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Clinical procedures and outcome of surgical extrusion, intentional replantation and tooth autotransplantation - a narrative review

Plotino G, Abella Sans F, Duggal MS, Grande NM, Krastl G, Nagendrababu V, et al.

Int Endod J, 2020 Dec;53(12):1636-1652.
PMID: 32869292 DOI: 10.1111/iej.13396

Surgical extrusion is defined as the procedure in which the remaining tooth structure is repositioned at a more coronal/supragingival position in the same socket in which the tooth was located originally. Intentional replantation is defined as the deliberate extraction of a tooth and after evaluation of root surfaces, endodontic manipulation and repair, placement of the tooth back into its original position. Tooth autotransplantation is defined as the transplantation of an unerupted or erupted tooth in the same individual, from one site to another extraction site or a new surgically prepared socket. The advent of titanium implant rehabilitation has reduced the use of these treatments in day-by-day clinical practice; however, the re-emerging trend to conserve and preserve natural sound tissues has led to a rediscovery of these treatments. All three distinct surgical methods are closely related, as they act to treat teeth that cannot be predictably treated using other more conventional procedures in endodontics, periodontics and restorative dentistry. Furthermore, these procedures share the same treatment approach and include the atraumatic extraction of a tooth, visual inspection of the tooth/root and its subsequent replantation. The clinical procedures for surgical extrusion, intentional replantation and tooth autotransplantation treatment have undergone several changes in recent years, and currently, there are no clear clinical treatment protocols/guidelines available. The clinician should be aware of the outcome of these treatments. Hence, the aim of this narrative review is to provide the background, clinical procedures and outcomes of surgical extrusion, intentional replantation and tooth autotransplantation.

Matched MeSH terms: Tooth Replantation*
Fulltext Non-Destructive Evaluation for Corrosion Monitoring in Concrete: A Review and Capability of Acoustic Emission Technique

Zaki A, Chai HK, Aggelis DG, Alver N

Sensors (Basel), 2015;15(8):19069-101.
PMID: 26251904 DOI: 10.3390/s150819069

Corrosion of reinforced concrete (RC) structures has been one of the major causes of structural failure. Early detection of the corrosion process could help limit the location and the extent of necessary repairs or replacement, as well as reduce the cost associated with rehabilitation work. Non-destructive testing (NDT) methods have been found to be useful for in-situ evaluation of steel corrosion in RC, where the effect of steel corrosion and the integrity of the concrete structure can be assessed effectively. A complementary study of NDT methods for the investigation of corrosion is presented here. In this paper, acoustic emission (AE) effectively detects the corrosion of concrete structures at an early stage. The capability of the AE technique to detect corrosion occurring in real-time makes it a strong candidate for serving as an efficient NDT method, giving it an advantage over other NDT methods.

Matched MeSH terms: Replantation
Fulltext Utilization of Bracing Arms as Additional Reinforcement in Pultruded Glass Fiber-Reinforced Polymer Composite Cross-Arms: Creep Experimental and Numerical Analyses

Asyraf MRM, Ishak MR, Sapuan SM, Yidris N

Polymers (Basel), 2021 Feb 19;13(4).
PMID: 33669491 DOI: 10.3390/polym13040620

The application of pultruded glass fiber-reinforced polymer composites (PGFRPCs) as a replacement for conventional wooden cross-arms in transmission towers is relatively new. Although numerous studies have conducted creep tests on coupon-scale PGFRPC cross-arms, none had performed creep analyses on full-scale PGFRPC cross-arms under actual working load conditions. Thus, this work proposed to study the influence of an additional bracing system on the creep responses of PGFRPC cross-arms in a 132 kV transmission tower. The creep behaviors and responses of the main members in current and braced PGFRPC cross-arm designs were compared and evaluated in a transmission tower under actual working conditions. These PGFRPC cross-arms were subjected to actual working loads mimicking the actual weight of electrical cables and insulators for a duration of 1000 h. The cross-arms were installed on a custom test rig in an open area to simulate the actual environment of tropical climate conditions. Further creep analysis was performed by using Findley and Burger models on the basis of experimental data to link instantaneous and extended (transient and viscoelastic) creep strains. The addition of braced arms to the structure reduced the total strain of a cross-arm's main member beams and improved elastic and viscous moduli. The addition of bracing arms improved the structural integrity and stiffness of the cross-arm structure. The findings of this study suggested that the use of a bracing system in cross-arm structures could prolong the structures' service life and subsequently reduce maintenance effort and cost for long-term applications in transmission towers.

Matched MeSH terms: Replantation
Fulltext Bio-asphalt concrete: From waste product to green aggregate replacement

Resdiansyah, Amidah Mohd Ujang, Zarinah Zaini

Pertanika Journal of Science & Technology, 2017;25(105):145-154.
MyJurnal

Malaysia has over 5 million hectares of land planted with palm oil, divided almost equally between peninsula Malaysia and East Malaysia. This paper presents a laboratory evaluation of the performance of the waste product palm kernel shell (PKS) in creating plant-based asphalt concrete (bio-asphalt concrete). PKS aggregate partially replaced granite aggregate in preparing the mixes (10%, 30%, and 100%) in the range of 5mm-14mm in ACW 14 mixed with 5% to 7% of bitumen content. 35 blows and 50 blows compaction of mixes was used to evaluate the potential of palm kernel shells in the preparation of bitumen to deal with light to medium traffic. Results showed that PKS aggregate can be used up to 30% PKS replacement for the light traffic design and only 10% PKS replacement was potential to be used in medium traffic design.

Matched MeSH terms: Replantation
Fulltext Squamous cell carcinoma involving the tibia treated by reimplantation of autoclaved resected bone

Pan KL, Mourougayah V, Jayamalar T

Med J Malaysia, 2003 Dec;58(5):783-5.
PMID: 15190672

We present an elderly patient with a squamous cell carcinoma over the subcutaneous aspect of the leg involving the tibia. En bloc resection of the tumour together with a 10 centimetre segment of the tibia was done. The resected bone was autoclaved, replaced in its original position and stabilized with bone cement and a locked nail. This allowed early ambulation with minimal cost.

Matched MeSH terms: Replantation*
Fulltext Successful ankle replantation in two cases with different presentations

Wen APY, Jusoh MH, Saad AZM, Halim AS, Faisham NWIW, Azman WSW

Arch Plast Surg, 2020 Mar;47(2):182-186.
PMID: 31462030 DOI: 10.5999/aps.2018.00514

We report our experience of treating two patients with ankle amputation with different presentations. The first case was a clean-cut sharp amputation. The second case was an avulsion injury following a motor vehicle accident in a patient who arrived 8 hours after the injury. Replantation was successful in both cases. In avulsion injuries, a secondary operation for wound coverage is required at a later stage. With good strategy and a support team, encouraging limb survival outcomes are possible post-replantation.

Matched MeSH terms: Replantation
Fulltext Reimplantation of an Extruded Femoral Segment After Gamma Sterilization in A Type IIIA Supracondylar Femur Fracture: A Case Report

Aizah N, Su Y, Shaifulnizam C, MRos M

Malays Orthop J, 2014 Jul;8(2):66-8.
PMID: 25279099 MyJurnal DOI: 10.5704/MOJ.1407.015

Extruded bone is a rare complication of high energy open fractures, and there is only a handful of literature on reimplantation of the extruded segment. No clear guidelines exist regarding timing of reimplantation, stabilization of extruded bone segments, and also bone disinfection and sterilization techniques. Previous reports describe sterilization using thermal or chemical methods. We present a case of successful reimplantation of an extruded metaphyseal segment of femur after gamma sterilization in a fourteen- year old boy.

Matched MeSH terms: Replantation
Prevention of alveolar bone resorption by the use of autogenous root implants

Lam RV, Hong EN, Ann LS

Dent J Malaysia Singapore, 1971 Oct;11(2):4-6.
PMID: 5290957
Matched MeSH terms: Tooth Replantation
Fulltext Which is the best method of sterilization of tumour bone for reimplantation? A biomechanical and histopathological study

Singh VA, Nagalingam J, Saad M, Pailoor J

Biomed Eng Online, 2010;9:48.
PMID: 20831801 DOI: 10.1186/1475-925X-9-48

Sterilization and re-usage of tumour bone for reconstruction after tumour resection is now gaining popularity in the East. This recycle tumour bone needs to be sterilized in order to eradicate the tumour cells before re-implantation for limb salvage procedures. The effect of some of these treatments on the integrity and sterility of the bone after treatment has been published but there has yet been a direct comparison between the various methods of sterilization to determine the one method that gives the best tumour kill without compromising the bone's structural integrity.

Matched MeSH terms: Replantation*
Fulltext Successful revascularisation of near total amputation of the upper limb after ten hours of warm ischaemia

Merican AM, Kwan MK, Cheok CY, Wong ELW, Sara TA

Med J Malaysia, 2005 Jun;60(2):218-21.
PMID: 16114164

Near total amputation of the upper limb if unsalvageable would cause severe disability. However, delayed revascularisation can be life threatening. We report two cases of revascularisation of the upper limb following near total amputation that was successful and functional after a warm ischaemic time of ten hours. The first was a traction avulsion injury of the arm leaving major nerves contused but in continuity. The second was a sharp injury through the mid-forearm attached by only a bridge of skin. Attempting revascularisation of a proximal injury beyond 6 hours, in selected cases is worthwhile.

Matched MeSH terms: Replantation/methods*
Fulltext Hand replantation and revascularization--six years experience in Hospital Kuala Lumpur 1990-1995

Razana A, Hyzan MY, Pathmanathan V, Gill RS

Med J Malaysia, 1998 Sep;53 Suppl A:121-30.
PMID: 10968194

A retrospective study was conducted in 130 patients who underwent replantation or revascularization of 195 amputations in Hand and Microsurgery Unit Hospital Kuala Lumpur from 1990 to 1995. There were 130 patients with 195 amputations in the duration of 6 years study, which were mainly males (111 patients, 85.4%). The commonest age group involved was 19-25 years old (49 cases, 63.7%). There were 146 complete amputations replanted and 49 cases of incomplete amputations were revascularized. The commonest part involved was thumb and index finger (23% of cases each) and majority was caused by industrial accident (60.8%). However in pediatric age group home accident was the leading cause of the amputation (93.8%). The overall survival rate for the amputation was 65.6%. Revascularization had a better survival rate (77.6%) than replantation (61.6%). A clean cut wound and ischaemic time less than 12 hours gave better survival rate. However, there was no significant different chance of survival on distribution of injured parts and ischaemic time (< 12 hours).

Matched MeSH terms: Replantation*
Fulltext Continuous brachial plexus block--regional anaesthesia for reimplantation surgery of the hand: a preliminary study

Sivarajah RS, Keh SA, Ong G, Teo WS, Delilkan AE

Med J Malaysia, 1984 Jun;39(2):112-5.
PMID: 6513849

Continuous brachial plexus block in six patients undergoing reimplantation of severed fingers or hand is described. The technique involved placement of a catheter within the neurovascular sheath enclosing the brachial plexus. This enabled us to give the local anaesthetic as required to last the whole duration of surgery.

Matched MeSH terms: Replantation/methods*
Management of an avulsed tooth with severe root resorption

Meon R

Singapore Dent J, 1988 Dec;13(1):53-6.
PMID: 3155008

Delayed replantation of an avulsed tooth with an open apex resulted in failure of revascularization, necrosis of the pulp and extensive external root resorption. Removal of the necrotic pulp and repeated intra-canal dressings of calcium hydroxide over a three year period arrested the inflammatory resorptive process. The process was replaced by replacement resorption leading to ankylosis and infra-occlusion of the affected tooth. As the tooth was asymptomatic, it was retained in the arch to act as a space maintainer. To improve aesthetics, the crown was recontoured using a light-cured resin.

Matched MeSH terms: Tooth Replantation*
Fulltext Peritoneal implantation of ureter in a cadaveric kidney transplant recipient

Tan SY, Lim CS, Teo SM, Lee SH, Razack A, Loh CS

Med J Malaysia, 2003 Dec;58(5):769-70.
PMID: 15190667

We report here a case of a kidney transplant recipient in whom the ureter was initially implanted into the peritoneum. Excessive ultrafiltration volume and reversal of serum vs dialysate creatinine ratio when the patient was recommenced on continuous ambulatory peritoneal dialysis first suggested the diagnosis which was subsequently confirmed by a plain abdominal x-ray demonstrating placement of ureteric stent in the peritoneum. This rare complication was successfully corrected with surgical re-implantation of ureter into the bladder and 5 years later, the patient remains well with good graft function.

Matched MeSH terms: Replantation
Fulltext In Vivo Anti-Tumor Effects of Citral on 4T1 Breast Cancer Cells via Induction of Apoptosis and Downregulation of Aldehyde Dehydrogenase Activity

Nigjeh SE, Yeap SK, Nordin N, Rahman H, Rosli R

Molecules, 2019 Sep 05;24(18).
PMID: 31492037 DOI: 10.3390/molecules24183241

Breast cancer is the most commonly diagnosed cancer and the leading cause of cancer death among females globally. The tumorigenic activities of cancer cells such as aldehyde dehydrogenase (ALDH) activity and differentiation have contributed to relapse and eventual mortality in breast cancer. Thus, current drug discovery research is focused on targeting breast cancer cells with ALDH activity and their capacity to form secondary tumors. Citral (3,7-dimethyl-2,6-octadienal), from lemon grass (Cymbopogoncitrates), has been previously reported to have a cytotoxic effect on breast cancer cells. Hence, this study was conducted to evaluate the in vivo effect of citral in targeting ALDH activity of breast cancer cells. BALB/c mice were challenged with 4T1 breast cancer cells followed by daily oral feeding of 50 mg/kg citral or distilled water for two weeks. The population of ALDH+ tumor cells and their capacity to form secondary tumors in both untreated and citral treated 4T1 challenged mice were assessed by Aldefluor assay and tumor growth upon cell reimplantation in normal mice, respectively. Citral treatment reduced the size and number of cells with ALDH+ activity of the tumors in 4T1-challenged BALB/c mice. Moreover, citral-treated mice were also observed with smaller tumor size and delayed tumorigenicity after reimplantation of the primary tumor cells into normal mice. These findings support the antitumor effect of citral in targeting ALDH+ cells and tumor recurrence in breast cancer cells.

Matched MeSH terms: Replantation
Fulltext Non-Surgical Retreatment After Failed Intentional Replantation: A Case Report

Ong TK

Eur Endod J, 2019;4(3):145-149.
PMID: 32161902 DOI: 10.14744/eej.2019.03016

A 27-year-old male patient complained of dental pain on previously root-treated tooth #17. Intentional replantation (IR) was performed. However, the symptoms returned at 10 months of follow-up, and a sinus tract was detected on the buccal gingiva of tooth #17. The patient refused extraction of the tooth and tooth was scheduled for non-surgical retreatment. Root canal retreatment was initiated with the removal of the previous root filling material while leaving the retrograde filling in situ. After 1 month of intracanal medication, the tooth became asymptomatic with complete healing of the sinus tract and the root canal filling was completed. Clinical and radiographic examination at 1 year follow-up revealed endodontic success with complete resolution of periapical radiolucency. This case report shows that non-surgical retreatment could be a viable alternative for failed IR.

Matched MeSH terms: Tooth Replantation
Replantation and revascularization of amputated upper limb appendages outcome and predicting the factors influencing the success rates of these procedures in a tertiary hospital: An 8-year retrospective, cross-sectional study

Kamarul T, Mansor A, Robson N, Albusaidi SH, Suhaeb AM, Samsudin EZ

J Orthop Surg (Hong Kong), 2018 1 13;26(1):2309499017749983.
PMID: 29320962 DOI: 10.1177/2309499017749983

PURPOSE: Worldwide advances in microsurgery have made salvaging of amputated hand via replantation and revascularization common procedures. The present study examines the outcome of these procedures in a tertiary hospital in Malaysia.
METHODS: Patients with hand amputation who underwent replantation or revascularization from 2005 to 2012 were identified and reviewed for patient characteristics, amputation characteristics and survival rates. Successfully treated patients were interviewed to assess the functional outcome using Quick Disability of the Arm, Shoulder and Hand (Quick-DASH) questionnaire and Michigan Hand Outcome Questionnaire (MHQ). Statistical analysis was performed to evaluate outcome and elicit predictive factors.
RESULTS: Fifty-five patients were enrolled: 37 (67.3%) underwent replantation and 18 (32.7%) underwent revascularization. The overall success rate of 78% ( n = 43) was within the range of previously reported data (61.6% to 96.0%). Ischaemic time <6 h provided significantly better survival rates ( p < 0.05). Functional outcomes were successfully assessed in 34 patients (79%), at a mean follow-up of 40 months (range 11-93 months). The overall Quick-DASH and MHQ scores were 42.82 ± 23.69 and 60.94 ± 12.82, respectively. No previous reports of functional outcome were available for comparison. Both Quick-DASH ( p = 0.001) and MHQ scores ( p < 0.001) were significantly higher for finger injuries, followed by thumb, wrist and palm injuries.
CONCLUSION: Ischaemic time and level of injury are important predictors of success rate of replantation and revascularization of amputated upper limb appendages.

Matched MeSH terms: Replantation/methods*
Fulltext Iatrogenic ureter injuries: eleven years experience in a tertiary hospital

Mahendran HA, Singam P, Ho C, Goh EH, Tan GH, Zuklifli MZ

Med J Malaysia, 2012 Apr;67(2):169-72.
PMID: 22822637 MyJurnal

Iatrogenic ureteric injuries are rare complications of abdomino-pelvic surgery but associated with high morbidity from infection and possible loss of renal function. A successful repair is related to the timing of diagnosis, site of injury and method of repair. This study was a retrospective review of outcomes of iatrogenic ureteric injury and factors contributing to successful operative repair. Twenty consecutive cases referred to the Urology Unit of the UKM Medical Center during an 11-year period from 1998 to 2009 were reviewed. Thirteen patients were diagnosed intraoperatively and underwent immediate repair. Seven patients had delayed diagnosis but also underwent immediate repair. In our series, there was no significant difference in outcome between injuries diagnosed intraoperatively versus injuries with delayed diagnosis. There was significant difference in the outcomes between methods of ureteric repair where ureter reimplantation via psoas hitch or Boari flap yielded better results than primary end-to-end anastomosis Three patients suffered loss of renal function from unsuccessful ureter repair. We conclude that all iatrogenic ureteric injury should be repaired immediately in the absence of overt sepsis. Ureter reimplantation using a Boari flap or psoas hitch is preferred to the end-to-end anastomosis especially when there is delayed diagnosis

Matched MeSH terms: Replantation
Histological analysis of motoneuron survival and microglia inhibition after nerve root avulsion treated with nerve graft implantation and minocycline: an experimental study

Wu W, Jafri M Abdullah, Faizul H Ghazali

Sains Malaysiana, 2016;45:1641-1648.

Motor vehicle accidents are the most common cause of injuries involving avulsion of the brachial plexus in humans,
resulting in debilitating motor dysfunction. Lack of an established animal model to test drug treatments hinders
the introduction of new pharmacological agents. Avulsion injury of cervical ventral roots can be replicated in rats,
resulting in a progressive loss of the motoneurons and increase in neurotoxic expression of microglia. This is a report
on the effect of prompt nerve implantation and minocycline treatment on the suppression of microglia activation and
survival of motoneurons. 20 adult female Sprague-Dawley rats were used for this study, which was approved by the
Animal Ethical Committee, USM (approval number /2011/(73)(346)). The animals underwent surgical avulsion of the
C6 nerve root, followed by reimplantation with peripheral nerve graft and treatment with intraperitoneal minocycline.
At 6 weeks postoperatively, immunohistochemistry using primary antibody Iba1 (microglia) and nicotinamide adenine
dinucleotide phosphate diaphorase (NADPh) with neutral-red staining (motoneuron) under flourescence microscopy
was performed at the C6 spinal cord segment and then quantified. This study showed significant reduction of microglia
expression in the study group; mean ranks of control and study group were 15.2 and 11.6, respectively; U=9.5, Z=3.02,
p<0.05. However, this did not translate into a significant increase of motoneuron survival in the combined group;
the mean ranks of control and study group were 40.6 and 41.6, respectively; U=44.5, Z=-.0378, p>0.05. This may
be due to the effect of the surgery; the surgery has the potential to cause additional trauma to the cord parenchyma,
leading to further motoneuron loss and an increase in scarring around the avulsed region, thus impeding regeneration
of the motoneuron.

Matched MeSH terms: Replantation
Periodontal response to two intracanal medicaments in replanted monkey incisors

Thong YL, Messer HH, Siar CH, Saw LH

Dent Traumatol, 2001 Dec;17(6):254-9.
PMID: 11766092

Intracanal medicaments are recommended for use in replanted teeth to inhibit inflammatory root resorption. This study compared the effect of calcium hydroxide (Pulpdent) and a corticosteroid-antibiotic paste (Ledermix) on periodontal healing and root resorption following replantation. Incisors of eight Macaca fascicularis monkeys were extracted, stored dry for 15 min and replanted. After 11 days, root canals in two adjacent maxillary incisors were treated with one medicament and contralateral incisors with the other medicament, or left as untreated controls. Animals were sacrificed 8 weeks later and the teeth prepared for histomorphometric evaluation of periodontal ligament inflammation and root resorption. Periodontal ligament inflammation and inflammatory root resorption were markedly inhibited by both calcium hydroxide and corticosteroid-antibiotic relative to untreated controls. Replacement resorption was lowest in the corticosteroid-antibiotic group, and significantly (P<0.05) more normal periodontal ligament was present in this group (79.6%) than in calcium hydroxide and control groups (64.6% and 62.7%, respectively). Treatment with the corticosteroid-antibiotic inhibited inflammatory resorption and was slightly more effective than calcium hydroxide in producing a periodontal healing response.

Matched MeSH terms: Tooth Replantation*

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