AVULSION

Abu-Hussein M.

AVULSION

( EXARTICULATION OR

TOTAL LUXATION )

DEFINITION : The tooth is

displaced totally out of it’s socket.

CLINICAL APPEARANCE

The socket is found empty or filled with coagulum.

EPIDEMIOLOGY

• Rare injuries(1.6% of dental injury)

• Primary dentition > secondary

dentition

• Boys > girls

• The teeth most commonly damaged

are upper central incisor

ETIOLOGY

• Cause: accident

contact sports

fighting

• Predisposing factor :

Cl II malocclusion

Periodontal disease

HISTORY TAKING

• When did the injury take place ?

• Where did the injury take place ?

• How did the injury take place ?

HISTORY TAKING

• Has treatment been provided elsewhere ?

• Has there been previous

trauma ?

• Has avulsed tooth been

accounted for ?

HISTORY TAKING

» MEDICAL HISTORY

» DENTAL HISTORY

» SOCIAL HISTORY

» FAMILY HISTORY

- Obtain information : loss of

consciousness, neck or head pain, and numbness

- Ask about the event….

amnesia?

- Other signs: nausea, vomiting,

drowsiness, blurred vision

Neurological Assessment

EXTRAORAL EXAMINATION

• Facial wound

• Fracture of mandible / maxilla

• Occlusion

• Mandibular movement

INTRAORAL EXAMINATION

• Solf tissue

• Foreign body

• Alveolar bone fracture

RADIOGRAPHIC EXAMINATION

• Are routinely to determine the

socket

• Check for supporting

structure and adjacent tooth

• Compare with the future radiographs

RADIOGRAPHIC EXAMINATION

TREATMENT OF AVULSED TOOTH

Success of treatment depend on

»Extraoral time

»Storage media

»Stage of tooth development

EXTRAORAL TIME

• After 60 minutes of dry

storage media very few PL

cells remain viable.

• 120 minutes - complete PL cells necrosis.

STORAGE MEDIA

– Hank’s balance salt

solution (HBSS)

– Milk

– Saliva

– Water

TREATMENT OF AVULSED TOOTH

• Preparation of the avulsed tooth

• Preparation of the socket

• Replantation

• Splinting

• Follow up

PREPARATION OF THE AVULSED TOOTH

• Saline to remove foreign bodies

• Avoid scraping the root surface

PREPARATION OF THE SOCKET

• The region should be anesthetized

• Gently clean with NSS to

remove clotted blood and foreign materials

PREPARATION OF THE SOCKET

REPLANTATION

• Press the tooth gently

into the socket

• Compress buccal and

lingual plate of bone

• Take radiograph immediately

REPLANTATION

SPLINTING

Requirements of splint

• Provide stabilization for the replanted tooth

• Slight physiologic movement

• Hygienically designed

• Not leave the replanted tooth in traumatic occlusion

SPLINTING

• Wire composite splint

• Composite splint

• Removable flexible

acrylic splint

• Orthodontics wire

• Etc.

SPLINTING

SPLINTING

How long?

the fixation period should

be sufficient to allow the

reattachment of PDL. This will take from 1 – 3 weeks.

FOLLOW UP

A well designed follow up procedure is diagnose complication.

• 1 week.

• 2 weeks.

• 3 weeks. A radiographic examination is able to demonstrate periapical radiolucency

FOLLOW UP

• 6 weeks. A clinical and

radiographic examination

A clinical and radiographic

examination is able to

demonstrate most case of inflammatory resorption

FOLLOW UP

• 2 and 6 months. Optional

for cases with questionable

healing

• 1 year. A clinical and

radiographic examination

can ascertain the long –term prognosis

WOUND HEALING AFTER REPLANTATION

• Surface resorption

• Replacement resorption

• Inflammatory root resorption

Surface resorption

Surface resorption is

manifested as a excavations

on the root surface without

associated breakdown of the lamina dura.

Surface resorption

Replacement resorption

Replacement resorption

(ankylosis) is initially seen

as a disappearance of PDL

space, later follow by a substitution with bone.

Replacement resorption

• PDL injury -> inflammation -> osteoclastic activity -> fusion

between bone and root surface

Inflammatory resorption

Inflammatory resorption is

seen as bowl shaped cavities

on the root surface with an

associate radiolucency affecting the lamina dura.

Inflammatory resorption

Summary

The influence of storage

conditions on the clonogenic capacity of periodontal cell :

implication for tooth replantation

P.C. Lekic , D.J. Kenny & E.J. Barrett

International Endodontic Journal (1998)31,137-140

INTRODUCTION

• Viable periodontal ligament

(PL) cells are required for the healing of avulsed teeth after

replantation.

INTRODUCTION

• The viability of PL cells in

extra- alveolar conditions may

be extended by incubating the

avulsed tooth in a physiologic storage medium.

INTRODUCTION

• Regeneration of PL following

replantation is closely related

to preservation of the viability PL cells that adhere

to avulsed teeth

OBJECTIVES

• To investigate the effects of

combinations of storage media

on the clonogenic capacity of

human PL cells at two different extra alveolar period.

MATERIALS AND METHODS

• 20 human premolar teeth were

extracted

• Aged 11 – 14 years

• 4 storage media (saliva , milk ,

HBSS , MEM)

• All teeth were assayed at 30

and 60 min

MATERIALS AND METHODS

Twenty extracted human premolars

Time

0 min

15 min

30 min

Saliva (23c) MEM (+4c)

Milk MEM (+4c)

One-half of PL tissue explanted from premolar(cells released and

analyzed for clonogenic capacity)

Saliva HBSS

15 teeth 5 teeth

5 teeth

Per condition

RESULTS

0

5

10

15

20

25%

of

ce

lls

wit

h c

lon

og

en

ic

ca

pa

cit

y

30 60Time (min)

Results of clonogenic capacity assay

MEM

Milk

HBSS

Saliva