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  Table of Contents    
CASE REPORT
Year : 2013  |  Volume : 31  |  Issue : 2  |  Page : 113-117
 

Maintaining vitality of immediately reimplanted avulsed tooth: Two-year follow-up case report


1 Department of Conservative Dentistry and Endodontics, Vasantdada Patil Dental College and Hospital, Kavalapur, Sangli, India
2 Department of Prosthodontics and Implantology, Vasantdada Patil Dental College and Hospital, Kavalapur, Sangli, India

Date of Web Publication26-Jul-2013

Correspondence Address:
A N Munavalli
Department of Conservative Dentistry and Endodontics, Vasantdada Patil Dental College and Hospital, Kavalapur, Sangli 416 306
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-4388.115714

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   Abstract 

Management of tooth avulsion in the permanent dentition often presents a challenge. Such injuries should be recognized and treated expeditiously because several studies support a more likely favorable prognosis with timely and appropriate initial management. This article describes the immediate management of an avulsed maxillary permanent incisor with afollow-up of 1 year.


Keywords: Incisor/injuries, tooth avulsion/therapy, tooth reimplantation


How to cite this article:
Munavalli A N, Sachhi R J, Kambale S S, Bandekar S D. Maintaining vitality of immediately reimplanted avulsed tooth: Two-year follow-up case report. J Indian Soc Pedod Prev Dent 2013;31:113-7

How to cite this URL:
Munavalli A N, Sachhi R J, Kambale S S, Bandekar S D. Maintaining vitality of immediately reimplanted avulsed tooth: Two-year follow-up case report. J Indian Soc Pedod Prev Dent [serial online] 2013 [cited 2020 Feb 24];31:113-7. Available from: http://www.jisppd.com/text.asp?2013/31/2/113/115714



   Introduction Top


Dental avulsion is a clinical situation in which the tooth is completely displaced out of its socket following a traumatic impact. Incidence of avulsion constitutes 0.5-16% of all traumatic injuries in the permanent dentition. [1] Avulsion is mainly seen in children and young adults, at an age when the alveolar bone is resilient and provides only minimal resistance to extrusive forces. The most commonly affected tooth is maxillary central incisors. Prognosis of avulsed tooth depends on the measures taken at the time of accident such as choice of transport medium and time taken before performing the treatment. Replantation of a tooth beyond 5 min has been defined by Andreasen as delayed replantation that affects tooth survival. [2]

Various storage media can be used for avulsed tooth such as Hank's balanced salt solution (HBSS), milk, saliva, Visapan, saline, etc., HBSS, a pH preserving fluid, is best used for traumatized tooth. It is biocompatible with the tooth periodontal cells and keep the cells viable for 24 h due to itsideal pH and osmolarity. [2]

Studies suggest there are two main reasons for delayed replantation of avulsed teeth. People who usually are present athe site of injury are lay persons, whose knowledge of how to manage an avulsed tooth is inadequate; soft tissue lacerations and bleeding are almost always associated with injuries to the teeth, which mask the loss of teeth. It is therefore not unusual for avulsion to be overlooked at the time of injury. [3]

Prolonged extraoral storage of an avulsed tooth before replantation will lead to total necrosis of periodontal ligament and will affect the outcome of treatment. Delayed replantation of avulsed teeth can lead to complications such as inflammatory resorption and replacement resorption. The reported clinical success rate of delayed replanted avulsed teeth has been low. One of the causes for this poor rate is the lack of recognition that avulsed teeth are presented in the dental office under different conditions that require different treatments.

Avulsions should be emphasized because of prompt and proper initial care, long-term clinical, and radiographic follow-up. On the other hand, the integrity of the periodontal ligament, advocated by many researchers as being essential for the success of replantation, cannot be controlled by the dental professional, as it depends on the interaction of factors. [4],[5]


   Case Report Top


A 12-year-old young girl reported for emergency treatment at Department of Conservative Dentistry and Endodontics with a history of fall at a playground 10 min before.

The avulsed tooth was placed back in the socket following injury by her teacher. She was having some lacerations over her lip and lower chin area. Intraoral examination revealed no dento-alveolar fracture and normal adjacent teeth. After which immediate reimplantation of avulsed teeth was planned. The half of the tooth was placed in the socket. The tooth was removed out of its socket and it was cleaned under running water to remove superficial debris on tooth surface and then it was placed into HBSS solution which was easily available in department. Then, fresh bleeding was prompted in the alveolar socket and the tooth was placed into the alveolar socket. A radiograph was taken to check the proper placement of the avulsed tooth and after confirmation of proper placement; tooth splinting was done with the composite splint. Any sharp edges were smoothened and adjacent tissues were irrigated using betadine solution. Extraoral lacerations were cleaned and dressing was done. After completion of the procedure, patient was recalled after 7 days for follow-up examination. Patient was asymptomatic after 7 days and after 2 weeks, removal of splinting was planned. At the end of 3 rd week, splint was removed and radiograph was taken. Radiograph after 3 weeks showed normal periapical tissues and vitality testing also showed the normal results. After that patient's follow-up was planned at 6 months1-year, and 2-year interval. At the interval of 6 months, 1 year, and 2 years, the tooth gave normal vitality results and radiographs also showed the normalperiapical findings [Figure 1],[Figure 2],[Figure 3],[Figure 4],[Figure 5],[Figure 6],[Figure 7],[Figure 8],[Figure 9],[Figure 10] and [Figure 11].
Figure 1: Pre-operative view

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Figure 2: Tooth in Hank's balanced salt solution

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Figure 3: Socket after tooth removal

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Figure 4: After replantation

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Figure 5: Splinting of tooth

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Figure 6: Immediate radiograph

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Figure 7: After 1 month

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Figure 8: After 6 months

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Figure 9: After 1 year

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Figure 10: After 2 years

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Figure 11: Hank's Balanced Salt Solution

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   Discussion Top


Trauma to the dentition is considered an emergency situation. It results in functional and esthetic disturbances accompanied by concern from both the patient and the parents. Similar to otherluxation-type injuries, avulsion of teeth is a serious assault on the gingival and periodontal ligament. Studies have shown that teeth replanted within 5 min after avulsion had the best prognosis. The teeth which cannot be replanted immediately should be stored in an appropripriate media such as normal saline, milk, saliva, hanks solution, or water .[6] The chance of pulpal and periodontal healing was inversely related to the stage of root development and the period of dry storage. High rates of avulsion injuries caused by road traffic accidents may be one of the reasons for delayed treatment. When a serious accident occurs, teeth are not the subject of greatest interestThough teeth are not of primary interest in an emergency situation endangering life, they are important for function and aesthetic. [7]

In the case presented here, the patient reported immediately to the department and the other important thing was that tooth was kept in her socket by her teacher. So it was considered a case which was having good prognosis. Some factors such as minimal extraoral time, carrying of the tooth to the clinic, and the young age of patient enhance the result of the case. Immediate root canal therapy prior to the placement of the avulsed tooth was not carried out to reduce the extraoral time. [8]

Splinting is required routinely after replantation of avulsed teeth. A splinting technique that allows physiological movement of the tooth during healing and that is in place for a minimal time period results in a decreased incidence of ankylosis. Semi-rigid (physiological) fixation for 7-10 days is recommended. [9] The splint should allow the movement of the tooth and should have no memory (so the tooth is not moved during healing) and should not impinge on the gingival area, and should not prevent maintenance of oral hygiene in the area. In this case, splinting was done for a period of weeks during which endodontic treatment was carried out.

Systemic antibiotics are often recommended after replantation, but their effectiveness in preventing root resorption is not mentioned. Systemic antibiotics are often recommended after replantation, but their effectiveness in preventing root resorption is questionable. [10] To date, the value of antibiotic therapy in replantation has been demonstrated only in the experimental setting. [11],[12] Andreasen and others, in their prospective study, showed that systemic antibiotics had no effect on periodontal healing clinically. [13],[14]

Follow-up evaluation was done at 1, 6, 12, and 24 months after replantation. While treating the avulsion cases, it is recommended that root canal therapy should be carried out either before placing the tooth into the socket or after placing the tooth according to extraoral time.

As in presented case due to minimal extraoral time, the root canal therapy was planned after placement of the tooth into its socket. But when follow-up was done, the tooth gave normal vitality response and no periapical changes were seen in the radiographs. Till now, after completion of 2 year, tooth is responding normal to all the tests and no root canal therapy seems to be required for this tooth. [15],[16],[17]

 
   References Top

1.Andreasen JO, Andreasen FM. Avulsions. In: Andreasen JO, Andreasen FM, editors. Textbook and Colour Atlas of Traumatic Injuries to the Teeth. Copenhagen: Munksgaard; 1994. p. 383-425.  Back to cited text no. 1
    
2.Andreasen JO, Andreasen FM, Andreasen L. Luxation injuries of permanent teeth, Concussion and subluxation, Extrusive luxation and lateral luxation. Textbook and Colour Atlas of Traumatic Injuries to the Teeth. 4 th ed. Oxford: Blackwell Munksgaard; 2007. p. 383-427.  Back to cited text no. 2
    
3.Andreasen JO, Andreasen FM. Avulsions. In: Andreasen JO, Andreasen FM, Andersson L, editors. Textbook and Colour Atlas of traumatic injuries to the Teeth. 4 th ed. Oxford: Blackwell Muksgaard; 2007. p. 444-88.Z  Back to cited text no. 3
    
4.Al-Jundi SH. Type of treatment, prognosis, and estimation of time spent to manage dental trauma in late presentation cases at a dental teaching hospital: A longitudinal and retrospective study. Dent Traumatol 2004;20:1-5.  Back to cited text no. 4
    
5.Andreasen JO, Borum MK, Jacobsen HL, Andreasen FM. Replantation of 400 avulsed permanent incisors. 1. Diagnosis of healing complications. Endod Dent Traumatol 1995;11:51-8.  Back to cited text no. 5
    
6.Hamner JE 3 rd , Reed OM, Stanley HR. Reimplantation of teeth in the baboon. J Am Dent Assoc1970;81:662-70.  Back to cited text no. 6
    
7.Cho SY, Cheng AC. Replantation of an avulsed incisor after prolonged dry storage: A case report. J Can Dent Assoc 2002;68:297-300.  Back to cited text no. 7
    
8.Sanu OO, Utomi IL. Parental awareness of emergency management of avulsion of permanent teeth of children in Lagos, Nigeria. Niger Postgrad Med J 2005;12:115-20.  Back to cited text no. 8
    
9.Berthold C, Thaler A, Petschelt A. Rigidity of commonly used dental trauma splints. Dent Traumatol 2009;25:248-55.  Back to cited text no. 9
    
10.Barrett EJ, Kenny DJ. Avulsed permanent teeth: A review of the literature and treatment guidelines. Endod Dent Traumatol 1997;13:153-63.  Back to cited text no. 10
    
11.Hammarström L, Blomlöf L, Feiglin B, Andersson L, Lindskog S. Replantation of teeth and antibiotic treatment. Endod Dent Traumatol 1986;2:51-7.  Back to cited text no. 11
    
12.Sae-Lim V, Wang CY, Choi GW, Trope M. The effect of systemic tetracycline on resorption of dried replanted dogs' teeth. Endod Dent Traumatol 1998;14:127-32.  Back to cited text no. 12
    
13.Andreasen JO, Andreasen FM, Andersson L. Physical and chemical methods to optimize pulp and periodontal healing after traumatic injuries. Textbook and Colour Atlas of Traumatic Injuries to the Teeth. Copenhagen: Blackwell Munksgaard; 2007. p. 172-94.  Back to cited text no. 13
    
14.Andreasen JO. Relationship between surface and inflammatory resorption and changes in the pulp after replantation of permanent incisors in monkeys. J Endod 1981;7:294-301.  Back to cited text no. 14
    
15.Andreasen JO. Periodontal healing after replantation and autotransplantation of incisors in monkeys. Int J Oral Surg 1981;10:54-61.  Back to cited text no. 15
    
16.Andreasen JO. Effect of extra-alveolar period and storage media upon periodontal and pulpal healing after replantation of mature permanent incisors in monkeys. Int J Oral Surg 1981;10:43-53.  Back to cited text no. 16
    
17.Andreasen JO, Kristerson L. The effect of limited drying or removal of the periodontal ligament. Periodontal healing after replantation of mature permanent incisors in monkeys. Acta Odontol Scand 1981;39:1-13.  Back to cited text no. 17
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11]



 

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    Abstract
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