. This paper reviews various treatment options including periodontal regeneration, surgical repositioning and distraction osteogenesis, composite build up to incisal levels and decoronation when maintaining a failing tooth. When extraction and restoration of edentulous gap is required the following treatment modalities are discussed: extraction technique to retain bone quantity, orthodontic space closure and opening (site development), autotransplantation, partial denture, resin bonded bridge and implants. All these options should be considered and available to an interdisciplinary team to ensure optimal care of children with anterior teeth of poor prognosis.

Dental trauma: part 2. Managing poor prognosis anterior teeth – treatment options for the subsequent space in a growing patient

This case report describes a patient’s severe Class III malocclusion, managed with a combination of orthodontic and orthognathic treatment. The medical history was complicated by osteogenesis imperfecta and dentinogenesis imperfecta. In addition the patient was a Jehovah’s Witness. Patients with osteogenesis imperfecta carry an increased risk of perioperative haemorrhage, and this led to bimaxillary surgery being carried out as two discrete surgical episodes for the patient described. In addition, the risk of enamel fracture led to orthodontic bands being cemented on all teeth. In spite of the increased risks a successful outcome was achieved.

Orthodontic and orthognathic management of a patient with osteogenesis imperfecta and dentinogenesis imperfecta: a case report.

Dental trauma is common in the UK, with more than one in ten children having experienced some form of dental trauma. In addition, one in ten patients have been reported to have experienced dental trauma before orthodontic treatment. A recent survey of orthodontists' knowledge and experience of orthodontic management of traumatised teeth has highlighted large inconsistencies in management of traumatised teeth among UK orthodontists, highlighting the need for further information or training on orthodontic management of traumatised teeth.Therefore, the following guidelines have been developed in order to provide an evidence-based approach to treat this cohort of patients. The following guidance is based on the available literature, expert opinion and UK orthodontists' consensus drawn from a recent survey.

https://journals.sagepub.com/doi/pdf/10.1177/1465312520977498

Guidelines for the orthodontic management of the traumatised tooth.

https://www.semortho.com/article/S1073-8746(14)00072-3/pdf

Upper incisor trauma and the orthodontic patient—Principles of management

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