Guidelines for the Management of Traumatic Dental Injuries II-Avulsion of Permanent Teeth

LUTHERAN MEDICAL CENTER
Dental Residency Program
Literature Review Form

Resident:Ray Murphy, Jr Date:8/28/09 Region: Prov.
Article title: Guidelines for the Management of Traumatic Dental Injuries II-Avulsion of Permanent Teeth
Author(s): Flores, Marie. Lars Andersson, et al.
Journal: Dental Traumatology
Volume #; Number; Page #s): 23, 130-136
Year: 2007
Major topic: How to treat permanent teeth avulsions
Type of Article: Clinical Review

Main Purpose: Discuss treatment options and modalities for permanent teeth avulsions
Overview of method of research; Review of Treatment options

Findings. Dental trauma occurs in 5% of adult injuries, and as high as 18% of pre school children injury. Avulsions of permanent teeth are the most serious of all dental injuries. The measures that were taken at the time of the accident or immediately following the accident greatly affect the prognosis. An appropriate treatment plan, depending on the circumstances are crucial for a good prognosis. The International Association of Dental Traumatology(IADT) has developed a consensus review after referencing the most current literature and group discussions. The IADT does not guarantee favorable outcomes from following the guidelines, but using them can maximize the chance of success. Guidelines can be accessed at www.iadt-dentaltrauma.org. As dentists, it’s important for us to give appropriate advice to the public about first aid for avulsed. First aid for avulsed teeth include keeping the patient calm, handling the tooth by the crown only, rinsing it briefly for 10 seconds, placing the tooth in HBSS or milk, and seeking emergency treatment immediately for pulp testing, radiographs, and splinting. Radiographs should include a shot at a 90 degree angle, an occlusal, and lateral view.
Tooth Re-implanted Prior to Arrival
-Irrigate area-apply flexible splint-Administer antibiotics(doxycycline 2x daily for 1 week)-Tetanus shot if needed-Initiate RCT 7-10 days after reimplantation-Soft diet for 2 weeks, .1% Chlorhexidine Rinse daily
Tooth Kept in special storage <60 min
-Irrigate root surface and apical foramen with a stream of saline and place tooth in saline. -Reimplant tooth slowly, suture gingival lacerations-Follow tx above starting at admin. Antibiotics
Tooth avulsed>60 min.
-Poor prognosis-Goal is to promote alveolar bone growth to encapsulate tooth(possible ankylosis)-Scrape PDL and necrotic tissue off-RCT in hand before reimplantaion-Irrigate socket-Soak tooth in 2% NaF for 20 min-Reimplant, splint for 4 weeks-SEE ABOVE for AB tx, etc
Reimplanted w/ open apex
-Goal is revascularization-Clean area-Administer AB-Possible booster tetanus-Soft diet, soft brush, Chlorhexidine .1% for 1 week
Tooth stored in Medium <60
-Clean area-Cover root w/ arestin, etc-reimplant-SEE ABOVE for cont. tx
Extra oral time >60 min
-Poor prognosis-Same tx as closed apex
Follow up
-RCT
-Good outcomes include the tooth being asymp, normal mobility, no percussion sound, no radiographic pathology.
-Poor outcomes include symptoms of pain, increased mobility, high pitched percussion sound, radiographic pathology.
Assessment of article: Overall a great review article on treatment of avulsed permanent teeth