Management of an avulsed permanent tooth

Avulsion of permanent teeth is seen in 0.5–3% of all dental injuries Numerous studies show that this

injury is one of the most serious dental injuries, and the prognosis is very much dependent on the actions taken at

the place of accident and promptly after the avulsion. Replantation is in most situations the treatment


of choice, but cannot always be carried out immediately. An appropriate emergency management and treatment

plan are important for a good prognosis. There are also individual situations when replantation is not indicated

(e.g., severe caries or periodontal disease, non-cooperating patient, severe medical conditions (immunosuppression and severe cardiac conditions) which must be dealt with individually. Replantation may successfully save the tooth, but it is important to realize that some of the replanted teeth have lower chances of long-term survival and may even be lost or extracted at a later stage. Guidelines for the emergency management are useful for delivering the best care possible in an efficient manner. The International Association of Dental Traumatology (IADT) has developed a consensus statement after an update of the dental literature and discussions in expert groups.

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Dentists should always be prepared to give appropriate advice to the public about first aid for avulsed teeth.

An avulsed permanent tooth is one of the few real emergency situations in dentistry. In addition to increasing the public awareness by, for example, mass media campaigns, healthcare professionals, guardians and teachers should receive information on how to proceed following these severe unexpected injuries. Also, instructions may be given by telephone to people at the emergency site. Immediate replantation is the best treatment at the place of accident. If for some reasons this cannot be carried out, there are alternatives such as using various storage media. If a tooth is avulsed, make sure it is a permanent tooth (primary teeth should not be replanted).

Choice of treatment is related to the maturity of the root (open or closed apex) and the condition of the

periodontal ligament cells. The condition of the cells is depending on the storage medium and the time out of

the mouth, especially the dry time is critical for survival of the cells. After a dry time of 60 min or more, all periodontal ligament (PDL) cells are nonviable. For this reason, the dry time of the tooth, before it was placed replanted or placed in a storage medium, is very important to assess from the patient’s history.

Article from the guideline of International association of dental traumatology

Management of an avulsed permanent tooth - Ultima modifica: 2014-08-06T13:38:52+00:00 da redazione


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