Management of avulsion (Permanent teeth) Flashcards
How should an avulsed tooth be dealt with at the place of incident?
Make sure its a permanent and not a primary tooth (should not be replanted). Keep the patient calm.
Find the tooth and pick it up by the crown w/o touching the root
If the tooth is dirty, wash under cold water max 10s.
Encourage caregiver or parent to then replant the tooth and for patient to bite on a hankerchief.
In which situations would the replantation of teeth be contraindicated?
Severe caries or periodontal disease Immunocompromised patient Severe cardiac conditions Non-cooperative patient Unconscious patient
What shuld be done if replantation at the place of injury is not possible?
Store the tooth in an ideal solution (glass of cold milk, Hanks balanced salt solution etc…). Or can keep in the side of the cheek if the patient is conscious.
What does an extraoral dry time of more than 60 minutes implicate?
All PDL cells are non-viable.
How can avulsed teeth be classified clinically prior to starting treatment?
1) PDL cells most likely viable. If the tooth has been replanted immediately or after a very short time at place of accident.
2) PDL cells viable but compromised. Tooth kept in a storage medium with a total dry time less than 60 minutes.
3) PDL cells non-viable. More than 60 minutes dry time or the storage medium was non-physiologic.
How should an avulsed permanent tooth with a closed apex be managed if it was quickly replanted prior to patients arrival?
Leave the tooth in place. Clean area with water spray and CHX.
Suture gingival lacerations if present.
Verify normal position of the replanted tooth both clinically and radiographically
Flexible splint up to two weeks
ADminister systemic Ab and check tetanus protection.
Initiate RCT 7-10 after replantation and before splint removal
How should an avulsed permanent tooth with a closed apex be managed if the PDL cells may be viable but compromised?
Clean the root surface and apical foramen with saline and soak the tooth in saline.
Give LA.
Irrgate socket with saline. Examine socket. If fractured, reposition with a blunt instrument.
Replant the tooth slowlly with digital pressure. NO FORCE.
Suture gingival lacerations
Verify normal position of replanted tooth (radiographically and clinically)
FLexible splint 2 weeks but kept away from gingiva.
ADmminister systemic Ab and check tetanus status.
Patient instructions.
Inittiate RCT 7-10 days after replantation before removal of splint.
How should an avullsed permanent tooth with a closed apex be managed if the PDL cells are non-viable (<60mins dry time)?
Remove non-viable tissue with gauze.
RCT prior to replantation (or 7-10 days after replantation as others)
LA
Irrigate socket with saline
Exmaine socket. If fractured, reposition appropriately.
Replant tooth
Suture gingival lacerations
Verify normal position clinically and radiographically.
Stabilise tooth with flexible splint for 4 weeks
Systemic Ab and check tetanus status.
Patient insstructions
What could one do with an vulsed permanent tooth with an extra-oral dry time of more than 60 minutes to slow down osseous replacement of the tooth?
Treat root surface with fluoride prior to replantation. Its been suggested to use 2% NaF for 20 minutes.
How should a permanent tooth that has been avulsed but replanted prior to the appointment be managed if the apex is opened?
Leave the tooth in place.
Clean the area with water spray, saline or CHX.
Suture gingival lacerations if present.
Verify normal position of tooth clinically and radiographically.
Flexible splint up to 2 weeks.
Systemic Ab and check tetanus status
Give patient instructions.
Monitor for possible revascularisatino of the pulp space and initiate RCT if this does not occur.
How shoudl an avulsed permanent tooth with an open apex be managed if the the PDL cells may be viable but compromised?
If contaminated, clean root surface and apical opening with saline.
Topical application of Ab has shown to improve revascularisation.
ADminister LA
Examine socket and reposition fractures if any.
Remove coagulum in socket and replant the tooth slowly with slight diital pressure.
Suture gingival lacerations.
Verify position of the tooth clinically and radiographically
Give sysstemmic Ab and check tetanus protection
Give patient instructions
How shoudl an avulsed permanent tooth with an open apex be managed if the PDL cells are non-viable?
Remove non-viable cells with gauze.
RCT carried out prior to replantation
Administer LA
Remove coagulum from socket and examine socket and fix appropriately
Replant tooth slowly with slight digital pressure.
Suture gingival laceration.
Verify pposition of tooth clincially and radiographically
Stabilise tooth with flexible splint for 4 weeks
Administer Ab and check tetanus status
Give patient instructions.
What are the patient instructions with regards to avulsed teeth?
Avoid cntact sports
Soft diet up to 2 weeks. Thereafter normal function as soon as possible.
Brush teeth with soft toothbrush after every meal
Use CHX mouthrinse (0.1%) twice a day for 1 week
How can non-viable PDL cells bbe removed atraummatically?
Soak in 5% Miltons solution
How should the endodontic treatment of avlused teeth be ccarried out?
Normally about 7-10 days after replantation unless revascularisation is the goal. CaOH is recommended as the intra-canal medication for 1 month.
Ledermix can be placed immedicately after replantation if PDL cells non-viable.
