Avulsion Flashcards
At what age is avulsion most common and why?
In young dentition, where root development is still incomplete and periodontium very resilient
What are most important factors determining success of treatment?
What conditions are required for optimal healing?
Tooth is out of its socket for as short a period as possible, extraalveolar storage is in a physiologic medium, and contamination of tooth is eliminated/reduced/controlled by antibiotics
When is gingival attachment re-established?
1 week after injury
When is PDL revascularized?
1 week after injury
What is pulp revascularized?
1 week after injury
What physiological storage mediums can be used to store an avulsed tooth?
Physiological saline, tissue culture media, saliva, and milk
When should you not replant a tooth?
In patients with open apices and a dry extraalvolar period greater than 60 min, as well as patients with severe periodontal conditions and gross, untreated carious lesiosn of involved teeth
How long should you splint an avulsed tooth for?
7 days
What follow-up schedule would you adopt?
A radiographic examination 3 weeks after replantation, follow-up again at 6 weeks, 3 months and 6 months after injury
What follow-up schedule would you adopt if radiographic findings vaguely suggest inflammatory resorption and periapical radiolucency, both indications of infected pulp necrosis?
Further examinations at 1-week intervals should be made
Make notes on antibiotic and anti-tetanus therapy
When observing teeth with open apices what signs and or symptoms indicate need for endodontic intervention?
What three groups should clinician classifying avulsed tooth into before commencing treatment?
PDL cells are most likely viable/PDL cells may be viable but compromised/PDL cells are likely to be non-viable
When are PDL cells most likely viable?
Tooth has been replanted immediately/within a very short time (about 15 minutes) at place of accident
What may PDL cells be viable but compromised?
Tooth has been kept in a storage medium (eg, milk, HBSS (Save-a-Tooth/similar product)/saliva/saline, and total extra-oral dry time has been <60 minutes).
When are PDL cells likely to be non-viable?
Total extra-oral dry time has been more than 60 minutes, regardless of tooth having been stored in a medium/not
What is endodontic treatment for an avulsed tooth with closed apices (mature teeth)?
Pulp extirpation should be started no later than 2 weeks after re-implantation
What is endodontic treatment for an avulsed tooth with open apices (immature teeth)?
May revascularise but needs to be closely monitored as resorption and pulp death are very common
Why should an avulsed tooth with open apices (immature teeth) be review more frequently?
Due to risk of infection-related (inflammatory) re-sorption and rapid loss of tooth and supporting bone when this is not identified quickly
What cases require consideration as replantation may not always be advisable?
Gross untreated caries may indicate that commitment to necessary follow up is not there, a patient who cannot tolerate treatment under local and awake, marked anterior crowding, and prolonged dry storage of avulsed tooth
What will avulsed incisor with a closed apex need?
Root treatment
