Storage of an avulsed tooth prior to replantation: A systematic review and meta‐analysis

Abstract

Background/Aim It is crucial to store an avulsed tooth appropriately to preserve the viability of the periodontal ligament cells prior to replantation. The aim of this systematic review was to identify the best available evidence for the effectiveness of any technique available to laypeople for storing an avulsed tooth compared with storage in milk or saliva. Methods The following databases were searched (September 2019): Cochrane Library, MEDLINE, and Embase. Two reviewers independently considered trial eligibility, then extracted and analyzed data, and assessed the risk of bias. The certainty of the body of evidence was appraised according to the GRADE methodology. Results Out of 4118 references, 33 studies were included and reported 23 comparisons of which 10 were synthesized in a meta‐analysis. The limited evidence available favors storing an avulsed tooth in Hank's balanced salt solution (pooled SMD 2.47, 95% CI [1.59;3.34], P < .00001), propolis solution (pooled SMD 1.73, 95% CI [1.12;2.33], P < .00001), oral rehydration salts (pooled SMD 4.16, 95% CI [2.10;6.23], P < .0001), rice water, and cling film compared with storage in milk. The cell viability rate was significantly lower in teeth stored in saline solutions (pooled SMD −4.35, 95% CI [−7.55;−1.14], P = .008), tap water, buttermilk, castor oil, GC Tooth Mousse, and turmeric extract than those stored in milk. There is insufficient evidence to recommend for or against temporary storage of an avulsed tooth in saliva compared with alternative solutions. The certainty of evidence was considered low to very low due to limitations in study design, indirect study populations and outcome measures, and imprecision. Conclusion Although milk was shown to extend the periodontal ligament cell viability before replantation compared with saline or tap water, the following media have also demonstrated efficacy at preserving the cell viability: Hank's balanced salt solution, propolis, oral rehydration salts, rice water, and cling film.

Evidence mapping and quality assessment of systematic reviews in dental traumatology

“…Forty‐four SRs had been published in last six years (2015‐2020) 18‐78 . Twenty‐eight of the SRs had been published in Dental Traumatology, 16,17,20‐27,29,30,36,39‐41,44,45,59,60,67,69,71,74,75,77,78 and five were from the Cochrane database 38,46,50,53,70 . The remaining SRs were spread across journals in general dentistry, sports medicine, orthodontics, special care dentistry, endodontics, maxillofacial radiology, oral and maxillofacial surgery, pediatric dentistry, oral sciences, periodontology, community dentistry, epidemiology, dental hygiene, education sciences, and restorative dentistry (Table 3).…”

“…The remaining SRs were spread across journals in general dentistry, sports medicine, orthodontics, special care dentistry, endodontics, maxillofacial radiology, oral and maxillofacial surgery, pediatric dentistry, oral sciences, periodontology, community dentistry, epidemiology, dental hygiene, education sciences, and restorative dentistry (Table 3). The highest number of systematic reviews had been performed in the domain of Prognostics (n = 19) 47‐65 followed by the domain of Epidemiology (n = 15), 12,18‐31 the domain of Therapeutics (n = 10), 17,38‐46 the domain of Oral Biology (n = 7), 72‐78 the domain of Diagnostics (n = 6), 32‐37 the domain of Preventive (n = 5), 66‐70 and the domain of Research Methods (n = 2) 16,71 …”

Executive Summary 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

“…When an injury causes tooth avulsion (ie, the tooth is pulled out with the root), the tooth must be stored in an appropriate medium to preserve viability until the tooth can be reimplanted. The First Aid Task Force sought a 2020 SysRev 111 to identify optimal media for temporary tooth storage, comparing the effects of many different media on periodontal ligament cell viability (surrogate for viability of the tooth for reimplantation). Although milk remains an effective medium, the task force concluded that other media as well as the use of clear cling film (ie, plastic wrap) were more effective in preserving viability.…”

“…The First Aid Task Force requested a 2020 SysRev of media used to store an avulsed tooth until it can be reimplanted. 111 Many RCTs found benefit from immersion of the tooth in Hanks’ Balanced Salt Solution 146 , 147 , 148 , 149 , 150 , 151 , 152 , 153 , 154 , 155 , 156 , 157 as well as in oral rehydration salt solutions 154 , 155 or from wrapping the tooth in cling film (ie, plastic wrap) 158 as compared with immersion in milk. However, milk was better than many other media for storing a tooth until reimplantation.…”

Severe Case of Delayed Replantation of Avulsed Permanent Central Incisor: A Case Report with Four-Year Follow-Up

“…The periodontal ligament cells’ vitality is the most important factor to allow the reattach following tooth replantation [ 1 ]. Furthermore, other factors like extraoral time, storage of the avulsed tooth, and maturity of the root are also important to dental prognosis [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 ].…”