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Gul A, Lauridsen E, Gerds TA, Andersson L. Risk of ankylosis of avulsed teeth immediately replanted or stored under favorable storage conditions before replantation: A long-term clinical study. Dent Traumatol 2024; 40:137-143. [PMID: 37864425 DOI: 10.1111/edt.12898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/02/2023] [Accepted: 10/03/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND/AIM There are few long-term clinical follow-up studies on human teeth replanted immediately or after storage in a suitable storage medium prior to replantation. This study aimed to assess the risk of ankylosis in avulsed human teeth replanted immediately or after storage in physiological media for a short time. MATERIAL Data from 116 patients with 145 replanted avulsed permanent teeth were selected from a comprehensive dental trauma database in Copenhagen University Hospital. The following teeth were selected: Group 1 comprised 36 teeth replanted immediately (dry time <6 min; wet time <6 min). Group 2 comprised 61 teeth replanted after physiologic storage media (saliva and saline) (dry time <6 min; wet time >5 min; wet time ranged from 7 to 170 min, and mean wet time was 59 min). Group 3 (control) included 48 teeth replanted after dry storage (dry time > 60 min). METHOD Clinical and radiographic registrations were carried out according to a standardized protocol; follow-up ranged from 7 months to 23 years. Ankylosis was diagnosed by percussion test and radiographs and related to the conditions prior to replantation and stage of root development. RESULTS The overall risk of ankylosis was 17.2% [95% CI: 4.61; 29.79] for immediately replanted teeth, 55.3% [95% CI: 42.54; 68.00] for teeth stored in physiologic media before replantation, and 85.7% [95% CI: 75.70; 95.73] for teeth stored dry more than 1 h. Mature teeth showed a significantly higher risk of ankylosis than immature teeth. CONCLUSION This clinical long-term study has verified earlier experimental studies showing that immediate reimplantation has the lowest risk of ankylosis. Physiologic storage media are good alternatives that also reduce the risk of ankylosis compared to dry storage, where ankylosis is more likely although not always seen. Mature teeth are significantly more likely to develop ankylosis.
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Affiliation(s)
- Abdulaziz Gul
- Department of Oral and Maxillofacial Surgery, Malmö University, Malmö, Sweden
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, Faculty of Dentistry, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Eva Lauridsen
- Department of Oral and Maxillofacial Surgery, University Hospital, Copenhagen, Denmark
| | - Thomas A Gerds
- Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Lars Andersson
- Department of Oral and Maxillofacial Surgery, Malmö University, Malmö, Sweden
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Amaro RG, Dos Santos LCM, Lima TCDS, Coste SC, Barbato Ferreira DA, Côrtes MIDS, Colosimo EA, Bastos JV. Pulp healing in immature replanted permanent teeth: A competing risk analysis. Dent Traumatol 2021; 37:447-456. [PMID: 33421350 DOI: 10.1111/edt.12652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Roberta Gabriela Amaro
- Dental Trauma Program, Department of Restorative Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Thiago César da Silva Lima
- Dental Trauma Program, Department of Restorative Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Sylvia Cury Coste
- Dental Trauma Program, Department of Restorative Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Daniela Augusta Barbato Ferreira
- Dental Trauma Program, Department of Restorative Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Maria Ilma de Souza Côrtes
- Dental Trauma Program, Department of Restorative Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Department of Dentistry, Pontifical University of Minas Gerais, Belo Horizonte, Brazil
| | - Enrico Antonio Colosimo
- Departament of Statistics, Institute of Exact Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Juliana Vilela Bastos
- Dental Trauma Program, Department of Restorative Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Krug R, Kremeier K, Krastl G. Long-term retention of avulsed maxillary permanent incisors replanted after prolonged non-physiological storage. Dent Traumatol 2018; 35:147-152. [PMID: 30296000 DOI: 10.1111/edt.12445] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/28/2018] [Accepted: 09/30/2018] [Indexed: 12/18/2022]
Abstract
Ankylosis and external replacement resorption (ERR) are two typical biological responses to delayed replantation of avulsed teeth in cases where adequate root canal treatment is performed. The patient's growth stage affects the progression of root resorption and the long-term outcome of the affected teeth. This case report describes the long-term outcome of an 18.5-year-old patient following an accident in which both of his maxillary central incisors were avulsed and replanted after four hours of non-physiological storage. ERR and ankylosis of teeth 11 and 21 were detected clinically and radiographically during the second year of follow-up. Sixteen years after replantation, replacement resorption was progressing very slowly, enabling functional tooth retention with favorable esthetics. Young adults, with delayed replantation of avulsed teeth, may benefit from tooth retention with slow ERR.
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Affiliation(s)
- Ralf Krug
- Department of Conservative Dentistry and Periodontology and Center of Dental Traumatology, University Hospital of Würzburg, Würzburg, Germany
| | | | - Gabriel Krastl
- Department of Conservative Dentistry and Periodontology and Center of Dental Traumatology, University Hospital of Würzburg, Würzburg, Germany
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4
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Lam R. Epidemiology and outcomes of traumatic dental injuries: a review of the literature. Aust Dent J 2016; 61 Suppl 1:4-20. [DOI: 10.1111/adj.12395] [Citation(s) in RCA: 162] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- R Lam
- International Research Collaborative - Oral Health and Equity, School of Anatomy, Physiology and Human Biology; The University of Western Australia; Western Australia Australia
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5
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Abd-Elmeguid A, ElSalhy M, Yu DC. Pulp canal obliteration after replantation of avulsed immature teeth: a systematic review. Dent Traumatol 2015; 31:437-41. [DOI: 10.1111/edt.12199] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Ashraf Abd-Elmeguid
- School of Dentistry; Faculty of Medicine and Dentistry; University of Alberta; Edmonton AB Canada
| | - Mohamed ElSalhy
- School of Dentistry; Faculty of Medicine and Dentistry; University of Alberta; Edmonton AB Canada
| | - Donald C. Yu
- School of Dentistry; Faculty of Medicine and Dentistry; University of Alberta; Edmonton AB Canada
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Hamanaka EF, Poi WR, Salzedas LMP, Alves LC, Panzarini SR, Sonoda CK, Martins CM. A method for the geometric standardization of intraoral radiographs for long-term follow up of replanted teeth: a case report. Dent Traumatol 2012; 29:121-6. [DOI: 10.1111/j.1600-9657.2012.01145.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Elizane Ferreira Hamanaka
- Department of Surgery and Integrated Clinics; School of Dentistry of Araçatuba, São Paulo State University (UNESP); Araçatuba; SP; Brazil
| | - Wilson Roberto Poi
- Department of Surgery and Integrated Clinics; School of Dentistry of Araçatuba, São Paulo State University (UNESP); Araçatuba; SP; Brazil
| | - Leda Maria Pescinini Salzedas
- Department of Surgery and Integrated Clinics; School of Dentistry of Araçatuba, São Paulo State University (UNESP); Araçatuba; SP; Brazil
| | - Lucieni Campoli Alves
- Department of Surgery and Integrated Clinics; School of Dentistry of Araçatuba, São Paulo State University (UNESP); Araçatuba; SP; Brazil
| | - Sônia Regina Panzarini
- Department of Surgery and Integrated Clinics; School of Dentistry of Araçatuba, São Paulo State University (UNESP); Araçatuba; SP; Brazil
| | - Celso Koogi Sonoda
- Department of Surgery and Integrated Clinics; School of Dentistry of Araçatuba, São Paulo State University (UNESP); Araçatuba; SP; Brazil
| | - Christine Men Martins
- Department of Surgery and Integrated Clinics; School of Dentistry of Araçatuba, São Paulo State University (UNESP); Araçatuba; SP; Brazil
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7
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Zhang X, Gong Y. Characteristics of avulsed permanent teeth treated at Beijing Stomatological Hospital. Dent Traumatol 2011; 27:379-84. [DOI: 10.1111/j.1600-9657.2011.01024.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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8
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Current developments in interim transport (storage) media in dentistry: an update. Br Dent J 2011; 211:29-33. [DOI: 10.1038/sj.bdj.2011.523] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2011] [Indexed: 12/20/2022]
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9
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Case report: endodontic and surgical treatment of an upper central incisor with external root resorption and radicular cyst following a traumatic tooth avulsion. ACTA ACUST UNITED AC 2010; 110:e61-7. [DOI: 10.1016/j.tripleo.2010.04.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2009] [Revised: 04/06/2010] [Accepted: 04/20/2010] [Indexed: 11/23/2022]
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Tzigkounakis V, Merglová V, Hecová H, Netolický J. Retrospective clinical study of 90 avulsed permanent teeth in 58 children. Dent Traumatol 2008; 24:598-602. [DOI: 10.1111/j.1600-9657.2008.00674.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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11
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Soares ADJ, Gomes BPFDA, Zaia AA, Ferraz CCR, Souza-Filho FJD. Relationship between clinical–radiographic evaluation and outcome of teeth replantation. Dent Traumatol 2008; 24:183-8. [DOI: 10.1111/j.1600-9657.2007.00528.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Peñarrocha M, García B, Martí E, Palop M, von Arx T. Intentional replantation for the management of maxillary sinusitis. Int Endod J 2007; 40:891-9. [PMID: 17877723 DOI: 10.1111/j.1365-2591.2007.01278.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
AIM To present a case that emphasizes the importance of the use of intentional replantation as a technique to successfully treat a periapical lesion and an odontogenic maxillary sinusitis through the alveolus at the same time. SUMMARY This case report presents a patient with odontogenic maxillary sinusitis secondary to periapical disease of a maxillary molar that had previously received root canal treatment. The molar was extracted, with drainage and rinsing of the maxillary sinus. The apices were resected extra-orally, the retrograde cavities prepared with ultrasound and retrograde fillings of silver amalgam placed. The tooth was then replanted. After 2 years, the patient was asymptomatic, periapical radiography showed no evidence of root resorption and computed tomography scanning demonstrated the resolution of maxillary sinusitis. KEY LEARNING POINTS *When root canal treatment or periapical surgery cannot be undertaken or has failed, intentional replantation may be considered. *This alternative treatment may be predictable in certain cases.
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Affiliation(s)
- M Peñarrocha
- Department of Oral Surgery, University of Valencia, Valencia, Spain.
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Abstract
Thirty-four patients with 45 avulsed and replanted permanent teeth were followed for 1 year. All teeth were soaked in tetracycline before replantation. In addition, enamel matrix derivative was used in teeth with dry storage times exceeding 30 min. Splinting was carried out with a non-rigid titanium splint and was limited to 7-10 days. Within that period, root canal treatment was begun in all teeth with a closed apex, whereas teeth with an open apex and ideal post-traumatic storage were not instrumented. All patients were given tetracycline systematically for 10 days. The survival rate of replanted avulsed permanent teeth was 95.6% at the 1-year follow-up. In 82.2%, root canal treatment was performed. Pulp survival was never observed, but three teeth had pulp canal obliteration. Normal periodontal healing was observed in 57.7% of teeth; 42.3% of teeth showed external root resorption (28.9% replacement resorption, 6.7% infection-related resorption, 6.7% surface resorption). The occurrence of replacement resorption correlated with the period of extraoral dry storage. Compared with other clinical studies on avulsed and replanted teeth, the present study reports a higher percentage of periodontal healing. The favorable treatment outcome may be associated with a strict protocol to enforce endodontic treatment, the use of topical and systemic tetracycline, and the relatively high number of ideally stored teeth following avulsion. In contrast, the present study has a follow-up period limited to 1 year.
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Affiliation(s)
- Vivianne Chappuis
- Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Berne, Switzerland.
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14
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Strobl H, Gojer G, Norer B, Emshoff R. Assessing revascularization of avulsed permanent maxillary incisors by laser Doppler flowmetry. J Am Dent Assoc 2004; 134:1597-603. [PMID: 14719756 DOI: 10.14219/jada.archive.2003.0105] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Laser Doppler flowmetry, or LDF, is a noninvasive method used to assess pulpal blood flow, or PBF. Dental avulsion is associated with loss of pulpal sensitivity. The authors conducted this study to assess whether LDF could be used to detect revascularization of replanted teeth. METHODS The authors used LDF to assess the PBF values of avulsed permanent maxillary incisors treated using replantation and splinting in 17 subjects. They took measurements at four sessions: on the day of splint removal and at 12 weeks, 24 weeks and 36 weeks after splint removal. Five vital control teeth and five nonvital control teeth were used to assess the background signal. At 36 weeks, the authors determined clinically and radiographically whether revascularization had occurred. RESULTS LDF readings correctly predicted the pulp status in 88.2 percent of the readings. Of the readings for vital teeth, 100 percent were correct, and of the readings for nonvital teeth, 80 percent were correct. Univariate analysis of variance demonstrated that in revascularized teeth, the PBF value increased significantly from splint removal to week 12 after splint removal and from week 24 to week 36 after splint removal. In the teeth that failed to revascularize, the PBF value dropped significantly from week 24 to week 36 after splint removal. CONCLUSIONS The results of this study suggest that LDF accurately diagnoses revascularization of avulsed maxillary incisors after replantation and splinting. CLINICAL IMPLICATIONS LDF may become useful in detecting revascularization much earlier than standard sensitivity tests.
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Affiliation(s)
- Heinrich Strobl
- Department of Oral and Maxillofacial Surgery, University of Innsbruck, Austria
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15
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Finucane D, Kinirons MJ. External inflammatory and replacement resorption of luxated, and avulsed replanted permanent incisors: a review and case presentation. Dent Traumatol 2003; 19:170-4. [PMID: 12752540 DOI: 10.1034/j.1600-9657.2003.00154.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
External inflammatory resorption and replacement resorption are complicating factors that may result from traumatic dental injuries when the tooth is luxated or avulsed and replanted. Resorption may, ultimately, result in loss of the tooth. However, with appropriate treatment, the prognosis for these teeth is greatly improved, with the possibility of preventing or arresting resorption. The purpose of this paper is to review these trauma entities, to discuss factors that influence the occurrence of resorption and to describe the most appropriate treatment. A case is presented, illustrating both resorption entities, but with varying outcomes.
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Affiliation(s)
- David Finucane
- Department of Paediatric Dentistry, Dublin Dental Hospital, Dublin 2, Ireland.
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16
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Donaldson M, Kinirons MJ. Factors affecting the time of onset of resorption in avulsed and replanted incisor teeth in children. Dent Traumatol 2001; 17:205-9. [PMID: 11678538 DOI: 10.1034/j.1600-9657.2001.170503.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Resorption is the main reason for loss of replanted teeth. The outcome examined in this study is the timing of the onset of resorption. The effect of dichotomised dry and wet time intervals as well as the presence of additional crown damage and of contamination were determined. Of 84 replanted teeth, 67.5% developed resorptions. Twenty-eight had detectable additional crown damage with a more rapid onset being seen in these cases (P=0.009). The critical limit for dry time was 15 min (P=0.038) and significant differences persisted for greater limits also. Serial analysis of the association between the time of onset of root resorption and dichotomised wet time variables failed to yield any significant associations. There was visible contamination detected in 32 teeth and these exhibited a more rapid onset of resorption than the other cases (P=0.030). Teeth with inflammatory root resorption (12.8%) had a more rapid onset of resorption than those that developed replacement resorption (54.7%) (P<0.001). It is concluded that the risk of early resorption is increased in teeth that have additional damage or have contamination, or are kept in dry conditions for longer than 15 min.
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Affiliation(s)
- M Donaldson
- Department of Paediatric and Preventive Dentistry, School of Dentistry, The Queens University of Belfast, Northern Ireland
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Barrett EJ, Kenny DJ. Avulsed permanent teeth: a review of the literature and treatment guidelines. ENDODONTICS & DENTAL TRAUMATOLOGY 1997; 13:153-63. [PMID: 9550040 DOI: 10.1111/j.1600-9657.1997.tb00031.x] [Citation(s) in RCA: 125] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Dental trauma represents one of the few situations where dentists are called upon to make unscheduled diagnostic and treatment decisions in an area that is outside their routine experience. Since patients who sustain an avulsion present infrequently, except in child-oriented or emergency-based practices, clinicians often make diagnostic and management decisions based upon their previous rare treatment experiences. Clinicians also rely on published guidelines for this aspect of their practice and expect these standards to be up-to-date and based on current research information. None of the current protocols has been tested by a prospective longitudinal outcome study in humans. Nevertheless, current guidelines have become the standard for clinical practice around the world. An effort must be made to develop treatment protocols that are based upon the biological mechanisms that underlie periodontal wound healing.
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Affiliation(s)
- E J Barrett
- Department of Dentistry, Hospital for Sick Children, University of Toronto, Canada
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Krasner P, Rankow HJ. New philosophy for the treatment of avulsed teeth. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1995; 79:616-23. [PMID: 7600227 DOI: 10.1016/s1079-2104(05)80105-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The success rate of replanted avulsed teeth has been low. This poor success rate results from the use of only one treatment regimen. This treatment regimen, replantation as quickly as possible regardless of circumstances, ignores much of the dental research that shows this regimen to not be efficacious. In addition, the profession has disregarded much of the research that shows many recommended storage media damaging to avulsed teeth. This article reviews the pertinent research on avulsed teeth and recommends a new treatment philosophy of avulsed teeth that delineates 10 treatment categories based on the type of storage medium used, the length of extraoral time, and the stage of development of the root apex.
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Affiliation(s)
- P Krasner
- Department of Endodontology, Temple School of Dentistry, Philadelphia, Pa, USA
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Andreasen JO, Borum MK, Jacobsen HL, Andreasen FM. Replantation of 400 avulsed permanent incisors. 4. Factors related to periodontal ligament healing. ENDODONTICS & DENTAL TRAUMATOLOGY 1995; 11:76-89. [PMID: 7641622 DOI: 10.1111/j.1600-9657.1995.tb00464.x] [Citation(s) in RCA: 432] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
400 avulsed and replanted permanent teeth were examined for periodontal ligament (PDL) healing, using standardized radiographic and clinical examination procedures (i.e. percussion test and mobility test). The effect of various clinical factors was examined, such as age and sex of the patient, type of tooth replanted, presence of crown fracture or bone fracture, stage of root development (including apical diameter and length of the pulp), type and length of extra-alveolar storage, clinical contamination of the root surface, type of root surface cleansing procedure, type and length of splinting period and antibiotic therapy. Surface resorption was generally diagnosed after 12 months; while inflammatory resorption and replacement resorption (ankylosis) were usually observed after 1 month and 1-2 months respectively. Most resorptive processes were diagnosed within the first 2-3 years. However, although rarely, even after 5 and 10 years new resorptive processes could be diagnosed. A univariate statistical analysis of 272 teeth revealed 9 factors significantly related to PDL healing. A subsequent multivariate analysis revealed that the following 4 factors had the strongest impact upon PDL healing, in descending order of significance: Stage of root development; length of the dry extra-alveolar storage period; immediate replantation and length of the wet period (saliva or saline storage). Nonphysiological storage, such as homemade saline and sterilizing solutions (chloramine and alcohol) always led to root resorption. Storage in tap water for more than 20 minutes usually led to root resorption. The common denominator for all these factors related to PDL healing appears to be survival of the PDL cells along the root surface. Based on these findings, immediate replantation is recommended irrespective of stage of root development.
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Affiliation(s)
- J O Andreasen
- Department of Oral Medicine and Oral Surgery, University Hospital (Rigshospitalet), Denmark
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20
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Andreasen JO, Borum MK, Jacobsen HL, Andreasen FM. Replantation of 400 avulsed permanent incisors. 1. Diagnosis of healing complications. ENDODONTICS & DENTAL TRAUMATOLOGY 1995; 11:51-8. [PMID: 7641619 DOI: 10.1111/j.1600-9657.1995.tb00461.x] [Citation(s) in RCA: 191] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A material of 322 patients with 400 avulsed and replanted permanent teeth were followed prospectively in the period from 1965 to 1988 (mean observation period = 5.1 yrs). The age of the patients at the time of replantation ranged from 5 to 52 yrs (mean = 13.7 yrs and median = 11.0 yrs). Standardized patient records were used through the entire period in order to obtain valid data concerning the extent of injury and treatment provided. At the follow-up period, pulpal and periodontal healing were monitored by clinical examination, mobility testing and standardized radiographic controls. Thirty-two of the replanted teeth (8%) showed pulpal healing. When related to teeth with incomplete root formation, where pulpal revascularization was anticipated (n = 94) the frequency of pulpal healing was 34%. Periodontal ligament healing (i.e. with no evidence of external root resorption) was found in 96 teeth (24%). Gingival healing was found in 371 teeth (93%). During the observation period, 119 teeth (30%) were extracted. Tooth loss was slightly more frequent in teeth with incomplete root formation at the time of replantation than in teeth with completed root formation.
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Affiliation(s)
- J O Andreasen
- Department of Oral Medicine and Oral Surgery, University Hospital (Rigshospitalet), Denmark
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