depending on the duration of storage, this can affect the success of subsequent replantation. Disease The epithelial rests of Malassez can become cystic, usually forming nondiagnostic, radiolucent apical lesions that can be seen on radiographs. This occurs as a result of chronic periapical inflammation after pulpitis occurs and must be surgically removed. The PDL also undergoes drastic changes with chronic periodontal disease that involves the deeper structures of the periodontium with periodontitis. The fibers of the PDL become disorganized, and their attachments to either the alveolar bone proper or cementum through Sharpey fibers are lost because of the resorption of these two hard dental tissue. Pathological damaged or diseased PDL can result in delayed healing of the alveolar socket in cases where the diseased tooth is ultimately extracted. Effect of tobacco smoking and nicotine There is a relationship between smoking tobacco and periodontal disease, wound healing and oral cancers. Nicotine, the major pharmacologically active ingredient in tobacco smoke, lessens a host's ability to defend against bacterial invasion induced by plaque. It is also the ingredient responsible for addiction. Tobacco smoking impairs phagocytic and chemotactic activities of leukocytes and impedes wound healing, specifically by affecting gingival blood flow. Cigarette smokers are more likely to experience destruction of the alveolar bone and periodontal ligament and are at a higher risk of developing periodontal disease. Nicotine and lipopolysaccharides synergistically induce the production of nitric oxide (NO) and PGE2, and increase inducible nitric oxide synthase (iNOS) and COX-2 expression in human periodontal ligament (hPDL) cells. At the cellular level, nicotine reduces the proliferation of red blood cells, macrophages, and fibroblasts and increases platelet adhesiveness. Macroscopically, this affects healing and tissue perfusion due to micro clot formation in the blood vessels. Nicotine also has a sympathomimetic action, stimulating epinephrine and norepinephrine release, which causes vasoconstriction and limits tissue perfusion. Nicotine jeopardises bone formation by inhibiting neovascularization and osteoblastic differentiation. Ankylosis Ankylosis is a condition where the cementum of the tooth's root fuses with the bone that is around the tooth. The osseous tissue replaces the periodontal ligament which causes the tooth to be fixed and cannot undergo eruptive change. Ankylosis usually occurs in primary molars, however this can also take place in other primary teeth, as well as secondary dentition. Ankylosis is common in the anterior tooth after trauma and can be referred to as replacement resorption. In this process PDL cells are destroyed and