Intentional replantation for a periodontally involved hopeless incisor by using autologous platelet-rich plasma Tolga Fikret Tözüm, DDS, PhD, a Hüseyin Gencay Keçeli, DDS, b Ahmet Serper, DDS, PhD, c and Behram Tuncel, DDS, PhD, d Sihhiye, Ankara, Turkey HACETTEPE UNIVERSITY The aim of the present case is to describe the use of autologous platelet-rich plasma (PRP) in an intentional replantation procedure for a periodontally involved lower right central incisor with 18 months follow-up. Brief information is also given on the preoperative preparation of PRP in the dental office. PRP preparation is a new biotechnology, and the prepared material contains thrombocyte concentrates and high levels of growth factors. This material promotes healing time in a range of various sites. In this case, a tooth with severe periodontal breakdown was treated with PRP with intentional replantation procedure. This tooth was previously treated with root canal treatment and root planing. The tooth was extracted, and was replanted with autologous PRP. Clinical and radiographic follow- up for 18 months demonstrated new bone formation around the apical portion of the root and all clinical parameters indicated a trend of healing. The mobility of this previously grade III mobile incisor returned to normal limits. We speculate that intentional replantation with PRP application may induce wound healing and may induce bone formation. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;101:e119 – e124) Intentional replantation has been defined as “the act of deliberately removing a tooth and following some pro- cedures, returning it to its original socket.” 1 The indi- cations for performing replantation are failure of root canal treatment, anatomic limitations, accessibility problems, patient management, accidental avulsion, in- voluntary rapid orthodontic extrusion, and patient ob- jection to periradicular surgery. 2 Between 52% and 95% of replanted teeth are retained with an average time of retention of 3-5 years. 3 Beyond these endodon- tic indications, progressive periodontal destruction has also been listed as an indication for intentional replan- tation. 4-6 Clinical studies have shown successful results with this opinion, where a periodontally involved and endodontically mistreated mandibular first premolar was replanted, and remained functional and asymptom- atic for 32 months. 4 Baykara and Eratalay 5 also per- formed intentional replantation of periodontally in- volved teeth and followed them for a period of 8 years. Their results demonstrated that teeth survived with healthy gingiva, there was significant decrease in pocket depth, and there was also evidence of new bone formation. Furthermore, Demiralp et al. 6 treated peri- odontally involved hopeless teeth with intentional re- plantation procedure using tetracycline-HCl, and re- ported a reduction in probing depths and an increase in the amount of alveolar bone. Recent interest has also focused on the regeneration and early wound healing of supporting structures, where platelet rich plasma (PRP) was speculated as a promoter of tissue regeneration and alveolar bone for- mation. 7-10 PRP is the component of blood in which the platelets are concentrated in a limited volume of plasma. 7-13 The medical literature provides evidence that platelets contain many growth factors including platelet-derived growth factor, insulin-like growth fac- tor, and transforming growth factor- that enhance wound healing and help to induce regeneration of the tissues. 14-16 This autologous plasma is a rich source of growth factors and its application is effective to induce early tissue healing and regeneration. 13,16-18 A significant increase in bone area and bone density in the artificially induced calvarial defects of rabbits treated with a combination of bone and PRP has been demonstrated, 19 and furthermore, bone defects around titanium implants was suggested to be treated success- fully with combination of PRP and bone powder in beagle dogs. 20,21 Marx et al. 13 reported the first clinical results with PRP a Assistant Professor, Department of Periodontology, Faculty of Den- tistry, Hacettepe University, Sihhiye, Ankara, Turkey. b PhD student, Department of Periodontology, Faculty of Dentistry, Hacettepe University, Sihhiye, Ankara, Turkey. c Professor, Department of Endodontics, Faculty of Dentistry, Hacet- tepe University, Sihhiye, Ankara, Turkey. d Resident, Department of Endodontics, Faculty of Dentistry, Hacet- tepe University, Sihhiye, Ankara, Turkey. Received for publication Feb 2, 2005; returned for revision Feb 12, 2005; accepted for publication Oct 17, 2005. 1079-2104/$ - see front matter © 2006 Mosby, Inc. All rights reserved. doi:10.1016/j.tripleo.2005.10.043 e119