Management of avulsed Permanent Incisors: A decision analysis based on changing concepts

Resident: Adam J. Bottrill
Date: 17SEP10
Region: Providence
Article title: Management of avulsed Permanent Incisors: A decision analysis based on changing concepts
Author(s):Lee, Jessica DDS et al.
Journal: Pediatric Dentistry
Page #s: 357-360
Year: 23:3, 2001
Major topic: Avulsion injuries
Minor topic(s): NA
Type of Article: Analysis of avulsion injury management
Main Purpose: Provide a decision tree describing the management of avulsed incisors.

Key points in the article discussion:

I. General:

A. Reported incidence of avulsion 1-16% of all traumatic injuries. Maxillary central incisors most common

B. Age 8-12 most common permanent incisor avulsion.
1. loosely formed PDL provides minimal resistance to avulsion force.

C. Most common cause... fights and sports.

D. Treatment is aimed at minimizing the number of complications that occur
1. ankylosis, pulpal infection, PDL damage etc...

II. Management

A. THOROUGH HISTORY
1. Time Interval, conditions of avulsion, storage material

B. If decision is made to re-implant, RINSE with saline to remove visible debris... DO NOT SCRAPE DEBRIS OFF.

C. Teeth have been shown to survive from 20-40 yrs with normal periodontium. In other words... under the correct conditions, the tooth CAN be saved.

III. "New" Tx regimens

A. Topical AB's for enhanced revascularization

B. Hank's to preserve PDL

C. >1hr dry storage ... scrape off PDL, rinse and replant

D. Systemic AB's at time of reimplantation

Assessment of article: I like decision trees (...dork, I know). So this article is sans shenanigans in my book.