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We performed a retrospective study of 34 replanted avulsed teeth placed in an EPTS before replantation. Even when extraoral time was 120 minutes or more, 91 percent of the teeth showed excellent or moderate success for follow-up periods ranging from three to 30 months. We think that the success of a replanted avulsed tooth is increased by use of a prefabricated tooth preserving and protecting system as described.
In Scandinavia, traumatic dental injuries can usually be treated professionally within a few hours. A fourteen-year-old boy suffered an avulsed tooth while playing basketball. Despite an extraoral period of more than twelve hours, a functional PDL survived.
This case report deals with the histologic examination of an avulsed tooth that was reimplanted in a socket where a distal root defect was augmented with hydroxyapatite. The 6-year results showed a "repair" type of connective tissue attachment. There were areas of ankylosis present on the distal root above an area of prior cystic debridement. The hydroxyapatite particles present demonstrated biocompatibility and encapsulation by new bone growth. There was a longer junctional epithelium present on the distal root than on its mesial counterpart. Histology of the distal root demonstrated fibrous repair, ankylosis, and osseous formation around the hydroxyapatite particles. This type of result was not apparent on the mesial root, devoid of hydroxyapatite, where a "splicing" type of healing occurred in the periodontal ligament.
The prognosis of replantation of an avulsed tooth is determined by which first-aid measures are taken during the first 15 min after avulsion. Knowledge of the correct first-aid measures is therefore crucial to successful replantation. The aims of this study were (i) to assess the present knowledge level of emergency measures for tooth avulsion in Kuwaiti schoolchildren, and (ii) to design and test an interview form with structured standardized questions. A total of 221 Kuwaiti schoolchildren (aged 7-15 years old) were interviewed by professionals using a standardized method to score several areas of knowledge about tooth avulsion and replantation. Earlier experience of first-aid information and subjection to dental trauma was registered. The following fields of knowledge were assessed: general body injury treatment principles, tooth avulsion and replantation principles, avulsed permanent/primary teeth, cleaning of avulsed tooth before replantation, extra alveolar time and storage media. The form for interviewing children proved to be sufficiently structured in performing the interviews and data management. The results of the interviews showed that 30.3% of the children had been exposed to dental trauma in the past. Among children 7-9 years of age, 25% had received information on general first aid as compared with 75% in children 10 years and older. Children 10 years and older, in general, had a high knowledge level of general principles of how to manage injuries to the body. Regardless of age group, there were generally a low knowledge level regarding tooth avulsion, replantation, extra-alveolar time and storage media. We conclude that first-aid knowledge in Kuwaiti schoolchildren is low on avulsion and replantation of teeth despite a high knowledge level of body injuries. The knowledge level of first-aid measures on avulsion and replantation of teeth could be increased through intervention programs.
A traumatic injury to a patient undergoing orthodontic treatment resulted in avulsion, dislodgement, and fracture of upper anterior teeth. Deciding when to institute endodontic treatment and when to resume orthodontic treatment was based upon minimizing the changes for ankyloses and root resorption. Endodontic treatment was carried out two weeks after trauma, and orthodontic treatment continued three weeks after trauma. Radiographs taken six months, one year, and two years after orthodontic completion showed progressive root resorption to the avulsed tooth and minimum root resorption to the remaining anterior teeth.
An infrequent traumatic injury in dogs is avulsion of a tooth from its alveolus. The management of the avulsed tooth is complex. This report describes the treatment of a traumatically avulsed maxillary canine tooth in a dog. Replantation and splinting of the tooth was performed. Despite a protracted extraoral time, follow up clinical and radiographic assessment of the tooth indicated successful replantation.
The reported incidence of tooth avulsion ranges from 1% to 11% of all traumatic injuries to the permanent dentition. The maxillary central incisor is the most frequently avulsed tooth in the permanent dentition, and the most frequently involved age group is 7-10 years. This article reviews the present day knowledge on avulsion and replantation of permanent teeth. Treatment objectives are explained, and clinical management outside and inside the dental office are discussed. Detailed treatment protocols are provided considering the extraoral time and the degree of apical closure.
Treatment of permanent tooth avulsions in an adolescent poses significant difficulties for the dental clinician. This case report gives details about the treatment of a complex dentoalveolar trauma involving multiple avulsions of primary molars, permanent incisors, permanent molars, and premolar toothbuds. Immediate treatment of the injury and short-term esthetic replacement of the dentition is described. A brief review of current research relative to the treatment of permanent tooth avulsions is provided.
Avulsion, following traumatic injuries, is relatively infrequent. The treatment of avulsed teeth is by replantation of the avulsed tooth into its own socket. However, sometimes the avulsed tooth cannot be found at the accident site. We report a case in which the avulsed maxillary central incisor is replaced by an embedded lower premolar. A 2-year follow-up shows complete periodontal healing and a very satisfactory clinical result.
Management of tooth avulsion in the permanent dentition often presents a challenge. Definitive treatment planning and consultation with specialists is seldom possible at the time of emergency treatment. Replantation of the avulsed tooth can restore esthetic appearance and occlusal function shortly after the injury. This article describes the management of a child with an avulsed maxillary permanent incisor that had been air-dried for about 18 hours. The replanted incisor retained its esthetic appearance and functionality 2 years after replantation, yet the long-term prognosis is not good because of progressive replacement root resorption.
Successful treatment of the avulsed tooth with immature root development is dependent on both pulpal and periodontal responses. The pulpal reaction is often one of revascularization with subsequent replacement of the necrotic pulp tissue. Continued root development and further calcification of the existing root structure are often seen with revitalization. The periodontal response to avulsion is dependent on the vitality of the periodontal ligament cells on the root surface. Normal healing occurs when the vitality is maintained, while replacement resorption results when the vitality is lost. Replantation after a short extra-alveolar period appears to provide the best prognosis for long-term retention of the avulsed tooth.
The aim of this study was to evaluate the influence of mailed guidelines and seminars to school teachers on self-care actions taken by children after trauma. Data was collected 6 months before and 5 months after provision of the guidelines. Particulars of school children who sought dental consultation, types of injuries, the medium used to store avulsed teeth and the time elapsed from injury to dental consultation were recorded. A non-significant increase was observed in a number of children who sustained tooth avulsion from primary schools that belonged to a seminar group and from nursery schools that belonged to a mailed guidelines group. There were no significant differences before and after provision of guidelines in the number of patients with soft-tissue injury, periodontal injury and injury to hard dental structures. Of the patients who sustained tooth avulsion, 36 (54%) brought the involved tooth to the dental clinic, (29%) sought dental consultation later than 7 hours after injury. None of those patients stored the avulsed tooth in a recommended transport medium. The findings of this study indicate that a single educational input to school teachers is not enough to promote children's self-care after injury.
This literature review examines the effects of extra-alveolar duration and storage conditions on the healing of the periodontal ligament (PL) of avulsed teeth following replantation. A critical assessment of the so-called "reconstitution theory" for PL cells is also presented. The ideal treatment for an avulsed tooth is immediate replantation (i.e. less than five minutes). Unfortunately, immediate replantation is not the norm, and most avulsed teeth experience delayed replantation. The greatest risk to the vitality of the PL cells attached to the root of an avulsed tooth is desiccation. Not surprisingly, storage media affect PL healing. Storing avulsed teeth in an isotonic liquid is superior to dry storage. Numerous studies support the use of Modified Eagle's Medium, Hank's Balanced Salt Solution (HBSS), ViaSpan, saline, milk, and saliva as storage media. A recent study has suggested that chicken egg white may also prove to be a suitable storage medium for avulsed teeth. Of these media, only saliva is always present at the scene of an accident, however. Milk can usually be obtained on short notice, but even 10 minutes of desiccation can affect the outcome of replantation. From a practical standpoint, milk packed in ice seems to be the best alternative for the temporary storage of avulsed teeth, due to its wide availability and the minimal detrimental effects it has on PL cells. There is no evidence to support the suggestion that HBSS or any other media will "reconstitute" the PL cells when the extra-alveolar duration of avulsed teeth is greater than 30 minutes.
OBJECTIVE: To evaluate the influence of two different modes for delivering guidelines on school teachers' knowledge on emergency treatment for dental injuries. DESIGN: Cross sectional questionnaire study. SETTING: Primary schools in Dar es Salaam city council in Tanzania. PARTICIPANTS: Primary school teachers. INTERVENTION: Provision of guidelines by mail or through seminar or no guidelines (control). MAIN OUTCOME MEASURES: Knowledge on emergency management of dental injuries RESULTS: The teachers did not have adequate knowledge on the emergency management of traumatised teeth. Significant differences were observed between the study groups. Teachers from the seminar group were likely to re-implant an avulsed tooth (five times more likely than the control group) or otherwise would transport it in the recommended medium. No significant differences were observed between the groups on their willingness to take the avulsed tooth to a doctor or dentist or on the method or liquid they would use to clean a dirty avulsed tooth. CONCLUSION: Compared to provision of information through mailed guidelines, seminar discussions better improved the school teachers' knowledge regarding emergency treatment for dental injuries.
Many patients with facial injuries are first seen by doctors in the emergency room. Injuries affecting teeth and alveolar process are common in children; approximately half of all children have sustained such an injury before adulthood. Dentoalveolar trauma does not pose a significant morbid risk for the trauma patient. However, failure to recognise or obtain appropriate consultation can result in premature tooth or alveolar bone loss, resulting in problematic prosthetic rehabilitation. Emergency room doctors should know the initial treatment guidelines for traumatic dental injuries to provide optimal treatment before the patient can seen by a dentist. An avulsed tooth should be replanted immediately, or kept moist until it can be replanted. Prognosis is related to storage media and the length of the extra-alveolar period. Teeth replanted within 5 minutes have the best prognosis. If the primary consultation is by phone the patient, or the parent, should be informed to replant the avulsed tooth. If this is not feasible the tooth should be stored in milk, saliva (oral cavity) or physiologic saline until replanted. Primary teeth are not replanted.
Prognosis in relation to an exarticulated, replanted tooth is poor. Late complications are frequent and often lead to tooth loss. However, the root of a replanted, avulsed tooth may be slowly resorbed preserving alveolar width and postpones replacement of the tooth to a more convenient time. During healing following transplantation or replantation of teeth, various dental and oral structures are involved. Late complications relate to various factors. Tissues and factors involved are reviewed. Knowledge of this subject derives mostly from results of transplantation studies in animals.
An 11-year clinical and radiographic follow-up of an avulsed tooth, replanted within 15 minutes, has been presented. The periodontal membrane can be traced around the replanted central incisor, indicating the tooth is not ankylosed and is functionally attached. It is not anchored immutably to the bone. The tooth has responded dynamically to growth and development of the maxilla and now abuts and aligns well with the other teeth in the arch.
The most important factors determining periodontal healing after replantation of an avulsed tooth are the extra oral period and the media in which the tooth is preserved before replantation. This case report describes an adequate periodontal healing of an avulsed immature tooth replanted after 20 min of extra alveolar dry time. Vitality was not regained and after disinfection of the pulp space mineral trioxide aggregate was used as the root filling. Follow-up confirmed complete healing periradicularly.