Replantation of 400 Avulsed Permanent Incisors. 4. Factors related to periodontal ligament healing

Meghan Sullivan Walsh September 20, 2010 Department of Pediatric Dentistry/LMC -Providence Literature Review

Article Title:

Replantation of 400 Avulsed Permanent Incisors. 4. Factors related to periodontal ligament healing

Author:

Andreasen JO, Borum MK, Jacobsen HL, Andreasen FM.

Journal:

Pediatric Dentistry

Volume (number), Year, Page #’s:

Endodontics & Dental Traumatology, 1995; 11:76-89

Major topic: To analyze factors related to an avulsion injury.

Overview of method of research:

400 avulsed and replanted permanent teeth with detailed patient records were examined and compared for various factors relating to PDL healing. Factors examined included age, sex, type of tooth, presence of crown or bone fracture, stage of root development, type and length of extra-alveolar storage, clinical contamination of the root surface, type of root surface cleansing procedure, type and length of splinting period and antibiotic therapy. Categories of healing was divided into normal periodontal healing, inflammatory resorption, ankylosis or a combination or resorption and ankylosis.

.

Findings:

Frequency of PDL healing: 24% of the 400 teeth had PDL healing

Chronology of PDL healing: Surface resorption 4.8% diagnosed within a year time frame

Inflammatory resorption: 30% usually found within 6 months

Replacement resorption (ankylosis): 61% evident within one to two months (found clinically.) Radiographic evidence found only after one year in 53% of cases.

Resorption diagnosis: most detected within first year, ankylosis as late as 5-10 years later.

Relationship between PDL and various factors: 9 FACTORS

Sex - no relationship

Tooth location - no relationship

Crown fracture and bone fracture - no relationship

Age - PDL healing less frequent in persons older than 16 yrs

Root development - PDL healing less frequent with advanced stages of root development

*Immediate replantation - MOST significant factor. The only teeth that showed resorption with immediate replantation had been rinsed prior to implantation.

Dry extra-alveolar storage period - An increase in dry storage showed a diminished likelihood of PDL healing. The time limit for PDL healing was 75 minutes extra oral dry time.

Wet extra-alveolar storage period - wet periods exceeding 20 minutes were accompanied by decreased PDL healing.

Dry and wet storage period- this combination resulted in a lower percentage of healing.

Dry and wet storage interaction - Those stored after 9 minute dry time showed significantly less PDL healing however, saline storage after 9 minutes showed little difference in healing.

Storage in other media:

Tap water - 9 of 36 teeth survived. Those stored more than 20 minutes resulted in less PDL healing

Ice - 2 teeth left on an ice rink both resorbed

Homemade Saline - of the 14 non survived

Sterilizing solution - all showed resporption

Plastic bag - 5 teeth 4 resportions

Contamination - better healing when teeth not contaminated

Cleansing - cleansing with saline resulted in negative PDL healing

Splinting - type of splint not relevant. Splinting more than 6 weeks resulted in lower frequency of healing

Antibiotics - no relationship

Erupting teeth causing resorption - canines in traumatized incisors caused lateral root resorption

Gingival healing - loss of gingival attachment found in 29 cases mostly in completed root formation cases

Key Points/Summary

5 of the 9 factors appeared to be relevant to PDL healing ; In order of importance were stage of root development, dry extra-alveolar period, immediate replantation and wet storage period. PDL healing probability can vary from 3% to 97% depending on the many variables. This study did find that only 25 % showed PDL healing which the author concluded to these teeth being handled incorrectly at the time of injury. In addition, the author concluded that many of these cases may have been misdiagnosed. He also concluded that base on these studies the observation period for these trauma cases should be observed for a least one year. The value of rinsing an avulsed tooth before replantation is still questionable. Should immediate implantation be unable to be carried out, the present study showed no preference for storage in the oral cavity or in saline. Antibiotics showed no effect on the PDL healing.

Assessment of Article

This article was a great summary for me especially considering the cases we’ve recently handled at Hasbro. It’s unfortunate that we do no see many of our patient’s for follow up. I would assume that should we be able to track these patients more regularly we can guarantee based on the literature and evidence that the majority of these cases have not survived. These results would be based on the length of time prior to implantation and the storage or storage media these children’s teeth are in at the time of entry to the ED past the time of trauma.