Intentional replantation as a last resort in the treatment of endodontic failures: Literature Review

— One of the main objectives of endodontic treatment is the decontamination of root canal systems visando alcançar o sucesso clínico com o paciente sem sinais e sintomas.However, sometimes endodontic treatment fails, causing a periradicular inflammatory lesion to persist. Given this, there are several treatment options, including non-surgical endodontic retreatment and apical microsurgery. Sometimes these options are unfeasible, and intentional reimplantation appears as the last therapeutic option for dental element extraction.The main objective of the present study was to analyze the effectiveness of intentional replantation as a last resort in the treatment of endodontic failures. As an inclusion criterion, articles from the PubMed, Google Scholar and SciELO database were used. In PubMed, 61 articles were found, 08 were selected. In Google Scholar, 131 articles were found, 8 of which were selected for the research. In SciELO, 2 articles were found, were 2 were selected. Also 4 articles were included by cross-reasearch.


INTRODUCTION
Teeth are vital sensory organs that contribute to our daily activities (CLARK; LEVIN, 2018), such as speech, food and aestheticsin addition to assisting in living together in society. Teeth can be lost for a variety of re asons, although dental trauma and caries are the most frequent causes (CLARK; LEVIN, 2018).
According to Park (2019) when any other organ in the human body presents a high injury, a great effort is made to try to recover that organ, in contrast, and this is not observed so intensely in dentistry. This is a negative phenomenon, because the more teeth a person has, the greater the probability of having a better quality of life (PARK et al., 2019). Chewing is an important role that teeth play, and the ability to chew food is directly associated with an individual's quality of life (YAMAMOTO; SHIGA, 2018).
The intentional reimplantation is a procedure that is part of the endodontic arsenal and, like the apical endodontic microsurgery, it has technical-scientific basis and is indicated to try to save teeth (KATAOKA; GONDIM, 2020). Intentional reimplantation is indicated in cases of post -treatment periapical pathology , in which non-surgical endodontic retreatment and/or apical surgery are impractical or failed later (GRZANICH et al., 2017) .
Conventional endodontic retreatment may be unfeasible either because of a complex coronary restoration that hinders access to the root canal, or because of an obstruction of the canal system that prevents access to the apical foramen, or because of the existence of a perforation whose intracanal repair is inaccessible (BECKER, 2018). This technique has been presented as an excellent therapeutic option, since all dental surfaces can be completely visualized and instrumented, without damaging the adjacent periodontal tissues, contributing to the reestablishment of the health of the periapical tissues. (GRZANICH et al., 2017).

Indications
In the literature several clinical indications for this technique have been presented:

II. MATERIALS AND METHODS
In order to produce a literature review, the research was carried out in databases such as Pubmed (Medical Publications), SciELO and Google Scholar. The articles were attached in different folders by the name of the database. In PubMed the keywords (Dental replantation, Endodontics, Intencional Replantation) were used, where 61 articles were found being selected 08. In SciELO the keywords were used (Dental replantation, Endodontics, Intencional Replantation), where 2 articles were found and 2 were selected. In Google Scholar the keywords were used (Dental replantation, Endodontics, Intencional Replantation), where 131 articles were found and 8 were selected. Also 4 articles were included by cross-reasearch. As an inclusion criterion, a scientific article were included that contained the keywords delimited from the year 2011 until the year 2021, no language restriction.

Fig.1: Articles selection process is represented in the flow diagram.
After removing the duplicates, 114 articles were obtained, from which the title and abstract were read, resulting in a total of 51 articles for full reading. From which only 19 were included, 4 articles were subsequently added by cross-reference.

IV. DISCUSSION
Intentional reimplantation is indicated in cases of post-treatment periapical pathology, in which non-surgical endodontic retreatment and/or apical surgery are impractical or failed later (GRZANICH et al., 2017).
Despite high success rates of up to 85% for primary root canal treatment, failure may still occur and new pathosis develop (NG et al., 2011). Nair (2006) discussed predisposing factos tha lead to persistence of periapical lesions following primary rootcanal treatment,namely: microbial intraradicular infection which might result from inadequate disinfection or coronal leakage,microbial extraradicular infection,including actinomycosis and Propionibacterium that can not be disinfected by conventional means,non-microbial non-radicular irritation (cholesterol crystals),exogenous non-root foreign body reaction, the true cystic lesion and surgical scar tissue Yan et al. (2019) presented 3 case reports involving type II or type III palatogingival grooves on lateral maxillary incisors that were treated with reintention rempantation, in all cases, the diagnosis of a combined periodontal-endodontic lesion with periodontal was made breakdown . The authors concluded that intentional replantation with a 2-segment restoration is a good therapeutic choice.
In 2015, Torabinajed et al reported in their systematic review, a survival rate of 88% of intentionally reimplanted teeth, at two years. In this systematic review, the author compared the survival of intentionally reimplanted teeth, reported in 8 articles, with the survival of implant-supported single crowns, reported in 27 articles.
In 2016, Cho et al., also carried out a prospective study with 159 patients, mostly female and under 40 years of age, in which the majority of intentionally reimplanted teeth were second molars that presented apical radiotransparency , adequate filling and absence of fistula, most of which were retrofilled with intermediate restorative material (IRM) and reimplanted in less than 15 minutes. In this study, the author reported a cumulative retention rate of 93%, at 12 years, and a cumulative clinical and radiographic healing rate of 91%, at 6 months, which decreases to 73%, at 3 years.
In 2017, Mainkar reported a survival rate of 89.1%, in a systematic review that compared not only the survival, but also the cost-effectiveness of intentionally reimplanted teeth compared to single implants, suggesting that this is better in cases of intentional reimplantation. Furthermore, authors like Choi, Lee and Kim evaluated the effect of orthodontic extrusion provided to intentional reimplantation and its influences on survival. They observed that the survival rate of intentional replantation in its results (91%) amounted to a Statistically significant way (up to 98%) with preoperative orthodontic extrusion. For rejected part, this done in had influence on further development resorption root (CHOI et al., 2014). Therefore point out this performance as a possible improvement of the prognosis of the redeployed tooth.
According to data obtained from case reports and literature reviews, all authors point out how crucial the need for the surgical act is to be minimally atraumatic,

V. CONCLUSION
It can be concluded in this literature review that intentional reimplantation is a viable alternative and presents a good cost-benefit.
Despite a pattern followed by the authors in the ir achievements lack of a standard protocol for performing the procedure, further research is suggested to adapt a gold standard clinical protocol aiming at achieving the best possible prognosis.
Furthermore, it is essential that a clinician has both the knowledge, skills and equipment to undertake this procedure with safety to ensure the best possible prognosis to the patient.

VI. ACKNOWLEDGMENT
First of all, I thank God, for making it possible for me to get here, for giving me strength at all times when I failed or felt like giving up. I would like to thank my teacher and advisor, Prof. Dr. Eduardo Fernandes Marques, whom I admire a lot, for all her willingness, knowledge, understanding, motivation and for the trust placed in me to carry out this study. I also thank my teacher and co-advisor, Me. Kaohana Thaís da Silva, for accepting my invitation. You are professionals that I have great admiration for.
To my parents and friends, I am immensely grateful for all of their patience, support and encouragement. Without you none of this would be possible.