Early prognostic indicators and outcome prediction model for replanted avulsed teeth

Pulp healing in immature replanted permanent teeth: A competing risk analysis

BACKGROUND/AIM

Tooth displacement during avulsion causes total rupture of the pulp's neurovascular supply. Revascularization and pulp healing may occur in immature teeth, which gives rise to the recommendation that root canal treatment may not be required. The aim of this study was to evaluate the prognostic factors for the pulp's response after replantation of young permanent teeth.

METHODS

Records from 117 patients with 133 replanted permanent immature teeth were reviewed, and pulp outcomes were classified as healing (hard tissue deposition on the dentinal walls followed by narrowing of the pulp lumen or ingrowth of bone-like tissue inside the pulp canal) or non-healing (pulp necrosis with infection). The effect of clinical and demographic co-variates on the hazards of both outcomes was assessed performing a competing risk model.

RESULTS

Pulp necrosis with infection was diagnosed in 78.2% of the teeth, and healing was observed in 12.8% of the teeth. A total of 12 teeth (9.0%) were censored due to prophylactic removal of the pulp or severe external root resorption caused by eruption of adjacent canines. The cs-Cox model demonstrated that the hazards of pulp healing increased in teeth with extra-alveolar periods <15 min (csHR: 7.83, 95% CI 1.76-34.80, p = .01), while the hazards of pulp necrosis with infection decreased (csHR: 0.31, 95% CI: 0.10-0.92, p = .04). Teeth replanted with Moorrees' stages 4 and 5 of root development had higher hazards of pulp necrosis with infection than teeth with stage 2 of root development (csHR: 2.23, 95% CI 1.11-4.50, p = .03; csHR: 2.89, 95% CI: 1.40-5.95; p = .01).

CONCLUSIONS

Pulp healing rarely occurred after replantation of young permanent teeth being associated with short extra-alveolar periods <15 min. Early stages of root development decreased the hazards of pulp necrosis with infection.

Assessment of Parents’ Knowledge and Attitudes on Emergency Management of Permanent Avulsed Teeth in Western Saudi Arabia

Objective:

One of the most common dental injuries is dental avulsion. This study, conducted in the western region of Saudi Arabia, aimed to evaluate parent’s knowledge and attitudes regarding the emergency management of avulsed permanent and deciduous teeth in children.

Methods:

A cross-sectional study was conducted among 393 parents recruited from six dental clinics and hospitals in Makkah and Jeddah, Saudi Arabia. The data were collected with a self-administered questionnaire that assesses the level of knowledge for managing deciduous and permanent avulsed teeth.

Results:

The total score for correct answers about managing permanent avulsed teeth had a mean of 4.77 and a standard deviation of 2.14 (out of 10 questions). With a permanent avulsed tooth, 35.37% were aware of dental reimplanting, 27.7% identified milk as an appropriate medium, and 57.5% would seek professional help immediately after dental trauma. Females and participants with a bachelor’s or higher degree had significantly higher levels of knowledge than males and participants with a high school or lower education. There were 28.5% of respondents who had a previous history of dental trauma for a child. A total of 62.1% knew that there is a difference in managing deciduous versus permanent teeth, but only 40.7% knew the proper management for deciduous avulsed teeth. Previous history of child dental avulsion was not found to be associated with more knowledge on managing avulsed deciduous or permanent teeth.

Conclusion:

Parents in the western region of Saudi Arabia have inadequate levels of knowledge to manage deciduous and permanent tooth avulsion. More efforts should be applied for conducting promotional health campaigns aimed at improving parents’ knowledge.