CBL#14: Intentional Replantation of a Mandibular Premolar

[Allen Ali Nasseh]

In this video, Dr. Nasseh shares a clinical case of intentional replantation with long recall period.
[See the full post at: CBL#14: Intentional Replantation of a Mandibular Premolar]

[Auste Liegute]

Thank You very much for great presentation! I would like to ask, what about those cases, when there is pus coming out after extraction? Or if the tooth is not moving?

[Allen Ali Nasseh]

@Auste Liegute: I’m not sure what you mean by “if the tooth is not moving”… I assume you’re saying it’s not a simple extraction. Root anatomy and ease of exodontia is a part of the treatment planning teeth for IR vs. apico or simple extraction. So, you need to have this figured out in advance by making sure you have confluent roots as opposed to divergent roots. Also, if necessary, you can use mild to moderate use of elevators to help loosen the tooth without too much damage to the root surface.
Lastly, if you get pus drainage, you can use a suction inside the socket and pull out all the pus, curette the socket mildly before preimplantation. If you can have direct suction inside the socket it won’t take you long to remove all pus. Good luck! 🙂

[BaylanDMD]

Dr. Nasseh,

Thank you for sharing this case. I am curious to know the post-op instructions you gave to the patient. How long would you expect it to take for the tooth to achieve osseo-integration? Would it be similar to the timeline of an implant? Thanks again.

[Allen Ali Nasseh]

@BaylanDMD: I have another video on post op instructions of IR you can find here. https://realworldendo.com/what-are-post-op-instructions-for-intentional-replantations-friday-questions/

But essentially, the tooth takes several weeks to have various levels of PDL regeneration. Generally, after 6-8 weeks the bone should be back in shape and the tooth should be stable. Most mobility is during the first two weeks. For PO, I don’t place sutures most of the time and patient is told to close their jaw together if they feel movement to stabilize the reimplanted tooth. Most of the time, post op meds are not necessary.

[Nelson Quan]

Thank you for sharing these case studies. I’m in talks w my dentist right now about this procedure for my 2nd molar on the jaw. Wanted to do as much research as possible for this procedure before I proceeded. It has been a great help. I just wish I was able to fly to the Boston area to find you but I’m in Asia. Hopefully, they can do this procedure well.

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