Resident: Swan
Article Title: Guidelines for the management of traumatic dental injuries: II: Avulsion of permanent teeth
Author: Flores, et al. (International Association of Dental Traumatology)
Journal: Dental Traumatology
Volume (Number): 23: 130-136
Major Topic: Avulsion Guidelines
Main Purpose: Provide evidence-based guidelines where possible and a consensus opinion where evidence is inconclusive regarding treatment of avulsed permanent incisors.
Findings: 1. Guidelines for Avulsed Teeth with Closed Apex
1a) Tooth has been replanted
-Clean area with water spray, saline, or chlorhexidine. Verify normal position clinically/radiographically. Flexible splint for 2 weeks
-Systemic antibiotics (Doxycycline 2X daily for 7 days) Pen VK as alternative
-If tooth contacted soil and if tetanus coverage is uncertain, refer to physician for tetanus booster
-RCT 7-10 days post-replantation, before splint removal. Calcium hydroxide as medicament until root canal filling
-Patient Instructions: soft diet 2 weeks, brush teeth w/soft toothbrush after every meal, chlorhexidine mouthrinse 2X daily for one week.
-Recommended follow up time: once a week during months 1,3,6,12 and yearly thereafter
1b) Tooth has been kept in special storage media (HBSS, milk, saline, saliva) or extra-oral dry time less than 60 minutes
-If contaminated, clean root with stream of saline or water and place the tooth in saline. Remove the coagulum from the socket with stream of saline. If alveolar fracture present, reposition with suitable instrument. Replant slowly with slight digital pressure. Verify normal position, splint 2 weeks.
-Systemic antibiotics
-Tetanus coverage prn
-RCT 7-10 days post-replantation
-patient instructions and follow up
1c) Extra-oral dry time greater than 60 minutes
-poor long-term prognosis due to necrotic periodontal ligament. Goal of delayed replantation is to promote alveolar bone growth to encapsulate the replanted tooth. Expected eventual outcome is ankylosis and root resorption of the root. In younger children, when infraposition is more than 1 mm, decoronation is recommended to preserve alveolar ridge contour.
-Delayed replantation technique: Remove attached necrotic soft tissue with gauze
-RCT prior to replantation, or 7-10 days after
-Remove coagulum from socket, reform sites of alveolar fracture
-immerse tooth in a 2% Sodium Fluoride solution for 20 minutes
-Replant with slight pressure, verify position
-Splint for 4 weeks using a flexible splint
-Systemic antibiotics, tetanus coverage, chlorhexidine rinse
-Patient instructions and follow up
2) Guidelines for avulsed permanent teeth with open apex
- Only real difference in treatment is that we allow for possible re-vascularization and don’t do RCT unless tooth becomes necrotic.
-Favorable outcomes: Asymptomatic, normal mobility, normal percussion sound, no evidence of resorption or osteitis, lamina dura appears normal. For open apex teeth, arrested OR continued root formation and eruption along with pulp canal obliteration is considered “favorable.”
-Unfavorable outcomes: Symptomatic, excessive or no mobility (ankylosis), high pitched percussion sound, evidence of inflammatory or replacement resorption
Assessment of Article: Great summary of current guidelines. Well-referenced and from a very credible mix of professionals from different specialties.
No comments:
Post a Comment