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PubMed2000

Delayed replantation of avulsed mature teeth with calcium hydroxide treatment.

Three avulsed teeth that were replanted and splinted after approximately a 200-min dry extraoral period in two patients are presented. In case 1 calcium hydroxide treatment was performed 1 month after replantation, because the patient did not come for endodontic treatment on the day after replantation as requested. In case 2, calcium hydroxide treatment was initiated on the day after replantation. Calcium hydroxide treatment was used to prevent or treat inflammatory root resorption. During the follow-up periods the teeth reported in these cases have remained in a stable, functional position and did not reveal clinical ankylosis or replacement resorption.

Calcium Hydroxide↗
PubMed1994

Replantation of avulsed permanent teeth with avital periodontal ligaments: case report.

Five maxillary anterior teeth lost during a grand mal epileptic seizure, were replanted using the technique recently described by Andreasen (1), after an extra-alveolar period of more than 72 h. The teeth were replanted surgically, 10 days after being avulsed, after they had been immersed in a 2.4% sodium fluoride solution and root filled with gutta-percha. Ankylosis was evident 3 months post-operatively. After 24 months there was evidence of considerable replacement resorption on the lateral incisors with little evidence of resorption on the other replanted teeth. Even though the long term prognosis is uncertain, this technique has an advantage of seeing the patient through the period of growth as well as maintaining the height of alveolar bone making possible the provision of an aesthetically acceptable prosthesis at a later age.

Adolescent↗
PubMedDate not supplied

Postreplantation management of avulsed teeth: an endodontic literature review.

Today's dental treatment goals are directed at reducing the incidence of root resorption resulting from periodontal ligament devitalization or pulp necrosis. Although the American Association of Endodontists recommends the use of long-term therapy, short-term therapy may be utilized with confidence in well-defined clinical applications. Early final obturation with gutta-percha will increase the long-term prognosis in those cases where patient motivation is questionable or long-term follow-up prior to obturation is not possible. However, where inflammatory resorption is already present, long-term calcium hydroxide therapy is indicated. Long-term post treatment follow-up is imperative in both calcium hydroxide therapies.

Calcium Hydroxide↗
PubMed1997

Avulsed permanent teeth: a review of the literature and treatment guidelines.

Dental trauma represents one of the few situations where dentists are called upon to make unscheduled diagnostic and treatment decisions in an area that is outside their routine experience. Since patients who sustain an avulsion present infrequently, except in child-oriented or emergency-based practices, clinicians often make diagnostic and management decisions based upon their previous rare treatment experiences. Clinicians also rely on published guidelines for this aspect of their practice and expect these standards to be up-to-date and based on current research information. None of the current protocols has been tested by a prospective longitudinal outcome study in humans. Nevertheless, current guidelines have become the standard for clinical practice around the world. An effort must be made to develop treatment protocols that are based upon the biological mechanisms that underlie periodontal wound healing.

Animals↗
PubMed1994

Traumatic injuries to permanent incisors: a case report.

A case report involving traumatized maxillary incisors is presented. The right central and lateral incisors were avulsed by direct trauma and were not found. The left central incisor was luxated and the left lateral incisor was fractured at the coronal portion. Placement of implant fixtures was selected as treatment to prevent resorption of alveolar bone and to maintain the integrity of intact adjacent teeth. The right incisors were replaced with two osseointegrated implants. The left central incisor was endodontically treated and a cast post and core was bonded into the root canal. All three of these teeth were restored with porcelain-fused-to-metal crowns. A composite resin restoration was placed on the left lateral incisor. The esthetic and functional results were satisfactory.

Accidents, Traffic↗
PubMed1997

An evaluation of after-office-hour dental trauma in Singapore.

The purpose of this study was to assess the post-traumatic sequelae and treatment outcome and the corresponding prognostic factors at the initial emergency visit. Over a 5-year period, the authors collected case records from 129 dental trauma patients. These patients had been referred subsequent to receiving emergency treatment after office hours at the Accident and Emergency Department of Singapore General Hospital. After the exclusion of 31 cases with concomitant fracture of maxilla and/or mandible and cases with insufficient documentation, the final study sample consisted of 98 patients (41 males, 57 females) who had sustained injuries to 264 permanent teeth. The main cause of dental trauma was falls (56%), and the main type of injuries was periodontal tissue injuries with or without concomitant injuries to hard tissue, including root fracture (73%). For the final evaluation, teeth with insufficient recall period were excluded before univariate and multivariate stepwise logistic regression analysis. It was found that for 100 teeth with luxation type of injuries, the presence of concomitant hard tissue injuries retained prognostic significance for pulpal outcome (p < 0.001) after adjusting for severity of luxation, while the severity of luxation was the only significant factor for periodontal outcome (p < 0.001). For 34 avulsed teeth, the stage of root development was the major factor associated with the pulpal outcome (p = 0.003), while extra-alveolar storage media were found to be significantly related to the periodontal outcome (p < 0.001). For 72 teeth with hard tissue injuries, first-visit interval played a significant role in the outcome (p = 0.03). Although the sample size in the root fracture group was too small for such statistical analysis, the results indicated that patient education on dental trauma was an important factor. Thorough standardized documentation was also recommended to facilitate optimal follow-up management and future research as well as medico-legal purposes.

Adolescent↗
PubMed1995

A retrospective clinical and radiologic study of teeth re-implanted following traumatic avulsion.

Re-implantation is the recommended therapeutic procedure following traumatic exarticulation of teeth though its long-term prognosis remains controversial. The purpose of the following study was to evaluate the periodontal healing of 33 reimplanted incisors lost after trauma. The sample, which included 24 upper and 9 lower incisors, was divided in two groups: 15 teeth were reimplanted within 1 hour (=Group A) and 21 teeth after 3 hours or more (=Group B). The reimplanted teeth were followed for different radiographic evaluation periods up to 5 years (mean=2-9 years). The results showed a high rate of periodontal healing in Group A (66.7%), while Group B demonstrated a high percentage (83.3%) of both inflammatory and replacement resorption. Thus, even if the whole sample was prevented from drying before reimplantation, the teeth were affected by different rates of root resorption. Among the various prognostic factors suggested by the literature, bacterial contamination during extra-alveolar storage seemed the most critical.

Adolescent↗
PubMed2001

Factors affecting the time of onset of resorption in avulsed and replanted incisor teeth in children.

Resorption is the main reason for loss of replanted teeth. The outcome examined in this study is the timing of the onset of resorption. The effect of dichotomised dry and wet time intervals as well as the presence of additional crown damage and of contamination were determined. Of 84 replanted teeth, 67.5% developed resorptions. Twenty-eight had detectable additional crown damage with a more rapid onset being seen in these cases (P=0.009). The critical limit for dry time was 15 min (P=0.038) and significant differences persisted for greater limits also. Serial analysis of the association between the time of onset of root resorption and dichotomised wet time variables failed to yield any significant associations. There was visible contamination detected in 32 teeth and these exhibited a more rapid onset of resorption than the other cases (P=0.030). Teeth with inflammatory root resorption (12.8%) had a more rapid onset of resorption than those that developed replacement resorption (54.7%) (P<0.001). It is concluded that the risk of early resorption is increased in teeth that have additional damage or have contamination, or are kept in dry conditions for longer than 15 min.

Adolescent↗
PubMed1990

After-hours treatment of anterior dental trauma in Newcastle and western Sydney: a four-year study.

This study investigated anterior dental trauma presenting after-hours in Newcastle and western Sydney. During the four-year period 1983-1986, all patients presenting with anterior dental injuries to the Royal Newcastle Hospital (n = 382) or Westmead Hospital (n = 362) on week nights, weekends or public holidays were studied. In both areas, upper central incisors were the teeth injured most frequently. The mean numbers of teeth injured per patient were 1.9 at Newcastle and 2.0 at Westmead. The frequencies of injury types found in Newcastle and Westmead were similar. Luxations and avulsions accounted for 39.5 per cent of injuries at Newcastle and 39.6 per cent at Westmead. In Newcastle, the rate of occurrence of trauma was highest and relatively uniform in the 6-11, 12-17 and 18-23 year age groups. At Westmead, it was highest in the 6-11 year age group, followed closely by the 12-17 year age group. In both centres, the four main causes of trauma were falls, assaults and fights, sports and bicycle accidents. These accounted for 69 per cent of all injuries in Newcastle and for 69.4 per cent at Westmead. This study found a great similarity between Newcastle and western Sydney in relation to the predominant age and sex groups affected, causes of trauma, injury types and numbers and locations of injured teeth per patient. It is suggested that anterior dental trauma presenting after-hours may be more severe, involve more teeth per patient and affect predominantly older age groups than is the situation during normal hours.

Adolescent↗
PubMed1995

Replantation of 400 avulsed permanent incisors. 3. Factors related to root growth.

Four hundred avulsed and replanted permanent incisors were examined for pulpal and periodontal healing. In 30 teeth, root formation was incomplete at the time of injury. Two teeth were excluded from the study due to nonphysiological extraalveolar storage (i.e. homemade saline). Of the 28 remaining replanted incisors, 7 showed subsequently completed root development, 8 partially completed root development and 13 arrested root development. Completed root development subsequent to replantation was found to be significantly related to pulpal revascularization, being rare in cases with pulp necrosis (5 of 15 teeth) and frequent after pulpal healing (11 of 13 teeth) (p = 0.01). Root development was not found to be significantly related to the extraalveolar storage period; but occurred slightly more frequently when the dry storage period was less than 45 min. (p = 0.13). Ingrowth of bone and formation of an internal periodontal ligament (PDL) was found in 6 teeth and was related to arrested root formation in cases with pulpal healing. The explanatory factor for these findings appeared to be damage to the Hertwig's epithelial root sheath.

Chi-Square Distribution↗
PubMed1999

Inflammatory and replacement resorption in reimplanted permanent incisor teeth: a study of the characteristics of 84 teeth.

Avulsion is a serious injury which can cause damage to some or all of the dental and surrounding tissues. This study examined the profiles of teeth showing inflammatory resorption, in terms of time prior to reimplantation, contamination, pulp extirpation time and period of splinting and compared them to teeth without resorption. There were a total of 71 children in the present study (mean age 9.8 years, range 6-16 years) with a total of 84 reimplanted teeth. Inflammatory resorption was present in 22 teeth. There was a significant relationship between the presence of inflammatory resorption and the time the teeth were dry prior to reimplantation, with a lesser effect for total delay time. There were slightly later pulp extirpation times for teeth with inflammatory resorption, with median delays of 16 and 11 days respectively and increased inflammatory resorption in teeth extirpated at 20 days or later. Replacement resorption was present in 40 teeth. There was a significantly longer splinting time in teeth with replacement resorption and more resorption in teeth splinted for longer than 10 days. It was concluded that pulp extirpation time was not critical unless the delay exceeded 20 days and that splinting time should not exceed 10 days.

Adolescent↗
PubMed2003

The effect of topical minocycline on replacement resorption of replanted monkeys' teeth.

Tetracycline has been reported to possess antiresorptive properties in addition to antimicrobial actions. Systemic administration of tetracycline showed variable results in the control of replacement resorption after replantation with good results in half of the cases, and almost no healing in the rest. The purpose of this study was to evaluate histologically the effect of topically applied minocycline on replacement resorption of replanted monkeys' teeth. Thirty-two roots from seven monkeys were endodontically treated aseptically to prevent inflammatory resorption of pulpal origin, a common sequela after avulsion injury. Teeth were then extracted as atraumatically as possible. Teeth in the negative control group (10 roots) were replanted almost immediately, while teeth in the positive control group (12 roots) were allowed to bench-dry for 1 h prior to replantation, both without further treatment. Teeth in the experimental group (10 roots) were bench-dried for 1 h, rinsed with saline, and then immersed in 1 ml of 50 mg ml(-1) minocycline hydrochloride for 5 min before replantation. No splinting was used. After 12 weeks, the animals were sacrificed and histological sections were prepared and evaluated according to a morphometric analysis modified from that described by Andreasen (1987) as complete healing, inflammatory resorption, and replacement resorption. Kruskal-Wallis test showed significant differences among the three groups in all the three healing categories. Further analysis with Mann-Whitney U-test showed teeth in the negative control group to have significantly higher complete healing and significant lower unfavorable healing, comprising of replacement resorption and inflammatory root resorption than the positive control group and the minocycline group. Topical application of minocycline to the root surface appeared to result in slightly higher occurrence of complete healing (32.46%) compared to the delayed replantation group with no minocycline treatment (positive control) (16.58%), but the difference was not statistically significant (P = 0.09).

Administration, Topical↗
PubMed2004

The effect of Emdogain gel on periodontal healing in replanted monkeys' teeth.

OBJECTIVE: We sought to histologically evaluate the effect of Emdogain gel on periodontal healing in monkeys' teeth undergoing delayed replantation. Study design Mature monkey teeth simulating avulsion were endodontically treated before extraction. Negative control teeth (group N = 10 roots) underwent immediate replantation, whereas the rest were bench-dried for 1 hour and treated in one of the following ways before replantation: the positive control teeth (group P = 12 roots) had no further treatment; group C teeth (4 roots) had the periodontal ligament removed; group D teeth (10 roots) were treated with Emdogain gel; group E teeth (6 roots) had the periodontal ligament removed before the application of Emdogain gel; and group F teeth (7 roots) had the periodontal ligament removed, the root surface conditioned, and Emdogain gel applied. Periodontal healing was evaluated after 16 weeks by undertaking histomorphometric analysis. RESULTS: The Kruskal-Wallis and Mann-Whitney U tests revealed that group N teeth had a statistically higher occurrence of complete healing than did all other groups, whereas group P was not significantly different in any of the healing categories from D, E, and F, the groups in which Emdogain gel was used. Group C teeth had a significantly higher occurrence of replacement root resorption than did the teeth in groups P and F-but were not significantly different from teeth in groups D and E. CONCLUSION: Emdogain gel did not appear to significantly reduce replacement resorption in monkeys' teeth that had undergone delayed replantation.

Acid Etching, Dental↗
PubMed1999

Investigations on a cell culture medium for storage and transportation of avulsed teeth.

Non-physiologic storage of avulsed teeth leads to a high incidence of root resorption, resulting in poor prognosis. This study investigated the suitability of specially composed cell culture media for storage of extracted teeth for up to 48 hours. Autoradiographic investigations revealed that the proliferative activity of periodontal ligament (PDL) cells of teeth stored in cell culture medium for up to 48 hours increased with storage time. Studies on proliferation of PDL cells after storage of teeth in different media for up to 24 hours demonstrated that the proliferative activity is dependent on the composition of the medium. Immunohistochemical investigations with markers for cell proliferation revealed that pulp cells of extracted immature teeth show numerous proliferations after storage for up to 24 hours in a special cell culture medium but few proliferations after storage in Hanks Balanced Salt Solution (HBSS). The investigations indicate that a special cell culture medium can preserve cell viability of PDL cells adhering to extracted teeth for at least 48 hours. The in vitro results are confirmed by a case presented: After storage of two upper central incisors for 36 hours in the cell culture medium the teeth could be successfully reimplanted after extraoral insertion of titanium posts into the root canal (auto-alloplastic reimplantation). Clinical and radiological follow-up examinations for 12 months revealed normal periodontal healing.

Autoradiography↗
PubMed1998

The effect of systemic tetracycline on resorption of dried replanted dogs' teeth.

The use of systemic penicillin after an avulsion injury has been recommended to decrease the occurrence of resorption complications. Tetracycline antibiotics have been reported to possess anti-resorptive properties in addition to their anti-microbial actions. The purpose of this study was to evaluate histologically the effect of systemically administered tetracycline and amoxicillin on the inhibition of resorption due to attachment damage after replantation of dogs' teeth. Thirty-one roots from the teeth of four beagle dogs were endodontically treated to inhibit subsequent inflammatory root resorption of pulpal origin. They were then extracted and left to bench dry for 1 h to ensure severe periodontal ligament damage before replantation. For the teeth in the experimental groups, two dogs were given tetracycline hydrochloride and the other two dogs were given amoxicillin, administered orally, on the day of extraction/replantation and for the following 6 days. The control group were teeth in these animals treated in the same manner but where no antibiotics had been given. After 12-16 weeks, the dogs were sacrificed and histological sections were prepared and evaluated for complete healing, inflammatory and replacement root resorption, and the groups were compared. It was shown that healing in the amoxicillin and the control groups was poor (10.90% and 11.28%, respectively), while for the tetracycline group, 35.45% showed complete healing. Individual teeth with over 50% complete healing sites were considered as having good healing, and significantly more of these teeth were found in the tetracycline group (5 of 11 teeth) compared to the amoxicillin (1 of 11 teeth) or control group (1 of 8 teeth).

Amoxicillin↗
PubMed2004

Type of treatment, prognosis, and estimation of time spent to manage dental trauma in late presentation cases at a dental teaching hospital: a longitudinal and retrospective study.

Traumatic dental injuries are emergencies that must be treated promptly and properly in order to reduce the suffering, costs, and time for patients, parents, and health care providers. The aim of this study was to investigate the treatment, long-term prognosis, and number of visits needed to manage cases resulting from complications of late presentation of traumatic dental injuries. The sample consisted of 195 children, all presented with complications of dental trauma at the Pediatric Dentistry Clinics in the Dental Teaching Hospital of Jordan University of Science and Technology in Irbid city, Jordan. Retrospective data relied on trauma forms as well the clinical notes and radiographs in the patients' records. Prospective data was collected by examining patients at recall appointments. The treatment of traumatized teeth in this sample ranged from no active treatment to extraction and prosthetic replacement. It was estimated that the number of visits needed to carry out the planned treatment for these patients ranged between 3 and 17.2 visits according to the type of treatment. Apexification procedure was the most time consuming. Thirty-two per cent of teeth with apexification ended up with root fracture mainly subsequent to another minor trauma episode (in 85%), the rest were reported to be spontaneous fractures. Almost half of the teeth with luxation injuries became necrotic after 3 years. Teeth with avulsion actually kept on deteriorating even at the 36-month follow-up appointment. The long-term prognosis of teeth with middle root fracture was favorable in (80%) of the teeth in the sample, despite the fact that they were splinted late. Luxation injuries led to more necrotic teeth (50%) than uncomplicated crown fractures. Multiple dental trauma episodes (MDTE) were reported in about 30% of the patients in the sample and were responsible for some of the complications noticed in this report. As all cases followed up in this report are late presentation of dental trauma, the findings may emphasize and highlight predictors for healing and favorable long-term prognosis for such injuries. This will help selecting the treatment option that would lead to better outcomes with less expense and less time consumption for dentists and patients alike. The findings of this report also stress the importance of prevention of dental trauma and minimize its complications through proper treatment, educational programs, supervision of children during play, use of mouth guards, and orthodontic treatment of proclined incisors.

Child↗
PubMed1999

Replantation of avulsed central incisor with advanced periodontal disease: a case report.

This paper describes the case of a 31-year-old woman with advanced periodontal disease who lost a tooth due to trauma. The avulsed tooth had minimal bony support of only 4-5 mm. The patient described was under good periodontal maintenance. The tooth was kept moist, and replantation occurred within an hour of avulsion. The tooth was returned to its position, splinted, and later endodontically treated. After 2 years the tooth appears and functions normally as it did before avulsion.

Adult↗
PubMed2005

Parental awareness of emergency management of avulsion of permanent teeth of children in Lagos, Nigeria.

BACKGROUND/OBJECTIVES: Traumatic injuries in children and adolescents affecting both the primary and permanent dentitions and their supporting structures are a common problem seen in children. Avulsion of permanent teeth in children resulting from trauma is an emergency in children. The prognosis of avulsed teeth depends on prompt and appropriate treatment, which often relies on lay people such as the children's parents and their schoolteachers who are present at the site of the accident, prior to the initial professional dental contact. Knowledge of parents on the emergency management is thus surveyed. METHOD: A 13- stemmed questionnaire comprising questions on demographic data, attitude and knowledge was distributed to parents who have accompanied their children (patients) to the Orthodontic/Paedodontic Clinics of Lagos University Teaching Hospital (LUTH) for treatment over a 12-week period from October- December 2002. RESULT: A total of ninety parents were studied. Over 90% of the parents felt they should seek professional help urgently following an avulsion injury, but their knowledge of transport medium for the tooth was poor. Only 1.1 per cent and 3.3 per cent knew that milk was the medium of choice for washing and transporting an avulsed tooth respectively. 91.1% of parents surveyed had never received advice on what to do in the event of an accident where a permanent tooth was avulsed. CONCLUSION: There is a need for educational campaigns aimed at parents to increase their knowledge of the emergency procedures required when the tooth is avulsed.

Adult↗