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PubMed2006

[Dental trauma protocol--treatment of avulsion and luxation injury].

The goal of this protocol is to provide clear instructions which simplify the process of decision making and treatment of Luxation and Avulsion. In teeth with a closed apex, one should perform root canal therapy at the second appointment in teeth with injuries of luxation and avulsion (except for injuries of subluxation and concussion). The tooth should be reimplanted at site of accident if it possible. For avulsed teeth, the preferred storage medium is milk. One should condition the roots of teeth which have been avulsed. In teeth which have not finished development, the preferred treatment is to allow the continued development of the root.

Animals↗
PubMed2006

Tooth loss treatment in the anterior region: autotransplantation of premolars and cryopreservation.

Avulsed and lost anterior teeth are common in young people. Using autotransplantation, it is possible to move problems in dental arches to regions where they are more easy to solve orthodontically. Transplantation of premolars with three-quarter root formation or full root formation with wide-open apical foramina provides the best prognosis for long-term survival. This article describes the use of autotransplantation and orthodontic treatment, together with cryopreservation, in connection with complicated trauma in the anterior region of an 8-year-old girl.

Bicuspid↗
PubMed2002

Complete tooth extraction: a case report.

Advanced Trauma and Life Support protocol is used in trauma situations to identify life-threatening injuries, and after those are addressed, it provides a systematic approach to identify minor injuries. A 17-year-old male, who was involved in a motor vehicle accident, was treated for an open toe fracture. He also had an "avulsion injury" to his left hand and was missing a tooth. On follow-up two days later, he was found to have a tooth in his left hand after he presented with cellulitis of a hand wound. He was appropriately treated with foreign body removal, incision and drainage, and antibiotics. This case is not only presented for being unique but also to emphasize the importance of the secondary survey and serial examinations instructed by Advanced Trauma and Life Support.

Adolescent↗
PubMed1998

The influence of storage conditions on the clonogenic capacity of periodontal ligament cells: implications for tooth replantation.

Viable periodontal ligament (PL) cells are required for PL healing of avulsed teeth following replantation. If immediate replantation cannot be accomplished, the ability of PL progenitor cells to reproduce (clonogenic capacity) and recolonize the wound may be extended by prevention of desiccation and storage in physiological media. This investigation examined the effects of storage in saliva, milk, Hank's balanced salt solution (HBSS) and Eagle's medium (alpha MEM) on the clonogenic capacity of human PL progenitor cells at 30 and 60 min extra-alveolar time. Twenty erupted human premolar teeth extracted as atraumatically as possible for orthodontic purposes were used in the present study. Fifteen premolars were placed immediately in freshly collected autologous saliva at room temperature, (+ 23 degrees C) for 15 min. These 15 premolars were next divided into three groups of five and stored in either saliva, milk or HBSS at + 4 degrees C in plastic cups surrounded by ice. The remaining five teeth served as positive controls and were immediately placed in alpha MEM at + 4 degrees C. PL tissue was scraped from one-half of the root surface with a scalpel at 30 and 60 min total extra-alveolar duration. Cells were released from the tissue sample with a 30 min enzymatic digestion procedure and the cells from the tissue samples analyzed for clonogenic capacity. There was a reduction in clonogenic capacity with time for all protocols. Periodontal ligament cells stored in alpha MEM showed the least reduction between 30 and 60 min and the greatest reduction was observed for PL cells stored in saliva. The difference in clonogenic capacity following transfer from saliva to milk or HBSS was not significant at 30 min. At 60 min, cells transferred from saliva to HBSS had a statistically higher percentage of clonogenic cells than those transferred to milk (5.9% vs. 3.5%; P < 0.05). We conclude that immediate storage of avulsed teeth in autologous saliva, followed by transfer to chilled milk, preserves the presence of sufficient progenitor cells in the PL to warrant replantation and the possibility of PL healing at 60 min extra-alveolar duration.

Animals↗
PubMed2000

Management of sports-related crown fractures.

Uncomplicated tooth crown fractures are the most common sports-related mouth injury and can have an excellent outcome if treated appropriately. Many times, however, crown fractures occur at the same time as concussion, luxation, displacement, or even avulsion injuries. This article discusses the treatment for and management of tooth crown fractures from sports-related injuries.

Athletic Injuries↗
PubMedDate not supplied

The complete endodontic obturation of an avulsed immature permanent incisor with mineral trioxide aggregate: a case report.

The use of mineral trioxide aggregate (MTA) for complete endodontic obturation of an immature maxillary central incisor is reported. The injured tooth of a 9-year-old male was avulsed secondary to a sports-related traumatic event. Early attempts at pulpal revascularization of the replanted tooth proved unsuccessful, as evidenced by radiographic signs of external inflammatory root resorption in the middle to cervical thirds of the root. Calcium hydroxide apexification over a 1-year period promoted cessation of the resorptive process, but was unable to adequately form an apical root canal barrier. Due to the extent of external resorption and the lack of an apical stop, a novel endodontic treatment using mineral trioxide aggregate was utilized. At 865 days post-injury, the tooth remained asymptomatic with clinical and radiographic evidence of periodontal health.

Aluminum Compounds↗
PubMed2001

Decoronation of an ankylosed tooth for preservation of alveolar bone prior to implant placement.

A 12-year-old patient sustained avulsions of both permanent maxillary central incisors. Subsequently, both teeth developed replacement resorption. The left incisor was extracted alio loco. The right incisor was treated by decoronation (removal of crown and pulp, but preservation of the root substance). Comparison of both sites demonstrated complete preservation of the height and width of the alveolar bone at the decoronation site, whereas the tooth extraction site showed considerable bone loss. In addition, some vertical bone apposition was found on top of the decoronated root. Decoronation is a simple and safe surgical procedure for preservation of alveolar bone prior to implant placement. It must be considered as a treatment option for teeth affected by replacement resorption if tooth transplantation is not feasible.

Alveolar Process↗
PubMed1999

A case report of a vital replanted tooth with unfavourable extra-alveolar condition: a 10-year follow-up.

This case report describes the survival of a maxillary left central incisor after an avulsion injury under unfavourable extra-alveolar condition, when the patient was 9 years old. At subsequent clinical follow-ups, the tooth maintained vitality 10 years after the injury. There was sign of gradual obliteration of the root canal space. Concomitantly, the replanted tooth manifested typical characteristics of ankylosis with minimally detectable resorption complication.

Adolescent↗
PubMed1997

Traumatic fractures of primary molars: a case report.

Dental trauma occurs very often in children and its consequences vary from tiny fractures to the complete avulsion of the tooth. According to Andreasen, 86.5% of incidents of dental trauma suffered by preschool children cause injury to maxillary primary incisors, whereas only 0.5% cause injury to primary molars. This case report is of a male patient aged 7 years who had fallen down a month before, struck his chin against a step, and fractured the maxillary and mandibular left primary second molars (65 and 75) and the mandibular right primary second molar (85). The 65 required only smoothing of sharp edges, 75 received endodontic treatment and a stainless steel crown, and 85 was extracted and a space maintainer fitted. The early diagnosis of fractures of posterior teeth is very important; a thorough examination of all posterior teeth should be made, especially when child suffers trauma to the chin region.

Child↗
PubMed1995

Radicular grooves in maxillary lateral incisor: case report.

The authors present a case report of a radicular groove in a maxillary lateral incisor in a 58-year old male patient. Endodontic and periodontal treatment was not carried out and therefore, avulsion of the tooth was indicated. The radicular grooves were very deep with pulp chamber communication.

Dental Pulp Cavity↗
PubMed1976

[Maturation of residual tissue, left in the jaw after injury].

An eight-year old patient was observed for a period of eleven months: after the traumatic loss of a front tooth, the root of which had not fully grown, the maturing of the remnants of the follicle which were probably injured by the avulsion and not yet fully mineralized, was studied. In the histological examination of the enucleated dental hard material, regions of irregular dentin were found.

Child↗
PubMed1990

Consumer product-related tooth injuries treated in hospital emergency rooms: United States, 1979-87.

The database of the National Electronic Injury Surveillance System was used to analyze episodes of consumer product-related traumatic injuries to teeth treated in hospital emergency room in the United States from 1979 through 1987. Results showed a slight but consistent increase in episodes of such injuries during this 9-yr period. Over 75% of such episodes occurred in persons under 15 yr of age. Over 60% of the tooth injuries in such episodes could be crudely classified into the following types by descending rank order: avulsed-, broken-, loosened-, chipped-, intruded-teeth and soft tissue injuries. The most common categories of consumer products and activities associated with such episodes were sports and play, followed by falls on floors, stairs or showers, and bicycles and other wheeled vehicles. The age composition of specific episodes of dental injuries varied considerably for different products and activities, suggesting a need for specific strategies for prevention of episodes of consumer product-related injuries to teeth for different age categories of the population.

Adolescent↗
PubMed2003

Clinical outcomes for permanent incisor luxations in a pediatric population. II. Extrusions.

A longitudinal outcome study was undertaken to identify variables that significantly influenced outcomes for extruded permanent maxillary incisors of children and adolescents. Clinical and radiographic data was available for 35 patients (18 males, 17 females) representing 55 incisors. Mean age at the time of injury was 10.6 years (range: 7.1-17.8 years). Mean time elapsed to follow up was 1320 days (range: 423-2887 days). Survival analysis was used to identify variables significantly related to the prognosis of these teeth. The loss of an incisor following extrusion was uncommon as only one tooth (1/55) required extraction. There was no statistically significant difference in survival between severely extruded teeth and avulsions that had been stored in physiological media (P > 0.10). Pulp necrosis (PN) was the most common complication following injury (43%) and it most often occurred during the first year. Although not statistically significant, a trend towards increased PN was found with more severely extruded teeth (P = 0.20, relative risk = 2.08). Pulp canal obliteration (PCO) was the second most common outcome (35%). The degree of extrusion was proven to be significantly associated with the development of PCO (P = 0.03, relative risk = 0.33). Root resorption was an uncommon outcome (3/55). This study represents the first outcome data on extrusions to permanent maxillary incisors in an exclusively pediatric population.

Adolescent↗
PubMedDate not supplied

Restoration of traumatized anterior teeth by interdisciplinary approach: report of three cases.

These cases had been discussed having massive coronal fracture, rotation and intrusion of teeth. In case one, both the central incisors, i.e. 11 and 21 were fractured only one-third of tooth material was remaining. In case two, 21 was fractured and intruded. In case three, 12 and 21 were avulsed and 11 was rotated and intruded. These cases were successfully treated by multidisciplinary approach. Fractured crown with periapical pathology were endodontically treated and then rotated and intruded teeth were repositioned by removable or fixed orthodontic appliance. Subsequent to endodontic and orthodontic treatment prosthodontic rehabilitation was done.

Child↗
PubMed1999

Management of an avulsed primary incisor.

The case describes the management of an avulsed maxillary central primary incisor of a 3 1/2-year-old girl. The tooth was retained in the oral cavity for 30 min. After replantation it was splinted for 17 days. At day 11 the root canal was completely instrumented and obturated with a calcium hydroxide paste. The 1-year follow-up documented no pathologic clinical or radiographic findings. One and a half years after the trauma the tooth was extracted since a fistula and extensive external inflammatory resorption had developed. The permanent successor erupted along with its neighboring central incisor without any complications 6 months later. Conventional approaches for treating avulsed permanent teeth could also be applied to avulsed primary incisors to preserve them for a certain period without the additional risk of damaging their developing permanent successors.

Child, Preschool↗
PubMed1982

[Sequestral osteitis with fracture of the mandibular angle occurring secondarily to the extraction of a wisdom tooth. Apropos of a case].

The authors report on a case of sequestrated osteitis complicated by a fracture of the angle of the mandible, following the avulsion of a wisdom tooth in a 20 year old man. The treatment consisted of an intermaxillary fixation of the mandibular arche lasting 40 days accompanied by wide-spectrum antibiotic therapy for 15 days, until such time as the ESR and blood count values returned to normal. In three months resorbtion of the sequestrated necrotic bone and disappearance of the osteitic cavity was noted, all of which was indicative of a satisfactory result. From the aetiological point of view it was possible to confirm by way of a routine X-ray taken 5 days after the extraction that the lesions had developed of their own accord, thus eliminating surgery and trauma as causes. The problem of what causes maxillary osteitis remains, and in particular, the role played by local anaesthetics containing adrenaline.

Adult↗
PubMed2000

Storage conditions of avulsed teeth affect the phenotype of cultured human periodontal ligament cells.

After severe injury to the periodontal ligament (PL), the phenotypes of cells recolonizing root surfaces influence the extent and type of repair processes. In teeth that are replanted following avulsion injury, recolonization of the PL space by osteogenic cells instead of by PL fibroblasts may favor bone formation (i.e. ankylosis) instead of PL regeneration. We consider here that recolonization processes depend in part on the storage conditions of the teeth following avulsion. We used an in vitro cell culture model to assess the effect of storage conditions on immunohistochemical staining of several marker proteins that are expressed by osteogenic cells (osteopontin and alkaline phosphatase) and fibroblasts (alpha-smooth muscle actin, type III and XII collagens). Prior to cell culture, extracted human premolar teeth were stored in air ("dry") or in alpha-MEM ("wet") for either 30 or 120 min as surrogate conditions for the variations of extra-alveolar tooth storage that may occur following avulsion. Collagenase/trypsin-digested suspensions of PL cells were prepared from the tissue adherent to the extracted root surface. Passage #2 or #3 cultures were immunostained and examined by fluorescence microscopy. For type XII collagen, cells from wet samples displayed perinuclear staining while cells from 30-min dry samples showed only isolated foci. The staining for 120-min dry samples was weak and non-specific. alpha-Smooth muscle actin was not incorporated into stress fibers in wet samples, whereas dry samples demonstrated prominent stress fibers stained for alpha-smooth muscle actin. Detached cytoplasmic fragments resembling cell processes that stained for alpha-smooth muscle actin were abundant in dry samples, indicating the presence of highly contractile cells. The staining for osteopontin was mainly perinuclear but was more intense in dry samples. The focal adhesion pattern of osteopontin staining in 120-min dry samples resembled that of migrating osteogenic cells. The pattern of staining did not vary for type III collagen or alkaline phosphatase, although staining for alkaline phosphatase was more intense in samples stored under dry conditions. We conclude that prolonged extra-alveolar dry storage favors increased in vitro growth of contractile cells expressing osteogenic cell markers while storage in cell culture medium favors growth of cells with the classical phenotype of PL fibroblasts.

Actins↗
PubMed2005

Results after replantation of avulsed permanent teeth. I. Endodontic considerations.

Following avulsion and replantation, teeth are at risk for infection and infection related resorption (IRR). Severe discolorations of tooth crowns and cervical root fractures are common. This study presents data on endodontic related complications of avulsed teeth replanted following an extraoral endodontic treatment. Periodontal aspects will be discussed in the second part of the present publication. Twenty-eight permanent teeth in 24 patients aged seven to 17 years were replanted after avulsion. All teeth could be evaluated. In all teeth extraoral endodontic treatment by retrograde insertion of ceramic or titanium posts was performed. Mean observation period was 31.2 months (median: 24.1 months). Nine teeth healed with a functional periodontal ligament (PDL) (functional healing, FH), 19 teeth exhibited replacement resorption (RR), which was succeeded by IRR in three teeth after observation periods of more than 14 months. Diagnosis was set to tunneling resorption (one case) and to cervical resorption preceded by complete RR (two cases). No early IRR was observed. All six teeth rescued in physiologic conditions (cell culture medium of tooth rescue box) exhibited FH. Discolorations of tooth crowns or other complications (cervical root fractures, fractures of posts) were not observed. No differences in the healing results of immature and mature teeth were observed which is in contrast to previous studies. This finding is explained with the different endodontic treatment protocols. Extraoral endodontic treatment by retrograde insertion of posts prevents early IRR and minimizes the overall incidence of IRR. The method does not negatively influence periodontal healing. As there are further advantages (no discoloration, no root fractures, patient not involved, less radiographs, less time consumption, less costs) the method is recommended in isolated teeth before replantation. Especially immature teeth profit from the prevention of complications.

Adolescent↗