Management of avulsed permanent incisors: A decision analysis based on changing concepts.

Department of Pediatric Dentistry Lutheran Medical Center
Resident’s Name: Joanne Lewis Date: 08/22/2008
Article title: Management of avulsed permanent incisors: A decision analysis based on changing concepts. Author(s): Jessica Y. Lee DDS MPH, William F. Vann Jr. DMD PhD, Asgeir Sigurdsson DDS Journal: American Academy of Pediatric Dentistry Volume (number): 23 Month, Year: 2001 Major topic: Management of avulsed permanent incisors. Minor topic(s): N/A Type of Article: Analysis Main Purpose: To present decision trees (flowcharts) for the management of avulsed permanent incisors. Overview of method of research: The decision trees were based on guidelines from the American Academy of Endodontics and incorporate some newer ideas and changing concepts. Findings: The two main complications of avulsed teeth are attachment damage and pulpal infection, so management and treatment should be aimed at minimizing these effects. Some interesting items from this article are: - If a tooth has been out of the oral cavity for greater than 60 minutes with dry storage, the periodontal ligament has no chance of surviving, meaning that ankylosis is certain. - When cleaning the tooth prior to reimplanting, scaling or scraping the root will remove any viable periodontal ligament cells. This may be desirable if ankylosis is predicted and the goal is to delay it as long as possible. An alternative is to soak the tooth in citric acid for three minutes. - After soaking the tooth in citric acid, it should be soaked in fluoride (APF or NaF) for 20 minutes - this has been shown to significantly reduce the rate of resorption. - Immature teeth that are soaked in a 1% Doxycycline solution prior to reimplanting have a greater rate of revascularization. (These studies were done in animals.) - For systemic antibiotics, Doxycylcine has been found to be the most effective in reducing inflammatory root resorption. Key points/Summary: The decision trees are presented in the article. Assessment of article: The decision trees are an easy, up-to-date reference for managing avulsed permanent incisors.