World Journal of Dentistry

Register      Login

VOLUME 10 , ISSUE 6 ( November-December, 2019 ) > List of Articles


Effectiveness of a Novel Calcium-enriched Mixture Root Cement to Decelerate Replacement Resorption in Replanted Teeth: A Case Report

Tony Francis, Nasil Sakkir, Sonal B Joshi

Keywords : Ankylosis, Avulsed tooth, Biosilicates, Calcium-enriched mixture cement, External replacement resorption

Citation Information : Francis T, Sakkir N, Joshi SB. Effectiveness of a Novel Calcium-enriched Mixture Root Cement to Decelerate Replacement Resorption in Replanted Teeth: A Case Report. World J Dent 2019; 10 (6):457-460.

DOI: 10.5005/jp-journals-10015-1679

License: CC BY-NC 4.0

Published Online: 01-12-2019

Copyright Statement:  Copyright © 2019; The Author(s).


Aim: To assess the effectiveness of calcium-enriched mixture (CEM cement) to decelerate replacement resorption in replanted teeth. Background: A high prevalence of traumatic injuries in the orofacial region have been reported in school children. External replacement resorption (ERR) is the most common complication of replanting an avulsed tooth. Ankylosed teeth were lost in the first few years after ERR was initiated in young patients. Fixed replacement using dental implants or bridges is best delayed until skeletal growth is completed in young patients. With the gamut of biosilicate cements available, operators can now attempt to salvage these young permanent teeth diagnosed with ERR until the age when skeletal growth is complete. Case description: In this case report, a novel biosilicate cement, CEM cement, was used to retard the progress of ERR and to preserve the affected teeth until the suitable age for receiving implants or bridges. In this 15-year-old patient, the resorptive process was regressed using CEM cement and the tooth remained functional till 22 years of age. The teeth were then extracted and implant treatment was initiated. Conclusion: Currently there is no suitable protocol for the management of these cases. Newer biosilicate cements such as CEM cement help decelerate the resorptive progress and can be considered as a suitable protocol in intervening ERR. Clinical significance: Losing an anterior tooth after ERR has functional, esthetic, phonetic, and psychological impacts on children and adolescents. Down regulating the resorptive process is critical and paramount in preserving esthetics and function until the time extraction and replacement can be done safely.

PDF Share
  1. Hamilton FA, Hill FJ, Holloway PJ. An investigation of dento-alveolar trauma and its treatment in an adolescent population. Part 1: the prevalence and incidence of injuries and the extent and adequacy of treatment received. Br Dent J 1997;182(3):91–95. DOI: 10.1038/sj.bdj.4809313.
  2. Gassner R, Bosch R, Tuli T, et al. Prevalence of dental trauma in 6000 patients with facial injuries: implications for prevention. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;87(1):27–33. DOI: 10.1016/S1079-2104(99)70290-8.
  3. Pohl Y, Wahl G, Filippi A, et al. Results after replantation of avulsed permanent teeth. III. Tooth loss and survival analysis. Dent Traumatol 2005;21(2):102–110. DOI: 10.1111/j.1600-9657.2004.00299.x.
  4. Diangelis AJ, Andreasen JO, Ebeleseder KA, et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations of permanent teeth. Dent Traumatol 2012;28(2):2–12. DOI: 10.1111/j.1600-9657.2011.01103.x.
  5. Finucane D, Kinirons MJ. External inflammatory and replacement resorption of luxated, and avulsed replanted permanent incisors: a review and case presentation. Dent Traumatol 2003;19(3):170–174. DOI: 10.1034/j.1600-9657.2003.00154.x.
  6. Fuss Z, Tsesis I, Lin S. Root resorption--diagnosis, classification and treatment choices based on stimulation factors. Dent Traumatol 2003;19(4):175–182. DOI: 10.1034/j.1600-9657.2003.00192.x.
  7. Pohl Y, Filippi A, Kirschner H. Results after replantation of avulsed permanent teeth. II. Periodontal healing and the role of physiologic storage and antiresorptive-regenerative therapy. Dent Traumatol 2005;21(2):93–101. DOI: 10.1111/j.1600-9657.2004.00298.x.
  8. Malmgren B. Decoronation: how, why, and when? J Calif Dent Assoc 2000;28(11):846–854.
  9. Gunraj MN. Dental root resorption. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;88(6):647–653. DOI: 10.1016/S1079-2104(99)70002-8.
  10. de Souza RF, Travess H, Newton T, et al. Interventions for treating traumatised ankylosed permanent front teeth. Cochrane Database Syst Rev 2010;1:CD007820. DOI: 10.1002/14651858.CD007820.pub2.
  11. Kawanami M, Andreasen JO, Borum MK, et al. Infraposition of ankylosed permanent maxillary incisors after replantation related to age and sex. Endod Dent Traumatol 1999;15(2):50–56. DOI: 10.1111/j.1600-9657.1999.tb00752.x.
  12. Agarwal N, Kumar D, Anand A, et al. Dental implants in children: a multidisciplinary perspective for long-term success. Natl J Maxillofac Surg 2016;7(2):122–126. DOI: 10.4103/0975-5950.201362.
  13. Sapir S, Shapira J. Decoronation for the management of an ankylosed young permanent tooth. Dent Traumatol 2008;24(1):131–135. DOI: 10.1111/j.1600-9657.2006.00506.x.
  14. Chung W-C, Tu Y-K, Lin Y-H, et al. Outcomes of autotransplanted teeth with complete root formation: a systematic review and meta-analysis. J Clin Periodontol 2014;41(4):412–423. DOI: 10.1111/jcpe.12228.
  15. Kahler B, Hu J-Y, Marriot-Smith CS, et al. Splinting of teeth following trauma: a review and a new splinting recommendation. Aust Dent J 2016;61(Suppl 1):59–73. DOI: 10.1111/adj.12398.
  16. Ahangari Z, Nasser M, Mahdian M, et al. Interventions for the management of external root resorption. Cochrane Database Syst Rev 2015;11:CD008003. DOI: 10.1002/14651858.CD008003.pub3.
  17. Op Heij DG, Opdebeeck H, van Steenberghe D, et al. Age as compromising factor for implant insertion. Periodontol 2000 2003;33:172–184. DOI: 10.1046/j.0906-6713.2003.03314.x.
  18. Mehra N, Yadav M, Kaushik M, et al. Clinical management of root resorption: a report of three cases. Cureus 2018;10(8):e3215. DOI: 10.7759/cureus.3215.
  19. Saberi E, Farhad-Mollashahi N, Sargolzaei Aval F, et al. Proliferation, odontogenic/osteogenic differentiation, and cytokine production by human stem cells of the apical papilla induced by biomaterials: a comparative study. Clin Cosmet Investig Dent 2019;11:181–193. DOI: 10.2147/CCIDE.S211893.
  20. Carrotte P. Endodontics: part 9. Calcium hydroxide, root resorption, endo-perio lesions. Br Dent J 2004;197(12):735–743. DOI: 10.1038/sj.bdj.4811897.
  21. Andreasen JO, Farik B, Munksgaard EC. Long term calcium hydroxide as a root canal dressing may increase risk of root fracture. Dent Traumatol 2002;18(3):134–137. DOI: 10.1034/j.1600-9657. 2002.00097.x.
  22. Aggarwal V, Singla M. Management of inflammatory root resorption using MTA obturation - a four year follow up. Br Dent J 2010;208(7):287–289. DOI: 10.1038/sj.bdj.2010.293.
  23. Fridland M, Rosado R. MTA solubility: a long term study. J Endod 2005;31(5):376–379. DOI: 10.1097/01.DON.0000140566.97319.3e.
  24. Asgary S, Eghbal MJ, Parirokh M. Sealing ability of a novel endodontic cement as a root-end filling material. J Biomed Mater Res A 2008;87(3):706–709. DOI: 10.1002/jbm.a.31678.
  25. Panzarini SR, Sonoda CK, Saito CTMH, et al. Delayed tooth replantation: MTA as root canal filling. Braz Oral Res 2014;28:1–7. DOI: 10.1590/1807-3107BOR-2014.vol28.0059.
  26. Utneja S, Nawal RR, Talwar S, et al. Current perspectives of bio-ceramic technology in endodontics: calcium enriched mixture cement - review of its composition, properties and applications. Restor Dent Endod 2015;40(1):1–13. DOI: 10.5395/rde.2015.40.1.1.
  27. Rahimi S, Mokhtari H, Shahi S, et al. Osseous reaction to implantation of two endodontic cements: mineral trioxide aggregate (MTA) and calcium enriched mixture (CEM). Med Oral Patol Oral Cir Bucal 2012;17(5):e907–e911. DOI: 10.4317/medoral.18136.
  28. Asgary S, Ahmadyar M. One-visit endodontic retreatment of combined external/internal root resorption using a calcium-enriched mixture. Gen Dent 2012;60(4):e244–e248.
  29. Asgary S, Nosrat A, Seifi A. Management of inflammatory external root resorption by using calcium-enriched mixture cement: a case report. J Endod 2011;37(3):411–413. DOI: 10.1016/j.joen.2010.11.015.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.