Tooth Avulsion and Replantation

Tooth Avulsion is the complete displacement of tooth from it’s alveolar socket. This is usually a consequence of traumatic injuries- be it accidental or sports related. Tooth avulsion in milk teeth (baby teeth) and permanent teeth (adult teeth) differ from each other in their pattern and severity of the trauma.

Among all dental trauma, avulsion is one of the most serious dental injuries warranting emergency treatment. Presence of tooth outside of the tooth socket leads to cutting off of vital blood and nerve supply eventually leading to tooth loss. Avulsion treatment outcomes are very much dependent on the first-aid measure as well as the agility to seek dental treatment i.e appropriate storage media and immediate reimplantation.The golden time for replantation is 20 to 30 minutes.

Treatment is in two phases:

1st phase: It is at the site of trauma which includes storage and handling of the avulsed tooth.Contamination can be reduced by appropriate use of storage media like ‘Save-a-Tooth’ solution available in medical stores.Milk /saliva or saline can be used,if this solution is not immediately available.Amongst these alternatives milk is considered as the best temporary storage medium to store the tooth, as it is most physiologically compatible with tooth cells and has little or no bacterial content. The storage period should be kept to a minimum of less than an hour to ensure the best treatment outcome.

2nd phase : In the dental clinic teeth splinting is the general line of treatment for avulsed teeth ,with and without alveolar bone fracture. Immediate dental splinting is an assembly to protect, stabilize and immobilize fractured, mobile, re-implanted teeth. Semi –rigid fixation(splinting) for two weeks along with adjunctive therapy of antibiotics, analgesics,,mouth wash and Tetanus vaccine is recommended to prevent avulsion related bacteremia and inflammatory resorption.Splint removal is recommended at 2 weeks to ensure adequate immobilzation of the avulsed tooth.

Root canal therapy and radiographical and clinical follow-ups are the key to optimum outcomes in avulsions cases . Clinical and radiographc monitoring at 2 weeks, 4 weeks, 3 months, 6 months, 1 year ,and hence once yearly for at least 5 years is recommended.

Favourable outcome of a replanted tooth is a functional, asymptomatic tooth with normal mobility and no sensitivity to percussion. The main adverse outcome of tooth replantation is replacement root resorption(ankylosis). It implies possible risks of infraocclusion, impairment of alveolar bone growth, and tooth loss. The risk increases dramatically with delayed replantation .

In milk teeth replantation is contraindicated due to risk of replacement root resorption ( ankylosis).Injury to the permanent tooth bud which lies under the roots of the milk tooth may lead to certain defects in the permanent tooth like tooth malformation, enamel defects and delayed eruption.

The long term prognosis of replanted avulsed teeth show great variability ranging from complete healing without any symptoms to inflammation and rapid tooth loss. Success rate ranges from 50 to 83% and may retain for 5- 10 years. Unfavorable outcome and low survival rate are due to delayed replantation and non-physiological storage. Immature teeth in young children show poor prognosis compared to mature teeth seen in adults.

Alternative treatments for the avulsed tooth in cases of the failure of aforementioned treatment are decoronation, autotransplantation, partial prosthesis, and dental implant. In conclusion, a little knowledge and swift response will empower you to increase the chances of saving a knocked out tooth and thus maintain aesthetics and functionality.

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