Interventions for treating traumatised permanent front teeth: avulsed (knocked out) and replanted

Abstract

The available evidence suggests that extra-oral endodontics is not detrimental for teeth replanted after more than 60 minutes dry time. Studies with moderate/high risk of bias indicate that soaking in thymosin alpha 1 and gentamycin sulphate followed by hyperbaric oxygen may be advantageous however, they have not previously been reported as interventions for avulsed teeth and need further validation. More evidence with low risk of bias is required and, with the low incidence of avulsed teeth, collaborative multicentre trials are indicated.

Periodontal healing following avulsion and replantation of teeth: a multi‐centre randomized controlled trial to compare two root canal medicaments

“…The evidence to support different treatment interventions provided by clinicians is limited. A recent Cochrane review (5) identified three randomized controlled trials that were eligible for inclusion. Two of the studies were at high risk, with the third categorized as moderate risk of bias.…”

“…As avulsion injuries present relatively infrequently even to specialist centres (2, 3), a multi-centre design would be required. The Cochrane review (5) was unable to identify any multi-centre randomized controlled trials (m-cRCT) teeth.…”

A systematic review of outcome measures used in clinical trials of treatment interventions following traumatic dental injuries

“…This highlights the need for consensus on the minimum period of follow up for TDI. The two Cochrane reviews in dental traumatology have identified that for periodontal healing, this period should be a minimum of 12 months (1,14). This time period, however, is too short to collect robust data for outcomes such as tooth loss (24).…”

“…Arrangements were made to translate and assess studies that were not published in English (13). One of the authors (PD) has been involved with a number of Cochrane reviews, and research papers translated for these reviews were also used where appropriate in this publication (1,14).…”

“…It is evident that TDI outcomes reported in such trials are numerous and diverse; furthermore, it is unclear how and at what time point these outcomes should be collected. This heterogeneity has been highlighted in recent systematic reviews that have looked at treatment interventions for various TDI (1)(2)(3)(4). Indeed, concerns have been raised over the validity of a series of systematic reviews (5)(6)(7), which undertook meta-analyses of non-randomized studies where there was significant heterogeneity in the data being amalgamated (8).…”