A Retrospective Study On Intentional Replantation For Refractory Periapical Periodontitis Tooth

Objective This study retrospectively explores intentional replantation in the treatment of refractory periapical periodontitis teeth with 1-4 years follow-up;explore postoperative healing factors related to intentional replantation.Methods Fourteen patients who met the inclusion criteria and received intentional replantation for refractory periapical periodontitis in Hefei stomatological hospital from2016 to 2020.All patients were followed up for more than 12 months.After operative,radiographic,and clinical examinations were performed and recorded for four weeks,3months,6 months,1 year and every year thereafter.ITK-SNAP software was used to measure the volume of periapical lesions in preoperative CBCT images,and other parameters,including age,gender and tooth position,type of teeth,extraoral time,mobility,sinus,and probing depth,on the prognosis of IR were analyzed.Statistical software SPSS 20 0 was used for data analysis,P<0.05 was statistically significant.Results In this study,the average follow-up time of 14 patients was（21.25±9.57）months.There were 8 males,and 6 females and average age was（31.29±6.68）years old.Among which 14 teeth,there were 5 from maxillary,9 from mandibular and 5 premolars and 9molars.The average volume of periapical lesions was（200.26±52.15）mm~3.Of the 14teeth,9 met the success criteria,3 met the retention criteria but failed to meet the success criteria,and 2 failed to be extracted.The success rate was 64.29%,the overall effective rate was 85 71%.Kaplan-Meier survival analysis showed that the cumulative survival rates at 1,2,3 and 4 years were 92.86%、84.42%、84.42%and 84.42%.Among the failed teeth,1 tooth was extracted at 14 weeks of follow-up due to uncontrolled infection postoperatively.The other tooth was removed because of the progressive inflammatory absorption of the root during the 16 months follow-up.The conclusion of Log-Rank univariate analysis showed that the extraoral time and the volume of periapical lesions may be the significant factors affecting the prognosis of intentional replantation（P<0.05）,and the other factors had no significant effect on the prognosis of replantation（P>0.05）.Conclusion Intentional replantation can achieve good effectiveness for refractory periapical periodontitis that does not meet apical surgery apical surgical indications.In the intentional replantation treatment,the volume of apical lesions and extraoral time more than 15 min may affect the success rate of replantation.Comprehensive preoperative evaluation and avoiding risk factors as much as possible can improve the success rate of replantation.However,large sample and long-term follow-up is needed to explore the risk factors affecting the prognosis and the long-term success rate of replantation.At least at present,intentional replantation is a alternative treatment for patients who really want to keep their teeth.