Avulsions
Avulsion
• Quick emergency intervention
• Urgent clinical treatment
• Multidisciplinary nature
Accident Site
• Replant if possible or place in appropriate
•
•
storage medium to minimize necrosis of PDL
cells
Storage media in order of preference, Hank’s
balanced salt solution, milk, saliva, saline or
water. Water is better then dry but is hypotonic
and rapid cell lysis, death and resulting
inflammation.
Single most important factor is speedy
replantation, make effort to replant with in 20
minutes.
Dental Office
• Prepare the socket
• Prepare the root
• Replant
• Construct splint
• Administer local or systemic antibiotics
Preparation of the Root
Extraoral dry time less then 60 minutes
• Closed apex: rinse root with saline and replant
•
gently. Pulp will die but if replanted within 20
minutes a good chance of PDL healing exists.
Over 60 minutes periodontal cell survival is
unlikely.
Open apex: gently rinse off debris with saline,
soak in doxycycline for 5 minutes. This
enhances pulpal revascularization. (1 mg in 20
ml of saline)
Preparation of the Root
extraoral dry time exceeds 60 minutes
• Closed Apex: remove entire PDL by placing in
•
acid, rinse with saline and soak in 2% stannous
fluoride for five minutes, replant.
Open Apex: Controversy regarding replanting.
Is yes same as above but definitely do
endodontics extraorally to facilitate the seal.
Will be lost do to osseous replacement
resorption but will maintain height and width of
alveolar bone
Preparation of the Socket
• Leave undisturbed before replantation
• If an organized clot is blocking
replantation gently rinse with saline and
lightly aspirate
• If alveolar bone has collapsed use a blunt
instrument to reposition the wall
Splinting
• Splint should allow some movement to stimulate
•
•
•
PDL fibers to reattach. A rigid splint promotes
ankylosis
Physiologic splint removed in 2 weeks
Make sure the repositioned tooth and splint are
not in traumatic occlusion.
Remember if the avulsed tooth occurs in
conjunction with an alveolar fracture splint must
remain for 4 to 8 weeks
Adjunctive Therapy
• Begin antibiotics from day of replantation
until splint removal.
• For patients not susceptible to tetracycline
staining use doxycycline (decreases
resorption) or Pen VK
• Gentle oral hygiene and chlorhexidine
rinses
• Pain relieve usually NSAI if needed
Endodontic Treatment
• Extraoral time less than 60 minutes with closed
•
apex: Initiate endodontic after 2 weeks use
long term CAOH before obturation to inhibit
resorption
Opened apex less than 60 minutes: Avoid
endodontic treatment, look for signs of
revascularization. Follow closely at first sign of
infection initiate apexification procedures.
Endodontic Treatment
• Extraoral time more than 60 minutes with closed
•
apex: Initiate endodontic therapy after 2 weeks,
use long term CAOH treatment
More than 60 minutes and an open apex: do the
endodontics outside the mouth before
replanting. If it was replanted without an
obturation initiate apexification. Remember
some would suggest not replanting because of
certain replacement resorption