Intracanal bisphosphonate does not inhibit replacement resorption associated with delayed replantation of monkey incisors.
Progressive replacement resorption following delayed replantation of avulsed teeth has proved to be an intractable clinical problem. A wide variety of therapeutic approaches have failed to result in the predictable arrest of resorption, with a good long-term prognosis for tooth survival. Bisphosphonates are used in the medical management of a range of bone disorders and topically applied bisphosphonate has been reported to inhibit root resorption in dogs. This study evaluated the effectiveness of a bisphosphonate (etidronate disodium) as an intracanal medicament in the root canals of avulsed monkey teeth, placed before replantation after 1 h of extraoral dry storage. Incisors of six Macaca fascicularis monkeys were extracted and stored dry for 1 h. Teeth were then replanted after canal contamination with dental plaque (negative control) or after root canal debridement and placement of etidronate sealed in the canal space. A positive control of calcium hydroxide placed 8-9 days after replantation was also included. All monkeys were sacrificed 8 weeks later and block sections were prepared for histomorphometric assessment of root resorption and periodontal ligament status. Untreated teeth showed the greatest extent of root resorption (46% of the root surface), which was predominantly inflammatory in nature. Calcium hydroxide treated teeth showed the lowest overall level of resorption (<30% of the root surface), while the bisphosphonate-treated group was intermediate (39%). Ankylosis, defined as the extent of the root surface demonstrating direct bony union to both intact and resorbed root surface, was the lowest in the untreated control group (15% of the root surface), intermediate in the calcium hydroxide group (27%) and the highest in the bisphosphonate group (41%). Bony attachment to the tooth root was divided approximately equally between attachment to intact cementum and to previously resorbed dentin. Overall, bisphosphonate resulted in a worse outcome than calcium hydroxide in terms of both root resorption and ankylosis.
Thong
Yo Len
YL
Department of Conservative Dentistry, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia. thongyl@um.edu.my
Messer
Harold H
HH
Zain
Rosnah Binti
RB
Saw
Lip Hean
LH
Yoong
Lai Thong
LT
D000818:Animals; D002126:Calcium Hydroxide / Q000008:administration & dosage / Q000627:therapeutic use; D003739:Dental Cementum / Q000473:pathology; D003773:Dental Plaque / Q000473:pathology; D003804:Dentin / Q000473:pathology; D004164:Diphosphonates / Q000008:administration & dosage / Q000627:therapeutic use*; D012968:Etidronic Acid / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D007180:Incisor / Q000293:injuries*; D008252:Macaca fascicularis; D008297:Male; D008768:Methylmethacrylates / Q000627:therapeutic use; D010513:Periodontal Ligament / Q000473:pathology; D012387:Root Canal Filling Materials / Q000627:therapeutic use*; D012389:Root Canal Obturation / Q000379:methods; D018915:Root Canal Preparation / Q000295:instrumentation / Q000379:methods; D012391:Root Resorption / Q000473:pathology / Q000517:prevention & control*; D013997:Time Factors; D020254:Tooth Ankylosis / Q000473:pathology / Q000517:prevention & control; D014084:Tooth Avulsion / Q000628:therapy*; D014090:Tooth Replantation / Q000379:methods*; D014092:Tooth Root / Q000473:pathology; D016896:Treatment Outcome; D015035:Zinc Oxide-Eugenol Cement / Q000627:therapeutic use
D004164:Diphosphonates; D008768:Methylmethacrylates; D012387:Root Canal Filling Materials; D015035:Zinc Oxide-Eugenol Cement; C031667:IRM cement; D012968:Etidronic Acid; D002126:Calcium Hydroxide