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PubMedDate not supplied

Replantation of avulsed teeth: considerations and complications.

Avulsion of teeth is a traumatic dental injury which can be managed by replantation. Important considerations for successful replantations are highlighted. Several sequelae to replantation are discussed in relation to the clinical features observed in a patient seen 6 years after replantation of two avulsed upper incisors. Many of these complications might have been avoided if the patient had returned to the clinic for root canal therapy shortly after the teeth was replanted.

Adult↗
PubMed2006

[Decoronation: indications and treatment timing].

Dental trauma in children is a frequent event and may involve functional, esthetic and orthodontic complications. Replacement resorption and ankylosis are frequently diagnosed following avulsion and replantation, severe intrusive luxation, and less frequently as a consequence of lateral luxations and root fractures. The optimal treatment for an ankylotic permanent incisor is yet to be found. The treatment of ankylosis and replacement resorption of a permanent incisor following dental trauma is further complicated when it involves a growing child. It is often associated with increasing infraposition of the tooth, retarded growth of the alveolar bone and tilting of adjacent teeth. To avoid such complications an ankylosed tooth should be removed before they changes become so pronounced that they necessitate orthodontic intervention and compromise future prosthetic treatment. The purpose of this article is to review the literature dealing with the considerations involved in the treatment of a permanent incisor diagnosed with replacement resorption and ankylosis. Different treatment options are considered. Decoronation is described and discussed.

Alveolar Bone Loss↗
PubMed2000

[Semi-rigid bracket splinting of teeth after traumatic luxation].

We describe a non-rigid procedure using brackets for splinting teeth after traumatic avulsion. This type of appliance preserves alveolodental ligament physiology and enables immediate mastication without occlusal obstruction. Installation is easy, except when severe bleeding or alveolar fracture occurs.

Dental Pulp Necrosis↗
PubMedDate not supplied

Luxation injuries of primary anterior teeth--prognosis and related correlates.

This study investigated the prognosis and related correlates of 307 luxation injuries of primary anterior teeth sustained by 222 patients. Primary anterior teeth that had sustained luxation injuries were identified from the dental records of a pediatric dental practice. Data collected included: the child's birth date, sex, and occlusion; date, etiology, and type of injury; treatment rendered; and post-traumatic sequelae. The mean age of children at the time of injury was 3.8 years, and the most common etiology was a fall. Those children sustaining intrusions were significantly younger than those sustaining extrusions or avulsions. Sports accidents were more likely to cause lateral luxations, while bike accidents were more likely to cause extrusions and avulsions. Root fractures were significantly associated with lateral luxations. The risk of sustaining a lateral luxation increased as age increased. There was an association between the development of post-traumatic sequelae and the repositioning of displaced teeth. Lateral luxations had a marked increase risk of necrosis when repositioned; conversely, intrusions had a decreased risk of necrosis when repositioned. Those groups with the best post-trauma tooth survival during the first year postinjury were those > 5 years old and < 2 years old. Hypoplastic defects were noted on 7.7% of the succedaneous teeth and their prevalence was not statistically associated with the type of luxation injuries.

Analysis of Variance↗
PubMed1989

Spontaneous apical closure of an avulsed immature incisor.

Apical closure of nonvital teeth can be achieved by appropriate endodontic intervention. A case is reported in which apical maturation appears to have occurred without treatment and in the presence of sporadic drainage from a sinus tract stoma.

Child↗
PubMed2002

Effect of immediate intracanal placement of Ledermix Paste(R) on healing of replanted dog teeth after extended dry times.

Ledermix Paste is a paste containing triamcinolone and demeclocycline with demonstrated anti-inflammatory activity that may slow down resorptive processes after severe traumatic injuries to the dentition. A total of 29 premolar roots of six mongrel dogs were extracted and instrumented with rotary nickel titanium files. Fifteen of these roots were then filled with a calcium hydroxide (Ca(OH)2) slurry and 14 roots were filled with Ledermix Paste paste. All accesses were sealed with glass ionomer and the roots replanted after an extraoral dry time of 60 min. After 4 months, the dogs were killed and the roots prepared for histological evaluation. Five-micrometer thick cross-sections of the root and surrounding tissue taken every 90 micro m were evaluated for healing. In addition, residual root mass was also measured to determine the extent of root structure loss for each treatment method. The Ledermix Paste-treated roots had statistically significantly more healing and less resorption than the roots treated with Ca(OH)2. Root filling with Ledermix Paste also resulted in significantly less loss in root mass due to resorption compared to those roots filled with Ca(OH)2. Immediate intracanal placement of Ledermix Paste at the emergency visit after an avulsion injury appears to decrease resorption and increase favorable healing.

Animals↗
PubMed2003

Assessing revascularization of avulsed permanent maxillary incisors by laser Doppler flowmetry.

BACKGROUND: Laser Doppler flowmetry, or LDF, is a noninvasive method used to assess pulpal blood flow, or PBF. Dental avulsion is associated with loss of pulpal sensitivity. The authors conducted this study to assess whether LDF could be used to detect revascularization of replanted teeth. METHODS: The authors used LDF to assess the PBF values of avulsed permanent maxillary incisors treated using replantation and splinting in 17 subjects. They took measurements at four sessions: on the day of splint removal and at 12 weeks, 24 weeks and 36 weeks after splint removal. Five vital control teeth and five nonvital control teeth were used to assess the background signal. At 36 weeks, the authors determined clinically and radiographically whether revascularization had occurred. RESULTS: LDF readings correctly predicted the pulp status in 88.2 percent of the readings. Of the readings for vital teeth, 100 percent were correct, and of the readings for nonvital teeth, 80 percent were correct. Univariate analysis of variance demonstrated that in revascularized teeth, the PBF value increased significantly from splint removal to week 12 after splint removal and from week 24 to week 36 after splint removal. In the teeth that failed to revascularize, the PBF value dropped significantly from week 24 to week 36 after splint removal. CONCLUSIONS: The results of this study suggest that LDF accurately diagnoses revascularization of avulsed maxillary incisors after replantation and splinting. CLINICAL IMPLICATIONS: LDF may become useful in detecting revascularization much earlier than standard sensitivity tests.

Analysis of Variance↗
PubMed1993

Treatment and prognosis of avulsed teeth. A discussion and case report.

A documented case that involves avulsion of an incisor is reported. Calcium hydroxide failed to prevent progressive irreversible root resorption. The importance of extraoral time, transport media, duration and type of splinting, as well as the rationale for the use of calcium hydroxide in the treatment of avulsed teeth are discussed. This case could serve as a reminder to practitioners, that patient compliance, timing and sequencing of endodontic therapy, and regular recalls is critical in the prevention or treatment of root resorption in avulsed teeth. It also emphasizes the frustration of many clinicians in treating avulsed immature teeth. The reporting of long-term documented cases should be encouraged so that replantation techniques may be evaluated.

Animals↗
PubMed1994

Splinting of avulsed central incisors with orthodontic wires: a case report.

A case of an 8-year-old boy who met with a road traffic accident causing trauma to the body and face and extrusion of the upper central incisors is reported. Laceration, oedema and limited mouth opening indicated the use of general anesthesia. During intubation the right central was avulsed accidentally and the left central further luxated and rotated. The avulsed central was reimplanted and the other one derotated and stabilised with orthodontic wire and brackets. Twelve weeks later the patients teeth were firm, immobile, radiographically normal and responded positively to vitality test.

Child↗
PubMed2000

Avulsion of posterior primary teeth and space maintaining appliance: case report.

A four-year-old child was presented to the Pediatric Dentistry Clinic of the Federal University, 21 days after an incident in which canine first and second primary molar teeth were avulsed, due to a trauma to the face. This was confirmed on radiological examination. The clinical examinations showed that tissues were normal. A removable space-maintaining dental-mucosa supported appliance was made in acrylic resin to replace the three missing teeth. After a period of eight months, the tissues were preserved, the device is helping the child to eat, to speak, and preserving the appearance of the patient. Radiograph examinations have shown that the first molar tooth and canine, first pre molar and second pre molar teeth are erupting normally. Trauma in primary dentition can cause psychological, morphological and functional problems. In the presented case the treatment was planned to recuperate the function and to avoid problems from the premature loss of primary teeth.

Acrylic Resins↗
PubMed1979

Fractured and avulsed permanent incisors in Finnish children. A retrospective study.

The frequency of traumatic injuries to permanent incisors was studied in a sample of 1614 children from the city of Lahti in Southern Finland. The children, 801 girls and 813 boys, ranged in age from 6 to 16 years. Injuries to hard dental tissues and exarticulations of teeth were recorded. The prevalence of injuries was 19.8%--14.6% in girls and 25.0% in boys. A rapid growth in the prevalence rates was found at the ages of 9--11 years, at which the estimated mean annual incidence was about 5% in girls and 7% in boys. In 78.4% of the children with injured incisors, one tooth only was injured. The teeth most commonly injured were the upper central incisors, 81.7%; and the most frequent type of injury was an uncomplicated crown fracture, 90.5%.

Adolescent↗
PubMed2005

Emdogain does not prevent progressive root resorption after replantation of avulsed teeth: a clinical study.

Emdogain has been shown in clinical and experimental studies to promote regeneration of all periodontal tissues: cementum with anchoring fibres, a functional, periodontal ligament and alveolar bone in connection with treatment of marginal periodontitis. The intention of this study was to analyse whether this regenerative capacity upon the periodontal ligament also worked in a trauma situation where a significant number of PDL cells have been eliminated because of unphysiologic storage or actual damage during avulsion or replantation. Furthermore if ankylosis sites already established because of earlier replantation after avulsion could be surgical removed and application of Emdogain could revert the ankylosis stage to a normal PDL situation. The first treatment situation was tested in seven patients with a total of 16 avulsed teeth with varying time of extra oral storage. The teeth were extra-orally endodontically treated and the root and socket covered with Emdogain before replantation. All teeth demonstrated subsequent ankylosis, primarily diagnosed by a percussion test. The second treatment situation where an ankylosis was already established constituted of seven patients with a total of 11 teeth because of previous replantation after avulsion. These teeth were all extracted, the ankylosis sites removed and the root and socket treated with Emdogain. After 6 months all teeth showed recurrence of ankylosis. It is concluded that Emdogain was not able to prevent or cure ankylosis.

Adolescent↗
PubMed1991

Traumatic avulsion of the mandibular right primary lateral incisor and cuspid.

Premature loss of the primary mandibular cuspid has been considered rare. When this occurs, however, space maintenance should be considered to prevent distal drifting of the lateral incisor. The purpose of this case report was to document traumatic avulsion of the mandibular right lateral and cuspid. A lingual arch appliance with a spur was fabricated to maintain space and prevent movement of the mandibular incisors. Sequelae of premature loss of primary teeth is presented.

Child, Preschool↗
PubMedDate not supplied

Growth considerations in planning treatment of avulsion in an adolescent.

Reimplantation failure of avulsed anterior teeth in an adolescent patient requires removal of the attempted-reimplanted teeth and consideration of several restorative options. These options may include a removable partial denture, as well as a transitional bridge or permanent fixed prosthesis. In all cases, the potential effects of the adolescent's expected amount and directions of maxillary and mandibular growth must be considered. A case is presented examining how maxillary growth may affect the restorative treatment options for avulsed anterior teeth replacement for an adolescent boy. Unfortunately, the patient and family were unable to complete treatment due to financial considerations. Consequently, the case presented here is submitted as a treatment planning exercise.

Adolescent↗
PubMed1995

Replantation of 400 avulsed permanent incisors. 2. Factors related to pulpal healing.

Four hundred avulsed and replanted permanent teeth were examined for pulpal healing. In 110 teeth, the apical foramen was either open or half-open. In 16 teeth, the pulps were extirpated prophylactically. Thus, pulpal revascularization was considered possible in 94 teeth. Revascularization occurred in 32 teeth (34%). Pulp necrosis could usually be demonstrated after 3 weeks. Positive pulpal sensibility and radiographis signs of pulp canal obliteration were usually observed after 6 months. The effect of various clinical factors was examined, such as sex, age, type of tooth replanted, stage of root formation, type and length of extra-alveolar storage, clinical contamination of the root surface, type of cleansing procedure of the root surface, type and length of splinting and the use of antibiotics. Finally, the width of the apical foramen and the length of the root canal were measured on radiographs taken at the time of injury. A multivariate statistical analysis revealed that pulpal revascularization was more frequent in teeth with shorter distances from the apical foramen to the pulp horns. Furthermore, that wet storage (saliva and/or saline) for more than 5 min decreased the chance of pulpal revascularization; whereas dry extraalveolar storage had a monotonous effect on pulpal revascularization, i.e. decreasing chance of revasculatization with increasing length of the extraalveolar dry storage. Based on these findings, immediate replantation after brief cleansing in either tap water or saline is recommended.

Age Factors↗
PubMedDate not supplied

The treatment and long-term management of severe multiple avulsions of primary teeth in a 19-month-old child.

Traumatic injury to the primary dentition is a common occurrence in young preschoolers. The maxillary incisors and, more specifically, the central incisors, are the most commonly injured teeth. The purpose of this article is to present the immediate and long-term treatment and management of a severe case of multiple avulsions involving all maxillary incisors and canines and the right first primary molar in a 19-month-old child, due to trauma. Esthetic, functional and orthodontic considerations are discussed.

Accidental Falls↗