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Abstract

Healing following avulsion and replantation is dependent on the extent of pulpal and periodontal ligament (PDL) tissue damage. Therefore, immediate replantation is the recommended treatment of choice for an avulsed permanent tooth. To achieve a more favourable prognosis following tooth replantation, use of an appropriate interim transport medium is usually advocated. Numerous studies have researched and advocated the use of media like saliva, milk, Hank's Balanced Salt Solution (HBSS) and ViaSpan. However, current research has indicated the use of few newer media as promising interim transport media for an avulsed tooth. This review summarises the current developments regarding the introduction of newer interim transport media for the treatment of avulsed teeth.

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Replantation of 400 avulsed permanent incisors. 4. Factors related to periodontal ligament healing.

Kathryn H Jacobsen, J Andreasen, F Andreasen … (1995)

400 avulsed and replanted permanent teeth were examined for periodontal ligament (PDL) healing, using standardized radiographic and clinical examination procedures (i.e. percussion test and mobility test). The effect of various clinical factors was examined, such as age and sex of the patient, type of tooth replanted, presence of crown fracture or bone fracture, stage of root development (including apical diameter and length of the pulp), type and length of extra-alveolar storage, clinical contamination of the root surface, type of root surface cleansing procedure, type and length of splinting period and antibiotic therapy. Surface resorption was generally diagnosed after 12 months; while inflammatory resorption and replacement resorption (ankylosis) were usually observed after 1 month and 1-2 months respectively. Most resorptive processes were diagnosed within the first 2-3 years. However, although rarely, even after 5 and 10 years new resorptive processes could be diagnosed. A univariate statistical analysis of 272 teeth revealed 9 factors significantly related to PDL healing. A subsequent multivariate analysis revealed that the following 4 factors had the strongest impact upon PDL healing, in descending order of significance: Stage of root development; length of the dry extra-alveolar storage period; immediate replantation and length of the wet period (saliva or saline storage). Nonphysiological storage, such as homemade saline and sterilizing solutions (chloramine and alcohol) always led to root resorption. Storage in tap water for more than 20 minutes usually led to root resorption. The common denominator for all these factors related to PDL healing appears to be survival of the PDL cells along the root surface. Based on these findings, immediate replantation is recommended irrespective of stage of root development.

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Guidelines for the management of traumatic dental injuries. II. Avulsion of permanent teeth.

, Thomas von Arx, Michael L. Hicks … (2007)

Avulsion of permanent teeth is the most serious of all dental injuries. The prognosis depends on the measures taken at the place of accident or the time immediately after the avulsion. Replantation is the treatment of choice, but cannot always be carried out immediately. An appropriate emergency management and treatment plan is important for a good prognosis. Guidelines 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 a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the group. In cases in which the data did not appear conclusive, recommendations were based on the consensus opinion of the IADT board members. The guidelines represent the current best evidence based on literature research and professional opinion. In this second article of three, the IADT Guidelines for management of avulsed permanent teeth are presented.

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Effect of extra-alveolar period and storage media upon periodontal and pulpal healing after replantation of mature permanent incisors in monkeys.

J.O. Andreasen (1981)

The effect of extra-alveolar period and storage media upon periodontal and pulpal healing after replantation was studied in green Vervet monkeys (Cercopithecus aethiops). Mandibular lateral incisors were extracted. The extra-alveolar period before replantation was 0, 18, 30, 60, 90, and 120 min. The storage media for the extracted teeth were tap water, physiologic saline, saliva or dry storage. The animals were sacrificed 8 weeks after replantation and the replanted teeth were examined histometrically. The following histologic parameters were registered for each tooth: surface resorption, inflammatory resorption, replacement resorption (ankylosis), periapical inflammatory changes, the extent of vital pulp and downgrowth of pocket epithelium. A significant relationship was found between the frequency of root resorption, extra-alveolar period and storage medium. This was especially evident after dry storage. Surface resorption was found with approximately the same frequency irrespective of extra-alveolar period and storage media. Inflammatory root resorption was especially common after dry storage and was related to the length of the extra-alveolar period. Already after 30 min dry storage, this resorption type was very prominent. Teeth stored in tap water, saline or saliva showed about the same frequency of inflammatory resorption, which increased slightly with increased extra-alveolar periods. Replacement resorption showed a strong relationship to dry storage and became very prominent after 60 min. Replacement resorption was rarely found among teeth stored in saline or saliva; whereas it was significantly increased among teeth stored in tap water. It is concluded that saline and saliva offer good protection against root resorption during the extra-alveolar period.

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PubMed ID:: 21738189

DOI:: 10.1038/sj.bdj.2011.523

ScienceOpen disciplines: Chemistry

Keywords: Cell Survival,drug effects,Dental Pulp,Humans,Organ Preservation Solutions,classification,therapeutic use,Periodontal Ligament,cytology,Prognosis,Tooth Avulsion,surgery,Tooth Replantation,methods

Current developments in interim transport (storage) media in dentistry: an update.

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Most cited references 49

Replantation of 400 avulsed permanent incisors. 4. Factors related to periodontal ligament healing.

Guidelines for the management of traumatic dental injuries. II. Avulsion of permanent teeth.

Effect of extra-alveolar period and storage media upon periodontal and pulpal healing after replantation of mature permanent incisors in monkeys.

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