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

Abstract

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.

Traumatic injury to permanent tooth resulting in complete root resorption: a case report

“…The prognosis of patients with such trauma is often affected by the skill and experience of the dentist. Numerous studies have attempted to determine the most appropriate treatment of avulsed teeth (2)(3)(4)(5)(6)(7)(8)(9).…”

Kuwaiti Parents’ Knowledge of First-Aid Measures of Avulsion and Replantation of Teeth

“…Storing the tooth in the patient's saliva is another alternative for shorter periods [7,14,16] . The use of specially composed cell culture media has been mentioned in the literature [1,10,13] , but such media are seldom accessible at the place of accident. Milk, however, which can usually be found in the vicinity of the place of accident, has a favorable osmolality and composition for the viability of periodontal ligament cells and therefore has been recommended for temporary storage of avulsed teeth before replantation [18,20] .…”

“…Dry storage of the tooth will cause irreversible injury to the periodontal membrane, resulting in loss of the replanted tooth over time [7,8,[13][14][15][16][17] . However, storing the tooth in water is not recommended because its osmolality is too low [18][19][20] .…”

Frontzahntrauma und kieferorthopädische Behandlungsplanung

“…74-96% develop an ankylosis as the most severe after-effect of a dental trauma, a factor that can hinder orthodontic treatment, particularly concerning individual tooth movement. The estimated average survival rate of completely luxated and replanted teeth is 57.3 months [22]. The prognosis depends on the state of the periodontal ligament and pulp.…”

“…In addition, the timing and quality of endodontic treatment is important to avoid an IRR [23]. Anti-resorptive regenerative treatment (ART) with local application of glucocorticoids, enamel matrix derivatives (Emdogain ® , Biora ® , Malmö, Schweden), if required [13], and a systematic dosage of doxycyclin, can improve the prognoses for replanted teeth [22]. dings 6 Monate bis 1 Jahr überwacht werden, da 1-11% der dislozierten Zähne auch eine Ankylose entwickeln, die die kieferorthopädische Therapie erschweren kann.…”