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Journal of Indian Society of Pedodontics and Preventive Dentistry Official publication of Indian Society of Pedodontics and Preventive Dentistry
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Year : 2007  |  Volume : 25  |  Issue : 5  |  Page : 17-19

Delayed replantation of avulsed teeth

1 Department of Oral and Maxillofacial Surgery, Dr. Z. A. Dental College and Hospital, Aligarh Muslim University, Aligarh (UP), India
2 Department of Pedodontics, Dr. Z. A. Dental College and Hospital, Aligarh Muslim University, Aligarh (UP), India
3 Department of Periodontics and Community Dentistry, Dr. Z. A. Dental College and Hospital, Aligarh Muslim University, Aligarh (UP), India

Correspondence Address:
M K Jindal
Department of Pedodontics, Dr. Z. A. Dental College, AMU, Aligarh.
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Source of Support: None, Conflict of Interest: None

PMID: 17921635

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Dental injuries are very common and their extent has been classified by Ellis. Avulsion of tooth is a grievous injury and ranges from 1-16% among the traumatic injuries, of which maxillary anterior are commonest. Reimplantation of avulsed teeth is a standard procedure. However, it has certain limitations. Most often their management is very challenging. In this case report we are presenting the management of maxillary incisors by replantation after 36 hrs in a 12 year old girl.

Keywords: Avulsed teeth, delayed replantation, trauma

How to cite this article:
Adil N F, Ahmed S S, Jindal M K, Arshad S H. Delayed replantation of avulsed teeth. J Indian Soc Pedod Prev Dent 2007;25, Suppl S1:17-9

How to cite this URL:
Adil N F, Ahmed S S, Jindal M K, Arshad S H. Delayed replantation of avulsed teeth. J Indian Soc Pedod Prev Dent [serial online] 2007 [cited 2023 Feb 5];25, Suppl S1:17-9. Available from: http://www.jisppd.com/text.asp?2007/25/5/17/34741

   Introduction Top

Dental injuries are very common and can occur at any age Tooth/teeth avulsion has become common due to sharp rise in road traffic accident cases (RTA cases). It is followed by fall and sport related injuries, usually the maxillary anterior teeth are the most affected. Reimplantation of avulsed teeth is the treatment of choice. It is quite challenging for the dental professional since avulsed teeth recover optimal function and esthetics after replantation under ideal conditions.

The term "tooth avulsion" is used to describe a situation where, as a result of trauma, a tooth has been displaced out from its socket which is in fact the severing of periodontal ligament fibers and the neurovascular bundle. There may be associated injuries to the alveolus and adjacent teeth. When the tooth is outside the socket, the cells of pulp and periodontal ligament begin to deteriorate due to the effects of lack of blood supply to the cells and other environmental factors like drying and/ or bacterial contamination. It is important to note that favorable periodontal ligament healing is the crucial factor for the success of replanted teeth.

   Case Report Top

A 12 year old girl reported to the casualty unit of Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh with the chief complaint of trauma to the upper anterior teeth and gingival bleeding due to RTA [Figure - 1].

Extraorally there were bruises on the forehead near right eye and on upper lip. Intra oral examination revealed avulsion of 11,21,22,23. The attendant of the patient showed all the 4 avulsed teeth, which was collected from the site of accident and all of them were intact and free of debris.

Radiographic examination revealed no fracture of adjacent teeth or any foreign object in the soft tissue.

Treatment planning

Since the patient was young, replantation of the avulsed tooth was decided in the best interest of the patient and to relieve her from psychological, cosmetic and functional trauma.

The avulsed teeth were rinsed gently and thoroughly with normal saline and followed by antibacterial solution and then were stored in normal saline.

Since the extraoral time was more than 2 hrs, root canal therapy was competed extraorally in all the avulsed teeth. Prior to replantation under local anesthesia, the socket was gently cleaned and light irrigation with saline solution was done [Figure - 2]. The teeth were then placed in position and splinted with orthodontic band and wire. The following antibiotic and anti-inflammatory drugs were advised for 5 days, a combination of Amoxycillin and Cloxacillin-500 mg TDS and A combination of Ibuprofen and Paracetamol-TDS. Apart from this the patient was advised to avoid biting with the splinted teeth. Soft diet and maintenance of good oral hygiene were advised [Figure - 3].

The splint was removed at the end of 6 th week and follow up radiograph after 6-month (IOPA) was taken which revealed normal root resorption, intact periodontal ligament and without any periapical pathology [Figure - 4]. The patient is still under review. Immediate post operative radiograph was taken for record.

   Discussion Top

Avulsion of tooth takes place when a tooth directly sustains trauma which displaces the tooth from the socket. The maxillary central incisors are the commonest avulsed teeth in both dentitions i.e., primary and permanent due to their prominence in the jaw.

The prognosis of an avulsed tooth is proportional to its extraoral time, which is a direct correlation of the status of the periodontal ligament cells. [1]

Although there are reports of replanted teeth remaining in function for over 30 years. On an average, [1] they are functional at least for 5 years and most are ultimately lost because of progressive root resorption or other associated problems like ankylosis. [2]

It is well accepted that shorter the extraoral period, the better the prognosis for retention of replanted teeth. [5] The storage and common transport media during extraoral time is also of vital significance. Common transport media are Hank's balanced salt solution (HBSS), milk, saline and saliva (Buccal vestibule). If nothing is available water can be used as storage and transport media. Teeth replanted from 6 hrs to 48 hrs after avulsion and treated endodontically are shown to be clinically functional for a number of years. [5],[7],[8] There are reports of ankylosis and replacement resorption but there was no evidence of periapical pathology. [9],[10]

In our case, since the extra oral time was more than 36 hrs, it was possible that the teeth had lost vitality,so root canal therapy was completed extra orally prior to the placement of the teeth in the socket. The ideal extra oral time for successful replantation is 20 min and the maximum extraoral time reported in journals is 48 hrs. [2]

Since the key to the success lies in the status of periodontal ligament, utmost care was taken to preserve the integrity of the periodontal ligament. Six-months follow up has shown successful outcome of the treatment.

The case has been presented for peculiar mode of splinting by orthodontic brackets and Australian wire, which gave better splinting and stability to the reimplanted teeth.

   References Top

1.Donaldson M, Kinisons MJ. Factors affecting the time of onset of resorption in avulsed and replanted incisor teeth in children. Dent Traumatol 2001;17:205-9  Back to cited text no. 1    
2.Tsukubushi M. Autotransplantation of teeth: Requirements for predictable success. Dent Traumatol 2002;18:157-80  Back to cited text no. 2    
3.Cohen Burns. 6 th ed. Mosby: 1994. p. 460-2  Back to cited text no. 3    
4.Mc Tigre DJ. Diagnosis and management of dental injuries in children. Dent Clin North Am 2000;47:1067-84  Back to cited text no. 4    
5.Andreasen JO, Ardreasen FM. Classification etiology and epidemiology of traumatic dental injuries. In : Andreasen JO andreasen FM, editors. Textbook and colour atlas of traumatic injuries to the teeth, 3 rd ed. Copentragen: Munks Gaaed; 1994. p. 151-77  Back to cited text no. 5    
6.Andreasen JO. Traumatic dental injuries: A manual Copenhagen. Munksgaend: 1999. p. 349  Back to cited text no. 6    
7.Andreasen JO, Borum MK andreasen FM. Replantation of 400 avulsed permanent incisors. 3. Factors related to root growth. Endod Dent Traumatol 1995;11:69-75  Back to cited text no. 7    
8.Andreasen JO, Borum MK, Jacobsen HL, Andraesen FM. Replantation of 400 avulsed permanent incisors. 1. Diagnosis of healing complications. Endod Dent Traumatol 1995;11:51-8  Back to cited text no. 8    
9.Krasner P, Rankow HJ. New philosophy for the treatment of avulsed teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995;79:616-23  Back to cited text no. 9  [PUBMED]  
10.Schatz JP, Hanshert C, Joh JP. A retrospective clinical and radiologic study of teeth re-implanted following traumatic avulsion. Endod Dent Traumatol 1995;11:235-9  Back to cited text no. 10    


  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]

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Nuvvula, S. and Mohapatra, A. and Kiranmayi, M. and Rekhalakshmi, K.
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