Avulsion Seminar
Avulsion Seminar
Avulsion Seminar
O. K. PREETHI
Ⅱyear MDS
CONTENTS
1. INTRODUCTION
4. TREATMENT MODALITIES
6. HEALING
DEFINITION :
Complete and total displacement of the tooth from its socket
INCIDENCE :
0.5-3% of traumatic injuries in permanent dentition
7-13% of traumatic injuries in primary dentition
The tooth has been kept in special storage media with the extraoral dry
time less than 60 minutes
×
Wrapping the tooth in Dehydration -
a dry handkerchief or periodontal
paper tissue ligament
• HBSS is essentially a pH-balanced salt solution contains ingredients, such as glucose, sodium
chloride, potassium chloride, calcium chloride, magnesium chloride, sodium bi- carbonate
and sodium phosphate, which can sustain and reconstitute the depleted cellular components
of the PDL cells.
• It can preserve cells and tissues for 24 h and both the pH (7.4) and the osmolality (280
mOsmol Kg-1) are ideal.
• HBSS - the most effective medium for preserving viability, mitogenicity, and clonogenic
capacities of PDL cells for up to 24 h at 4°C when compared with other solutions.
Ashkenazi et al, 2001
HANK'S BALANCED SALT SOLUTION (HBSS)
• 94% cell viability after storage of cultured human PDL cells for 24 h
• The Save-A-Tooth solution, which contains HBSS, showed inferior results than
the original product, which may be explained by the fact that HBSS is prepared
for immediate use, when it has a better performance.
Extra-Alveolar Storage Media for teeth : A Literature review by Sangappa SK et al, 2014
VIASPAN
Extra-Alveolar Storage Media for teeth : A Literature review by Sangappa SK et al, 2014
CULTURE MEDIUM
Extra-Alveolar Storage Media for teeth : A Literature review by Sangappa SK et al, 2014
CUSTODIOL
Extra-Alveolar Storage Media for teeth : A Literature review by Sangappa SK et al, 2014
MILK
Extra-Alveolar Storage Media for teeth : A Literature review by Sangappa SK et al, 2014
EGG WHITE
• Teeth stored in egg white for 6-10 h had a better incidence of repair than those
stored in milk for the same amount of time.
• Egg white has a pH of 8.6–9.3 and its osmolality is between 251 and 298
mOsmol Kg-1.
• No significant difference between egg white and HBSS at storage times of 1,
2, 4, 8 and 12 h has been established.
• Some experiments show a small loss of efficacy overtime, possibly due to
egg‘s high pH and also because the PDL cells could target the several egg
proteins as strange bodies.
Extra-Alveolar Storage Media for teeth : A Literature review by Sangappa SK et al, 2014
COCONUT WATER
• Coconut water is biologically pure and sterile, with a rich presence of amino
acids, proteins, vitamins, and minerals.
• This natural isotonic fluid is available in its natural form directly from the
coconut or in long shelf life packages and plastic bottles, mainly in tropical
countries.
Extra-Alveolar Storage Media for teeth : A Literature review by Sangappa SK et al, 2014
Coconut water was Inflammatory resorption was more frequent
superior to HBSS, milk or when the tooth was maintained in coconut
propolis in maintaining water compared with milk.
the viability of PDL cells. Thomas et al, 2008
Gopikrishna et al, 2008 Pearson et al, 2003
• Though studies had showed promising results as storage / transport media for
avulsed teeth, their lack of availability limit their indication and its biological
properties have not been established yet.
Extra-Alveolar Storage Media for teeth : A Literature review by Sangappa SK et al, 2014
GROWTH FACTORS
• The use of growth factors supplemented in storage media can function as potent biological
mediators for the promotion of PDL regeneration.
• After 24 h of storage in different storage media supplemented with growth factors, that there
was an increase in the mitogenicity of PDL fibroblasts by 20 to 37%.
• However, this supplementation did not increase the mitogenic capacity of PDL fibroblasts
stored at room temperature for 2 to 8 h.
• Thus, supplementation of growth factors in storage median improved the effectiveness of the
media only when the storage period was long (more than 24 hours).
• For short periods of storage (2 to 8 h), the use of media without growth factors is preferable.
• However addition of growth factors on storage media need to be manufactured and distributed
for clinical use.
PATIENT’S OWN SERUM
The histologic picture after the tooth had been preserved in serum for about one
hour showed that the tissues still stained well, indicating that serum can maintain
the vitality of the periodontal membrane during the critical extra-alveolar period
during tooth transplant or replant procedure.
EURO-COLLINS
• Hypothermal medium developed for preserving organs to be transplanted.
• Ph of 7.4 and osmolality of 420 mOsmol Kg-1 – favourable for cell growth
• Teeth stored in the Euro-Collins solution, observed similar results to those
observed after immediate replantation, with good repair of supporting tissues,
repair and reorganization of vessels and PDL collagen fibers and neoformation
of cementum. Their lack of availability and high cost make their routine use
unviable.
Extra-Alveolar Storage Media for teeth : A Literature review by Sangappa SK et al, 2014
RICETRAL
Extra-Alveolar Storage Media for teeth : A Literature review by Sangappa SK et al, 2014
PROBIOTIC SOLUTION
• Probiotic may be able to maintain PDL cell viability as HBSS, milk, or saline.
Extra-Alveolar Storage Media for teeth : A Literature review by Sangappa SK et al, 2014
NORMAL SALINE
• Saline solution was harmful to the cells of PDL in avulsed teeth if it is used
for longer than two hours.
×
Extra-Alveolar Storage Media for teeth : A Literature review by Sangappa SK et al, 2014
TAP WATER
×
Extra-Alveolar Storage Media for teeth : A Literature review by Sangappa SK et al, 2014
STORAGE MEDIA
Eagle's culture medium = Viaspan = Euro collins = Custodiol = HBSS > Milk ≥
Propolis ≥ Green tea ≥ Egg > coconut water ≥ Ricetral.
Extra-Alveolar Storage Media for teeth : A Literature review by Sangappa SK et al, 2014
EMERGENCY TREATMENT AT THE SITE OF AVULSION INJURY
1. Wash the tooth in running water without brushing or cleaning it and examine it
to be certain that the tooth is intact
4. Replace the tooth in its socket using gentle, steady finger pressure
Administer systemic
Verify normal of
antibiotics - Apply a flexible
the replanted
Doxycycline splint for a
tooth both
In young patients - period of 2
clinically and
phenoxymethyl weeks
radiographically
penicillin
GROSSMAN’S ENDODONTIC PRACTICE – 12th EDITION
OPEN APEX CLOSED APEX
CLOSED APEX
• If contaminated, clean the root surface and apical foramen with a
stream of saline and place the tooth in saline
• Remove the coagulum from the socket with a stream of saline
• Examine the alveolar socket
• If there is a fracture of the socket wall, reposition it with a suitable
instrument
• Replant the tooth slowly with slight digital pressure
• Continue with the treatment as in the case of the tooth that has already
been replanted at the site of avulsion
Reimplantation
OPEN APEX
CLOSED APEX
• In teeth with closed apex, ideal time to begin root canal treatment is 7
-10 days after replantation procedure. Calcium hydroxide - intracanal
medication for up to 1 month followed by root canal filling.
• In teeth with open apices, that have been replanted immediately or
kept in appropriate storage media, pulp revascularization is possible.
Root canal treatment is avoided unless there is clinical and
radiographic evidence of pulpal necrosis.
• Root canal treatment - done prior to replantation in a tooth that has
been dry for more than 60 minutes before replantation.
SURFACE INFLAMMATORY
REPLACEMENT RESORPTION
RESORPTION RESORPTION
RADIOGRAPHICALLY
CLINICALLY
Tooth is immobile. Children-infraocclusion.
Percussion tone is high
TEXTBOOK AND COLOR ATLAS OF TRAUMATIC INJURIES TO THE TEETH BY
J.O.ANDREASEN AND F.M.ANDREASEN – 3rd EDITION
HEALING