Surgical Extraction and Replantation with Bone Substitute Material for Inverted and Impacted Maxillary Central Incisor

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  • 小児の上顎中切歯逆生埋伏に対して抜歯再植を応用した1例

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Abstract

<p>Inverted and impacted maxillary incisors are generally treated by extraction or fenestration-traction,with the angle of the impacted tooth a critical factor for treatment selection. When the angle between the impacted tooth and occlusal plane is greater than 90°, extraction is conventionally chosen. Here,we report treatment of a 7-year-old boy referred from a primary dental clinic who had a completely inverted and impacted maxillary right central incisor, as well as impacted mesiodens. Since the angle of the impacted incisor was nearly 180°and bone support for fenestration-traction would be lost after mesiodens extraction, we employed a novel method for treatment. Following extraction of the primary central incisor and mesiodens, the impacted central incisor was gently removed and then replanted in a correct orientation using a bone substitute material to fix the tooth. The replanted incisor spontaneously appeared within 2 weeks and its mobility remained at the latest examination. Furthermore, electrical pulp diagnosis findings indicated that the pulp remained vital. On the other hand, root development stopped at half the length of the healthy side, thus the root canal was not developed, though the pulp remained vital. At the time of surgical treatment, we noted that the length of the impacted central incisor was only one-quarter of normal, indicating that it was premature for replantation use. Nevertheless, the post-operative course has remained uneventful for 5 years 8 months after replantation. We plan to carefully observe the patient for an extended period.</p>

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