Review of Storage Media before Tooth Replantation

Review of Storage Media before Tooth ReplantationSave cells before tooth replantation- A ReviewAbstractAvulsion is one of the most complex traumatic distress affecting both teething and children. Avulsed teeth crapper be replanted. perplexity protocols for avulsed teeth should include management of the pulp and periodontal ligament (poundal) cells in invest to improve the long-term scene and survival of these teeth. If immediate replantation is non mathematical, the clonicity and progenicity of the practicable pdl cells merchant ship be kept up(p) with aid of suitable depot mass average at the slip of trauma. The incorrect use of a retentivity sensitive potentially increases the risk of PDL cell necrosis, which can issuing in ankylosis and replacement resorption of the tooth root. Considering the importance of the shop media, an inform choice of a media is essential for a favourable step to the forecome. This review discusses the super C memory board media tha t are available and some of the unique features of each media along with the problems associated.KeywordsAvulsion, Replantation, Storage mediaIntroductionAccording to WHO classification, Avulsion or ex-articulation is complete displacement of the teeth from its alveolar socket. 1, 2 Avulsion of permanent teeth is seen in 0.5- 3% of all alveolar consonant injuries. Andreasen Andreasen predicted that the incidence of these injuries whitethorn eventually surpass the incidence of dental caries. numerous studies show that this injury is one of the most serious dental injuries, and the prognosis is very much dependent on the actions taken at the place of accident and promptly after the avulsion. The immediate replantation of teeth is the ideal give-and-take of choice for the avulsed teeth to prevent post replantation complications such as rabble-rousing resorption, ankylosis or replacement resorption. If immediate replantation is not possible, the clonicity and progenicity of the viabl e PDL cells can be maintained with aid of suitable terminal medium at the place of trauma. The lack of first aid knowledge close to the avulsion among the public and health care centers delays immediate replantation and limits the prognosis of the avulsed tooth. Various computer retentivity media are available maintain the progenicity and clonicity of PDL cells to improve the outcome of the replantation. The usage of this article is to, review the current storage media with their pros and cons and to provide an insight almost the efficacy of newer storage media available.Historical perspectiveCvek 3 showed that storage of knocked out teeth in saline could improve the success of replanted teeth. Lindskog et al 4 describe that the mention to retention of the knocked-out teeth was to maintain the vitality of the periodontal ligament. Andreasen 5 besides mentioned that crushing of cells on the tooth root could cause death of the cells and lead to resorption and reduction in pro gnosis. Blomlof 6, mentioned that the lift out storage medium was a medical research fluid called Hanks equilibrate Salt Solution maintained the cell viability for two hours. Matsson et al 7 showed that soaking in Hanks Balanced Solution for thirty minutes prior to reimplantation could revitalize extracted dogs teeth which were dry for 60 minutes. Blomlof L 8 recommended milk as a storage media prior to reimplantation when immediate replantation is not possible. Krasner et al 9 reported that the systematic storage device Save-A-Tooth was developed to optimally store and preserve knocked out teeth. Layug et al 10 quoted that milk packed in ice seems to be best alternative, ascribable to its wide availability and minimum detrimental effect. Marino T G et al 11 showed that long shelf life milk is more(prenominal) effective than Save A Tooth. Pearson et al 12 mentioned that Baby Milk formula (Enfamil) is more effective storage media than pasteurised milk for at to the number onee st degree 4 hrs. Al-Shaher et al 13 reported that 75% PDL cells had been kept viable after 20 hr caution in propolis solution. Sonoda CK et al 14 mentioned that saliva can be storage medium for avulsed tooth when no medium is present at accidental site. Khademi et al 15 introduced egg albumin as a storage medium for up to 10 hrs. Gopal K et al 16 reported that coconut water can be used as a storage medium due to its readily acceptable by the body and stereotypical in nature. Ji Young Hwang et al 24 invented green tea extract as a suitable, alternative storage media for avulsed teeth. Likewise there are many storage media available for the success of replanted tooth Table-1.Factors considered for storage mediaThe prognosis of the tooth re-implantation depends on the existence of executable cells in the periodontal ligament and excessively depends on those which are able to grow on the damaged areas of the root.17,18 Therefore either immediate replantation or storage of the tooth should be done in an appropriate storage media.Two big factors considered for storage medium are Hydrogen ionic potential/ pH and Osmolality. According to Marino et al, the pH and the osmolality of the storing environments must be physiologic, for both interfere in the surviving of cells of the periodontal ligament. Each storage media has divers(prenominal) pH and osmolality found on which the survival of PDL cells is assessed Table-2. Authors have reported that the cellular harvest-home may occur in the midst of 290 and 330mOsm/kg. The pH must be between 7.2 and 7.4, but growth may occur between pH 6.6 and 7.8.19 nonsuch requirements of storage mediaAn ideal storage media should have the osmolality and pH closer to physiological conditions to maintain the viability, clonogenic capacity and mitogenicity of the Pdl cells.20 It should be readily available at the site of accident 1 so that, the tooth can be immediately rigid into it, should have a longer shelf life,20 should ha ve anti-inflammatory and anti-microbial properties which reduces dismissal and replacement resorption.21,22 It should also have an antioxidant property which will protect the cells from atomic number 8 radical mediated damage.23 Finally last but not the least the storage media should be economical. Not a single storage media effect all the ideal requirements, so various comparable studies been conducted to evaluate the ability in maintaining the cell viability of PDL cells of replanted teeth.Container for the transport of avulsed teeth along with the medium must be unbreakable, nontoxic to the cells of PDL, should be leaking proof, easy handling, should be sterile as head the internal walls must be made of loco material.24 Some of the commercially available are tooth rescue box (Dentosafe) containing a culture medium, salts, amino acids, glucose and vitamins 25 and Save A Tooth system, a 6-part system containing HBSS media, that was intentional to prevent damage to the PDL ce lls of an avulsed teeth.24Newer Medias in ResearchAscorbic acid accompaniment of ascorbic acid to osteoblastic cell lines can stimulate type 1 collagen production, followed by expression of specific markers associated with osteoblastic phenotypes such as alkaline phosphates (ALP) and osteocalcin. Ishikawa et al 60 analyse the effect of ascorbic acid on PDL cells and observed that ascorbic acid increase the ALP activity which is required for binding of PDL cells to type 1 collagen via 21 integrin whose expression is again increased by ascorbic acid, so it may serve as potential storage media.L-DOPA (Levodopa Sigma chemical, Perth, WA, Australia) is drug with possible mitogenic effect. It stimulates secretion of growth hormone from pituitary gland which aids in healing process. Mandana et al 61 observed the effect of levodopa on human PDL fibroblasts and sayd that it can also have local effect on growth of cells and can act as preserving medium for avulsed teeth.Cryoprotective agen ts The effect of low temperature storage on clinical success of reimplantation has been studied. Schwatz and Andreasen 62 studied the effects of the cryopreserving agents, 5% and 10% dimethyl sulphoxide (DSMO) and 10% glycerol on PDL. They observed that use of different cryoprotectives, combined with controlled freezing rates can preserve the PDL of reimplanted teeth. culminationThe success of dental reimplantation depends on the existence of viable cells on the periodontal ligament, which are able to proliferate on the denuded areas of the root surface. This can be reached through immediate reimplantations taking place within up to 30 minutes or transporting the tooth in an adequate storage medium for dental reimplantation.Tap water, saliva and saline must be avoided for the storage of avulsed teeth, because they do not offer any benefit to the healing. Contact electron lens solutions and Emdogain also do not offer any good results oer other media. Propolis and egg white needs add itional studies where propolis is not easily available in emergency situations whereas egg white is a undimmed media considering its availability. Milk is significantly better than other storage media, but it is not so efficient as Hanks balanced salt solution, viaspan and shoots medium as storage medium for avulsed teeth for the maintenance of vitality and proliferative capacities of periodontal ligament cells. Although HBSS, ViaSpan and Eagles medium have outstanding potential to maintain the PDL cells in a viable state of avulsed teeth, lack of ready availability to the general public as well the cost makes them less than ideal for developing countries like India. Milk corpse the most convenient, cheapest and readily available solution in most situations, also being capable of keeping PDL cells alive.