Avulsed permanent maxillary incisors

Resident’s Name:  Joanne Lewis                                                                        Date: September 4, 2009

Article title:  Survival of avulsed permanent maxillary incisors in children following delayed replantation

Author(s):  E. J. Barrett, D. J. Kenny

Journal:  Endodontics and Dental Traumatology

Volume:  13

Date:  1997

Major topic: Avulsed permanent maxillary incisors

Type of Article:  Research article

Main Purpose:  To identify the variables that significantly influence the survival of incisors replanted after extended extraalveolar duration

Overview of method of research:  38 patients (25 males, 13 females) with a total of 52 reimplanted permanent maxillary incisors were included in the study.  Only teeth in which reimplantation was delayed (more than 5 minutes between avulsion and reimplantation) were included in the study.  A minimum follow-up time of 1 year was required for inclusion in the study.  Prior to reimplantation, the teeth were held by the crown and cleaned with physiologic saline.  The teeth were reimplanted and stabilized with a 0.014 or 0.016 stainless steel orthodontic wire.  All patients were placed on a 7 day course of penicillin or erythromycin and given a follow-up appointment in 7 to 14 days.  At the initial follow-up appointment, the splint was removed and endodontic therapy was initiated.  Calcium hydroxide was placed in the canal and left for 6 to 24 months; the calcium hydroxide was replaced when follow-up radiographs revealed a loss of material from the root canal.  The teeth were assessed periodically (3-6 weeks, 3 months, 6 months, 1 year) with radiographs and clinical exam.  Root canal obturation with gutta percha and sealer was completed following treatment with calcium hydroxide for 6 to 24 months unless the replanted tooth had an open apex; teeth with open apices were treated with calcium hydroxide until apexification occurred. 

Findings:  The majority of teeth that failed were lost within the first 2 years.  The relative risk of failure for incisors replanted with open apices was 4.2 times greater than for incisors replanted with closed apices.  Replanted incisors that required prolonged treatment with calcium hydroxide were found to be 10 times more likely to fail than teeth that were obturated.  Patients who were younger than 11 at the time of replantation showed decreased tooth survival.

Key points/Summary:  Incisors with open apices showed significantly lower survival rates than did teeth with closed apices.  The completion of root canal obturation had a significant influence on survival time.

Assessment of article:  Interesting….I always thought an open apex would improve the prognosis.