Avulsion Management

Avulsion of permanent teeth is one of the most serious dental injuries, and a prompt and correct emergency management is very important for the prognosis.Tooth avulsion or exarticulation is a traumatic injury of dental tissue characterised by complete displacement of the tooth out of its socket. Successful treatment outcome of such an injury is dependent on the survival of the viable periodontal ligament cells attached to the tooth root surface. The viability of the periodontal ligament cells is best preserved either when the tooth is immediately replanted into its socket or if it is stored in an appropriate storage /transport medium till a time, the tooth can be replanted into its socket.

Outcomes Of Avulsion

The speed with which the avulsed tooth is replanted is the most important factor for success. There are several possible effects on the root surface and attachment apparatus of an avulsed tooth.

Case Report

This case report  of delayed replantation of avulsed maxillary central incisors after an extended dry extra-alveolar period. 10-year-old girl presented with avulsed maxillary central incisors due to trauma occurring 14 hours earlier.

His parents had let the avulsed tooth dry in a piece of paper and brought it to the clinic. 

After informing the parents of the patient about possible risks, treatment procedure started.

Treatment

Hold the tooth by the crown & Clean the root surface  with a stream of saline.

Administer local anesthesia.

Rinse the socket with saline and Chlorhexidine.

Reposition the tooth very gently in the dental socket with a light digital pressure.

Verify normal position of the replanted tooth clinically and radiographically.

In cases of soft tissue lacerations, suturing should be done to stop the bleeding

Apply a flexible/semirigid splint for 7 to 10 days.

 In cases of bone fracture, the tooth should be splinted for a longer period, (1 or 2 months), depending on the clinical situation

Administer systemic antibiotics .

It is recommended to prescribe antibiotic therapy to avoid the onset of infection during the first week after replantation The administration of systemic antibiotic prevents the development of external root resorption.

Patient instructions

Soft food for up to 2 weeks.

Brush teeth with a soft toothbrush after each meal.

Chlorhexidine rinses  prescribed and strict hygiene instructions given, for the entire splinting period.

 The parents were informed about the importance of regularly returning for clinical and radiographic follow-up. 

Follow-up

Splint removal and clinical and radiographic control after 2 weeks.

As the tooth has been out of the socket and kept dry for more than 1 hour, the calcium hydroxide filling was done for a long follow-up period to evaluate the rate of the replacement root resorption.

Clinical followup examination 1 week, 2  weeks,  4 weeks, 3 months, and then  6 months done.