Clinical observations regarding the treatment of traumatically avulsed mature teeth. Part 1

A documented case involving the simultaneous avulsion of two maxillary incisors, intraorally and extraorally, was reported. Long-term observations following replantation treatment revealed several interesting clinical features: The prognosis of replanted teeth may be more favorable following intraoral avulsions. The intrusion phenomenon associated with replanted incisors appears to be directly related to replacement root resorption or ankylosis; occlusal forces may be a factor. Teeth extraorally avulsed for a few hours may still provide a useful function, albeit temporary, with replantation treatment. These teeth may not reveal clinical ankylosis or replacement resorption for periods of 1 to 2 years, or possibly longer, following replantation. Long-term studies can help evaluate replantation techniques.     

Clinical observations regarding the treatment of traumatically avulsed mature teeth. Part 2

Two documented cases involving avulsions of an incisor and a cuspid are reported. Long-term observations following replantations indicated factors in addition to those reported in Part 1 of this study. Endodontic metallic implants may retard the intrusive process. A fixed-bridge splint also appears to have retarded the ankylosis phenomenon. The three case reports in the two parts of this study indicated that splint time may not be a critical factor in the prognosis of replanted teeth. Calcium hydroxide failed to prevent early root resorption and eventual ankylosis in an early replantation case; the other two cases, with longer replant time, fared better without calcium hydroxide. Endodontic treatment of avulsed teeth soon after replantation is suggested; a time period of several weeks does not appear critical to the prognosis. Removal of the apical root segment prior to replantation does not appear to affect the replacement root resorption process. The reporting of long-term documented cases should be encouraged in order that replantation techniques may be evaluated.     

An investigation of replantation of traumatically avulsed permanent incisor teeth.

The success of treatment of 46 replanted, avulsed permanent incisors in 36 children was investigated in relation to some of the factors which have been reported to affect prognosis. Treatment was considered to have been successful if the tooth was still present in the mouth and required no further treatment. If more treatment was necessary, the outcome was considered to be uncertain, while if the tooth had been lost a failure was recorded. Treatment was considered to be successful for 21 teeth, uncertain for 20 teeth and a failure for 5 teeth. A significant relationship was found between success and the method of storing the avulsed tooth, with milk, saliva or saline being the best media. No relationship was demonstrated between the time the avulsed tooth was out of the mouth and success. Root resorption was the most frequent complication of replantation and occurred in 24 teeth. However, no significant relationship between resorption and the time that the avulsed tooth was out of the mouth was demonstrated.     

Splinting a traumatically avulsed tooth

A method of immobilization of the traumatically avulsed tooth using an arch bar and brass ligature wire is described. The type of splint used is quick and easy to fabricate and apply, requiring no complicated equipment or laboratory assistance. It is strong enough to support the tooth adequately for the required period of time, yet will allow access to the tooth for the performance of root canal therapy.     

Parental awareness of the emergency management of avulsed teeth in children

Although public awareness campaigns on avulsed teeth have been mounted in the past, no study has investigated the knowledge parents possess of the protocol for the management of this dental emergency. The purpose of this investigation was to evaluate, by means of a questionnaire, the parental awareness of the emergency management of avulsed teeth in children. Over 2000 parents were surveyed during a four-week period at 20 suburban vacation swimming centres. The results indicated that almost two-thirds of respondents would attempt replantation of an avulsed tooth but further questioning showed they did not know the correct procedures. Thirty-three per cent of respondents were unaware of any after-hours emergency dental services. Ninety-two per cent felt they should seek professional help urgently following an avulsion injury, but their knowledge of transport media for the tooth was poor. Only 5 per cent knew that milk was the medium of choice for both washing and transporting an avulsed tooth. Ninety per cent of parents surveyed had never received advice on what to do in the event of an accident where a permanent tooth was avulsed. This study revealed the need for educational campaigns aimed at parents to increase their knowledge of the emergency procedures required when the tooth is avulsed.     

Orthodontic movement in traumatically intruded teeth: a case report

Abstract  – Intrusive luxation of permanent mature teeth is one of the most serious injuries to the periodontal ligament in dental traumatology. Various treatment approaches are currently practised. The treatment of choice for traumatically intruded teeth was to combine orthodontic repositioning and endodontic treatment. This case report describes the treatment of a 50-year-old male patient, with four completely intruded mature permanent maxillary incisors. Orthodontic extrusion was initiated 1 week after the trauma. After 10 days, the crowns of the teeth were exposed to start endodontic therapy. Nine weeks after the injury and 8 weeks after the beginning of orthodontic extrusion, the intruded incisors were back about to their original position before the displacement occurred. All treatment management as well as a follow-up 8 years after the trauma are described.     

Unusual teeth transpositions: two case reports

Tooth transposition is a rare dental anomaly that is characterized by the interchanged position of two adjacent permanent teeth in the same quadrant or ectopic eruption of one tooth in the place of another. This article presents two case reports of transpositions. In the first case, a 21-year-old man presented with a left maxillary canine to molar site transposition. Radiographs showed that the canine was transposed completely. In the second case, a 35-year-old man presented with a right mandibular second premolar that had erupted between the first and second molars. Radiographs showed that the second premolar was positioned between the first and second molars. Maxillary canine to first molar site transpositions are extremely rare. To date, just eight cases have been reported in the English literature. Early loss of the first permanent molar may trigger distal migration of a developing canine bud. A mandibular second premolar erupting between the first and second molars is also a rare position anomaly that has not been reported in the English literature.     

Treatment and prognosis of avulsed teeth: A discussion and case report

A documented case that involves avulsion of an incisor is reported. Calcium hydroxide failed to prevent progressive irreversible root resorption. The importance of extraoral time, transport media, duration and type of splinting, as well as the rationale for the use of calcium hydroxide in the treatment of avulsed teeth are discussed. This case could serve as a reminder to practitioners, that patient compliance, timing and sequencing of endodontic therapy, and regular recalls is critical in the prevention or treatment of root resorption in avulsed teeth. It also emphasizes the frustration of many clinicians in treating avulsed immature teeth. The reporting of long-term documented cases should be encouraged so that replantation techniques may be evaluated.     

Functional fixation for traumatically luxated teeth

Abstract A splinting method is described for the fixation of traumatically luxated or auto transplanted teeth. The splint is constructed from a thin stainless steel wire by an acid-etching technique. The composite is applied to the wire only on the enamel surface, thus leaving the interdental space uncovered. The splint meets most of the demands of tooth fixation and serves as a means of functional fixation, as it allows slight vertical movement of the teeth. The reliability of electrometric pulp-testing during splinting was examined on 3 people with a root-filled upper central incisor. It is shown that if the test is performed palatally after thorough drying of the enamel, no false positive results are achieved. A case report on the fixation of exarticulated upper central incisors in an 11-year-old girl is also presented.     

Replanting avulsed primary teeth.

Tooth replantation is a viable procedure if performed under the following acceptable guidelines: Replant the tooth if time lapse is less than 30 minutes (a time lapse of more than one to two hours results in a poor prognosis); Transport the tooth or teeth in milk, saliva or blood; and Keep teeth and replant area clean to minimize infection. Quick action by the mother in bringing the child to the hospital emergency room was a vital first step. The fact that the child held the teeth in her mouth en route to the hospital--bathed in saliva and blood, still attached by the bit of gingival tissue in the warm mouth's environment--helped to contribute to a positive situation as well as did the good home care.