By Dr Bertrand Stuart, DDS
PEOPLE sometimes call me to ask if I do dental implants, and if they could have it done. It may be difficult to believe this, but the average price one would pay for the implantation of one tooth in Guyana is half a million dollars and the process takes nearly a year to complete. That tooth, of course, is artificial, and without adequate care, it could literally fall out (and there goes your hard earned money).

But on the other hand, what would you say to your dentist if he or she suggested removing a tooth from your brother or sister with the intention of replanting the same tooth in your mouth? The fact is, this was being done for over a thousand years now.

Intentional replantation is the act of deliberately removing a tooth and, following examination, diagnosis, endodontic treatment and repair, returning the tooth to its original socket or to one that has been created. In general terms, a tooth becomes a potential candidate for intentional replantation when a small mouth — or difficulty in opening the mouth wide — negates adequate space to perform root canal treatment. Also, when the tooth’s condition and its position in the jaw prohibits proper manipulation, the dentist may choose to work on it while the tooth is outside the mouth.

Intentional replantation is not recommended when the patient has a medical history that precludes oral surgery or extraction (e.g. severe uncontrolled high blood pressure, recent myocardial infarct, sub-acute endocarditis, uncontrolled haematologic problems such as hemophilia, leukemia and diabetes). This technique is not to be done when the tooth is very decayed, shaking with gum disease present, or when the patient is unwilling to accept the risk.

Teeth that are replanted are not expected to last a lifetime. Records show that when the technique is considered a success, the replanted tooth lasts between five and 20 years without a related problem. The most important factors that are responsible for successes are the method of extraction and the length of time the tooth is out of the socket. If the extracting forceps are injurious, the periodontal membrane (which holds the tooth in place) will be crushed and abused. In this case, simple repair and re-attachment will not be possible. The extraction must be done very slowly.

The duration of time the tooth is out of the socket is critical. The greatest danger to the life of the periodontal membrane (which covers the root) is exposure to air. Ninety per cent success occurs when avulsed teeth are replanted within 30 minutes. The major failure of the intentional replantation technique is external root resorption and ankylosis. An ankylosed tooth which is fused to the bone cannot absorb the forces of mastication without inducing absorption of the jaw bone. In fact, that is the major problem with the modern implants we hear so much about. Replantation (natural root) has much more potential for success than implantation (artificial root).