Trauma 3 - Avulsion Flashcards
What is avulsion?
Complete displacement of tooth from socket
Separation of PDL + exposure of root surface
What are some critical factors for avulsion replantation?
- Extra-alveolar dry time - EADT
- Extra-alveolar time - EAT
- Type of storage medium
What is EADT?
Time that tooth is out of the mouth before it was placed in a storage medium
(should be less than 30 mins or the cells will become non-viable)
EADT time frame (2)
Should be less than 30 mins or the cells will become non-viable
Increases chance of PDL healing + cementum
What is EAT?
Time tooth was out of socket, including the time was in the storage medium
EAT time frame
Should be less than 60 mins or the tooth will become non-viable even if stored in a medium
What happens to a tooths prognosis if it exceeded EADT + EAT time frame?
Not much chance of PDL healing
Need for bony healing
Protocol if a patient attends with the tooth already replanted (3)
> Don’t remove
Leave it and follow instructions regarding splinting
Radiograph to establish status of root development
List some public advice for an avulsed tooth (4)
- Hold by crown
- Wash in cold running water
- Replace in socket + child bites on tissue
OR
Store in milk/saliva/saline - GET TO DENTIST
Periodontal healing outcome post avulsion if tooth placed back into socket
Regeneration
Periodontal healing outcome if tooth wasn’t placed back into socket ASAP
PDL/Cemental healing
What can uncontrolled healing after avulsion lead to the production of? (3)
- Granulation tissue
- Infection
- Abscess
Pulpal outcomes post avulsion for an open apex
Regeneration - as the pulp is really wide and has more nerves coming the area
Closed apex has 1 vessel 1 nerve coming in so once ripped its less likely to regenerate
Why would you conduct a controlled necrosis?
When you know the tooth is going to become non-vital
You can take the live bit out before it dies or causes infection
This stops an uncontrolled infection that leads to a necrotic pulp
Tx for EAT<60mins and stored in medium closed apex
Chance of cement/PDL healing
- Replant tooth under LA
- Flexible splint for 14 days
- Consider antibiotics and check tetanus status
- After replantation + splinting, carry out pulp extirpation ideally 0-10 days unless apex is open (immature root)
- Following extirpation + disinfection, place an antibiotic steroid paste as intra-canal medicament (leave in for 2 weeks)
- Remove splint after 14 days
- At 2 weeks clean + replace intracranial medicament with NSCaOH - Obturation with GP should take place within 4-6wks
- Teeth with an open apex may revascularise
Tx for EAT <60mins open apex
Immature open apex
If decision made not to RCT it must be closely monitored clinically + radiographically for signs of continued growth vs loss of vitality
REVIEW INTERVAL 2wks (splint removal) 4 wks 2 mths 3 mths 6 mths Yearly
Course of action if tooth found to be non-vital and immature?
Extirpate pulp + refer
Review timeframe for EAT <60mins closed apex
3mths
6mths
12mths
yearly
Tx for EAT> 60mins closed apex
Unlikely to get PDL healing
Aim for bony healing by ankylosis
- Scrub root clean of dead PDL cells
- Extra-oral endodontics can be carried out prior to replantation
- Replant tooth under LA
- Splint: 4 weeks flexible splint
- Consider antibiotic prescription
If extra-oral ends not carried out extirpate at 7-10days and use NSCaOH as initial intra-canal medicament for 4wks prior to obturation with GP
Tx for EAT > 60 mins + open apex
Unlikely to get PDL healing
V small chance pulp will revascularise
Do not RTx unless signs of loss of vitality on follow up
- Replant tooth under LA
- Flexible splint for 4 weeks
- Consider antibiotics
- Check tetanus status
- Monitor closely for signs of necrosis vs continued root development
Review interval for >60mins EAT + open apex
2 weeks 4 weeks (splint removal) 2months 3months 6months yearly
When should replanting be avoided?
Immunocompromised
Other serious injuries that are priority
Usually even as a temporary space maintainer replanting is advised to help guide position of the adjacent erupting tooth
Course of action if pulpal necrosis detected in open apex teeth?
Pulp extirpation to avoid inflammatory resorption
