Intentional replantation

A list of what was once advocated when performing a replantation versus what is done now follows: 1. It used to be advocated always to curettage the socket after removing the tooth. Now clinicians know not to touch the walls of the socket and only to aspirate gently the apical region if needed. 2. After removal, the tooth used to be held in gauze, desiccating viable PDL cells. Now the tooth is kept bathed in an emesis basin filled with HBSS, which maintains the viability of the PDL for 30 minutes. 3. All clinicians were able to do was visual inspection; now the microscope is used to illuminate and magnify the working area. 4. Splinting was done on every case; now clinicians rarely splint after replantation. 5. Narcotic pain medication was prescribed routinely; now clinicians premedicate with chlorhexidine rinse, anti-inflammatory medication, and sometimes antibiotics, rarely using narcotics. With increased understanding of the periodontium and improved techniques, replantation should no longer be viewed as a treatment of last resort, but rather a successful treatment alternative.