AVULSION
AVULSION
( EXARTICULATION OR
TOTAL LUXATION )
DEFINITION : The tooth is
displaced totally out of it’s
socket.
CLINICAL APPEARANCE
The socket is found empty
or filled with coagulum.
EPIDEMIOLOGY
• Rare injuries(1.6% of dental injury)
• Primary dentition > secondary
dentition
• Boys > girls
• The teeth most commonly damaged
are upper central incisor
ETIOLOGY
• Cause: accident
contact sports
fighting
• Predisposing factor :
Cl II malocclusion
Periodontal disease
HISTORY TAKING
• When did the injury take place ?
• Where did the injury take place ?
• How did the injury take place ?
HISTORY TAKING
• Has treatment been provided
elsewhere ?
• Has there been previous
trauma ?
• Has avulsed tooth been
accounted for ?
HISTORY TAKING
» MEDICAL HISTORY
» DENTAL HISTORY
» SOCIAL HISTORY
» FAMILY HISTORY
Neurological Assessment
- Obtain information : loss of
consciousness, neck or head
pain, and numbness
- Ask about the event….
amnesia?
- Other signs: nausea, vomiting,
drowsiness, blurred vision
EXTRAORAL EXAMINATION
•
•
•
•
Facial wound
Fracture of mandible / maxilla
Occlusion
Mandibular movement
INTRAORAL EXAMINATION
• Solf tissue
• Foreign body
• Alveolar bone fracture
RADIOGRAPHIC
EXAMINATION
• Are routinely to determine the
socket
• Check for supporting
structure and adjacent tooth
• Compare with the future
radiographs
RADIOGRAPHIC
EXAMINATION
TREATMENT OF AVULSED
TOOTH
Success of treatment depend on
»Extraoral time
»Storage media
»Stage of tooth
development
EXTRAORAL TIME
• After 60 minutes of dry
storage media very few PL
cells remain viable.
• 120 minutes - complete PL
cells necrosis.
STORAGE MEDIA
– Hank’s balance salt
solution (HBSS)
– Milk
– Saliva
– Water
TREATMENT OF AVULSED
TOOTH
•
•
•
•
•
Preparation of the avulsed tooth
Preparation of the socket
Replantation
Splinting
Follow up
PREPARATION OF THE
AVULSED TOOTH
• Saline to remove foreign bodies
• Avoid scraping the root surface
PREPARATION OF THE
SOCKET
• The region should be
anesthetized
• Gently clean with NSS to
remove clotted blood and
foreign materials
PREPARATION OF THE
SOCKET
REPLANTATION
• Press the tooth gently
into the socket
• Compress buccal and
lingual plate of bone
• Take radiograph
immediately
REPLANTATION
SPLINTING
Requirements of splint
• Provide stabilization for the
replanted tooth
• Slight physiologic
movement
• Hygienically designed
• Not leave the replanted
tooth in traumatic occlusion
SPLINTING
• Wire composite splint
• Composite splint
• Removable flexible
acrylic splint
• Orthodontics wire
• Etc.
SPLINTING
SPLINTING
How long?
the fixation period should
be sufficient to allow the
reattachment of PDL. This will
take from 1 – 3 weeks.
FOLLOW UP
A well designed follow up
procedure is diagnose
complication.
• 1 week.
• 2 weeks.
• 3 weeks. A radiographic
examination is able to
demonstrate periapical
radiolucency
FOLLOW UP
• 6 weeks. A clinical and
radiographic examination
A clinical and radiographic
examination is able to
demonstrate most case of
inflammatory resorption
FOLLOW UP
• 2 and 6 months. Optional
for cases with questionable
healing
• 1 year. A clinical and
radiographic examination
can ascertain the long –
term prognosis
WOUND HEALING AFTER
REPLANTATION
• Surface resorption
• Replacement resorption
• Inflammatory root resorption
Surface resorption
Surface resorption is
manifested as a excavations
on the root surface without
associated breakdown of the
lamina dura.
Surface resorption
Replacement resorption
Replacement resorption
(ankylosis) is initially seen
as a disappearance of PDL
space, later follow by a
substitution with bone.
Replacement resorption
• PDL injury -> inflammation ->
osteoclastic activity -> fusion
between bone and root surface
Inflammatory resorption
Inflammatory resorption is
seen as bowl shaped cavities
on the root surface with an
associate radiolucency
affecting the lamina dura.
Inflammatory resorption
Summary
The influence of storage
conditions on the clonogenic
capacity of periodontal cell :
implication for tooth
replantation
P.C. Lekic , D.J. Kenny & E.J. Barrett
International Endodontic Journal (1998)31,137-140
INTRODUCTION
• Viable periodontal ligament
(PL) cells are required for the
healing of avulsed teeth after
replantation.
INTRODUCTION
• The viability of PL cells in
extra- alveolar conditions may
be extended by incubating the
avulsed tooth in a physiologic
storage medium.
INTRODUCTION
• Regeneration of PL following
replantation is closely related
to preservation of the
viability PL cells that adhere
to avulsed teeth
OBJECTIVES
• To investigate the effects of
combinations of storage media
on the clonogenic capacity of
human PL cells at two different
extra alveolar period.
MATERIALS AND METHODS
• 20 human premolar teeth were
extracted
• Aged 11 – 14 years
• 4 storage media (saliva , milk ,
HBSS , MEM)
• All teeth were assayed at 30
and 60 min
MATERIALS AND METHODS
Twenty extracted human premolars
Time
15 teeth
0 min
Saliva (23c)
5 teeth
5 teeth
MEM (+4c)
Per condition
15 min
30 min
Milk
Saliva
HBSS
MEM (+4c)
One-half of PL tissue explanted
from premolar(cells released and
analyzed for clonogenic capacity)
RESULTS
% of cells with clonogenic
capacity
25
MEM
20
Milk
HBSS
15
Saliva
10
5
0
30
60
Time (min)
Results of clonogenic capacity assay
CONCLUSION
• Immediate storage of a avulsed
teeth in autologous saliva , a
followed by transfer to chilled milk
, preserves the presence of
sufficient progenitor cells in the PL
to warrant replantation and the
possibility of PL healing at 60 min
extra-alveolar duration.
Any
Questions?
Thanks for
your attention
REFERENCES
•
Peter J. Robinson,Louis H. Grernsey: Clinical
Transplantation in Dental
Specialties.C.V.Mostby,Missouri,1980
•
G.J.Robert,P.Longhurst: Oral and Dental Trauma in
Children and Adolestcents,Oxford university press Inc.
New York, 1996
•
Mitsuhiro Tsukiboshi: Autotransplantation of
Teeth,Quintessence,Tokyo,2001
•
J.O.Andreasen,F.M.Andreasen,L.K.Bakland, et al: Traumatic
Dental Injury.Munksgaard.Copenhagen,1999
•
M.E.J.Curzon: Handbook of Dental Trauma,Wrigth,Jordan
Hill,Oxford,1999