|
Avulsion |
|
Replantation of avulsed teeth can be successful where there is: ¨ Minimal damage to the pulp and periodontal ligament ¨ Suitable storage medium ¨ Short extra-alveolar storage time
Treatment: 1. Replant as soon as possible if appropriate 2. LA is alveolar fracture and manipulation 3. Gently irrigate socket with saline and suction, avoid curettage. Rinse root surface 4. Handle tooth by crown, gentle repositioning 5. Splint for 1 week with semi-rigid splint 6. Antibiotics and tetanus booster? 7. Advise soft diet and Chlorhexidine mouthwash 8. Review after 1 week 9. In a mature tooth extirpate the pulp within 1—2 weeks 10. If any sign of root resorption extirpate and dress with calcium hydroxide.
Prognosis: The main complication is root resorption which is related to necrosis of part or all of the periodontal ligament, and may further be complicated by necrosis of the pulp and / or infection.
A critical period of dry storage has been reported to be between 18—30 minutes, after which a marked increase in root resorption is seen. Prolonged drying of the root presents the worst prognosis because of loss of vitality of the periodontal ligament and dehydration of the pulp.
Cold, fresh milk appears to be the best storage medium for storage.
Andreason and Hjorting– Hansen, 1966 ¨ 90% of teeth replanted within 30minutes did not develop root resorption when reviewed at intervals ranging between 1—13 years ¨ Teeth replanted within 15minutes following avulsion have a favourable long-term prognosis ¨ Teeth replanted after 60minutes would become ankylosed and resorbed within 3—7 years in young patients, whereas a tooth replanted under similar conditions in older patients might remain in function for considerably longer. |
|
Complete displacement of the tooth out of its socket |
