[Clinical studies on the use of hyperbaric oxygen in replantation of young permanent teeth]. Thymosin alpha 1 provides short-term and long-term benefits in the reimplantation of avulsed teeth: a double-blind randomized control pilot study. Clinical evidence and literature to compare two different therapeutic protocols in tooth avulsion.
To investigate the treatment effects of hyperbaric oxygen(HBO) in replantation of young permanent teeth.
                A total of 138 luxation injuries to young permanent teeth undergoing treatment. The teeth were replanted and then divided into 2 groups. The HBO group was exposed to 0.25 MPa pure oxygen 40 x 2 minutes each day for 10 days continuously while the control group were compared.
                The total effective rates of the HBO group and the control group were 97.26% and 70.77% respectively, and showed significant difference (P < 0.05); respective frequencies of missing tooth after 1 year were 1.37% and 18.46%, and provided a statistical significance (P < 0.001).
                HBO used in replantation of luxated young permanent teeth could promote the recovery of periodontal membrane, pulp, and prevent resorption of root. This study investigates the short-term and long-term effects of thymosin alpha 1 (Talpha1) on reimplantation of avulsed teeth.
                Seventy-three patients with avulsed teeth were double-blind randomly assigned to a control group and group that used Talpha1. The teeth were reimplanted after treatment with Talpha1 or saline. Patients were monitored for both short-term and long-term parameters.
                The thymosin group demonstrated a lower interferon, tumor necrosis factor alpha and interleukin-6 levels (P < .05) and higher white blood cell levels than the control group (P < .05). The thymosin group demonstrated greater periodontal healing (P < .05), less ankylosis (P < .05), less tooth movement, and greater lifetime of the replanted teeth.
                The use of Talpha1 has both short-term and long-term beneficial effects during reimplantation of avulsed teeth. This is to assess the priority in tooth avulsion: replantation as quickly as possible and deferred endodontic treatment, or replantation and elimination of every irritating stimulus for the periodontal ligament. The objective is to establish a univocal protocol by analysing and comparing the various components of these therapeutic procedures.
                Study design: 20 patients were selected and divided into 2 groups: in group A we focused our attention on the rapidity of replantation, in group B we focused on the elimination of the necrotic pulp and every possible irritating stimulus that might lead to root resorption of inflammatory nature.
                Clinically, dental mobility seems to be greater in the first group. However after 15 days teeth have a comparable mobility and after one month they all show a mobility degree 1. Radiographically a greater incidence of resorption can be observed in group A compared to group B as in the first one a higher number of replanted teeth undergo resorption. Such lesions have the tendency to remain constant or even increase.
                The results of this study seem to take only one direction: extraoral endodontic therapy.
The available evidence suggests that extra-oral endodontics is not detrimental for teeth replanted after more than 60 minutes dry time. Studies with moderate/high risk of bias indicate that soaking in thymosin alpha 1 and gentamycin sulphate followed by hyperbaric oxygen may be advantageous however, they have not previously been reported as interventions for avulsed teeth and need further validation. More evidence with low risk of bias is required and, with the low incidence of avulsed teeth, collaborative multicentre trials are indicated.