A comprehensive survey research analysis on tooth reimplantation and insightful prognosis assessment

A comprehensive survey research analysis on tooth reimplantation and insightful prognosis assessment ( Dr Mriganka SG, Dr Adhikansh Jaggi, Dr Naga Sai Lakshmi Pranavi Nittala, Dr Shubham Jain, Dr Rashid Ali, Dr Kowshik. V, Dr Goutham Kumar Arra, Dr Ruqaiyah Johar, Dr Nivedita Biswas, Dr Rahul Pandey, Dr Gaddamedhi Pranaya Goud, Dr Brijesh, Dr Tauseef Sheriff Mohammed, Dr Rupali Radhakishan Patwekar, Dr Asif Ali Mudgal, Dr Harinikhita Kamisetty.) Abstract: Tooth avulsion is caused by trauma to the dentition which requires appropriate and timely management to achieve the best outcome⁴. Tooth reimplantation is a treatment modality to replace an avulsed tooth into the tooth socket². The prognosis for this therapy is varied and has a diverse possibility of outcomes that may either lead to the success or failure of the reimplanted tooth². This article intends to establish the encounters of such cases in dental clinics and assess the prognosis range of tooth reimplantation. Introduction: Trauma to the dentition can sometimes cause tooth avulsion, which can be defined as the complete luxation of the tooth of the socket in the alveolar bone¹. Most commonly this happens with children and more often in the anterior teeth². Tooth reimplantation is a potent therapeutic option to reposition the tooth back in its original position¹. It is recommended to store the tooth in Hank’s Balanced Salt Solution (HBSS), or isotonic saline or milk³. The tooth is placed back into the socket after administering local anaesthesia and is stabilized using a splint³. With avulsed teeth, the sooner the tooth is repositioned back into the socket, the better the prognosis³. Almost all reimplanted teeth will ultimately require a root canal treatment to be done. The tooth is considered to have a poor prognosis if it has been out of the socket for more than 2 hours ³. The tooth which has been reimplanted can have several outcomes, and it is difficult to judge the prognosis. The tooth can become ankylosed to the bone through functional healing². A reimplanted tooth can also be resorbed and be replaced by the bone and undergo replacement resorption². In both cases, the teeth are generally symptom-free, give a high-pitched sound when percussed and it has no mobility after complete healing². On the contrary, the tooth can have inflammatory resorption. Such teeth are tender when percussed, mobile and have increased inflammation which can be presented as pain, swelling or fistula in the oral cavity². AIM OF THE SURVEY RESEARCH: The following survey was conducted with the aim of

• Identify the need for tooth reimplantation or be aware of the different scenarios in which the procedure is being performed.
• To figure out the different post-operative complications of the procedure.
• To observe the prevalence of IV fluid therapy given to patients of tooth reimplantation either preoperatively, postoperatively or while operating.
• To recognize the prognosis and the success of the procedure.

METHODOLOGY An online questionnaire and face-to-face interview-based survey were conducted to understand the prognosis and methodology used for the tooth reimplantation procedure. DATA COLLECTION PROCEDURE AND TOOLS Before the start of the survey, the training and calibration of the 16 examiners were done to ensure uniformity and eliminate the examiner’s bias. Survey interview The assessment was done using a questionnaire consisting of open-ended questions like the gender of the dental practitioner, his/her demographic details, and his/her qualification; and one close-ended question– “Have you done tooth reimplantation in your clinical dental practice till today?”, after that the interview questions were asked which involve questions like “In what case did you perform the tooth reimplantation?”, “Are there any post complications with the tooth reimplantation? If yes, please mention it”, “Was IV fluid therapy given to the patient of tooth reimplantation preoperatively, postoperatively or while operating? If yes, please mention which IV fluid and why was the IV fluid given.”, and What was the prognosis of the tooth reimplantation that was done. Results A survey including 275 dentists from different parts of India was conducted to understand the requirements, complications, and success of the tooth reimplantation procedure. Among the participants, 86 were male and 188 were female dentists. Where 137 were BDS, 64 were MDS dentists, and 74 were MDS pursuing.

Among all the dentists 26% (71) had performed tooth reimplantation procedures, 70%(194) had never performed the procedure, and 4% (10) were not sure about the procedure they performed. The first question was asked about the case in which the dentist performed the tooth reimplantation, which showed. Table 1: Shows Re-implantation was done in case of avulsion by 42 dentists, in trauma by 14 dentists, missing tooth by 10 dentists, and in extraction by 5 dentists. The second question was asked about the post-operative complications of the tooth Re-implantation procedure performed by the dentist.

Table 2: Shows the complication that occurred in the reimplantation procedure, 9 have observed ankylosis, 4 have observed resorption, 5 have seen tenderness on percussion (TOP), necrosis by 2 and mobility of the tooth by 3, 8 were not sure or do not remember the complication. The third question was asked about whether IV(intravenous) fluid was given to the patient or not, its type and reason for giving IV fluid. Table 3: shows that the normal saline was used by 14, DNS(Dextrose and Sodium Chloride) was used by 4, ringer’s lactate was used by 4 and 49 dentists did not use any of the IV fluid. The fourth question was asked about the prognosis of the tooth Re-implantation. Table 4: shows that an Excellent prognosis was achieved by 4 dentists, a good prognosis was achieved by 30, fair by 10 poor by 23 and 4 were not sure about the prognosis.

Limitations:

The Limitations of this research are as follows: · The sample size is very small( as only 275 dentists participated in this survey research). · There is no sufficient medical literature present that states the rationale for the use of IV fluid therapy in general dental practice. No clear guidelines are there for IV fluid administration in day-to-day dental procedures and as such very few dentists in this survey research have reported the use of IV fluid therapy in patients of tooth reimplantation. In this survey research, the reason for dentists to give IV fluid therapy to patients of tooth reimplantation ( just after the tooth reimplantation procedure was over, the IV fluid therapy was given)postoperatively, was to remove weakness in patients( of tooth reimplantation). Some disadvantages of tooth reimplantation are as follows:

• Risk of Ankylosis: Ankylosis, the fusion of the reimplanted tooth with the surrounding alveolar bone, is a common complication that may stabilize the tooth initially. However, it can lead to abnormal tooth resorption or infra occlusion, particularly in growing children. Müller et al. (2020) highlight this as a frequent long-term limitation in reimplanted teeth​.
• Replacement Resorption: Reimplanted teeth often undergo replacement resorption, where the tooth structure is gradually replaced by bone over time. This complication typically results in the eventual loss of the tooth. As noted by Müller et al. (2020), this type of resorption is often asymptomatic but leads to tooth loss in the long term​.
• Inflammatory Resorption: Inflammatory root resorption is another serious complication that compromises the success of reimplantation. This condition is characterized by swelling, pain, and tooth mobility, often leading to further tooth damage and eventual failure​.
• Uncertain Long-term Prognosis: Despite early success, the long-term prognosis of reimplanted teeth remains uncertain. Continuous follow-up and potential secondary treatments are often required due to the unpredictable nature of biological healing​.