Survival of avulsed permanent maxillary incisors in children following delayed replantation

Resident: Roberts

Date: 9/23/10

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

Author: Barrett EJ, Kenny DJ.

Journal: Endodontics and Dental Traumatology

Year: 1997

Disscussion

Permanent incisors are the teeth most commonly avulsed because of trauma. Studies have proven that the survival rate is directly related to the time elapsed before reimplantation. The present study had two objectives: to describe the survival rate of permanant maxillary inciors that had remained avulsed for longer than 5 minutes and to test whether the survival rate had any relation to: patient age, stage of root development, root canal treatment performed post trauma, storage of an avulsed tooth in a physiologic medium prior to implantation

Results

The mean extra alveolar time was 123 min. Teeth reimplanted with open apices had a significantly decreased surivial rate when compared to those with closed apices. Those with open apices had a tendency to undergo severe progressive external root resorption. There was also a significant association between increased survival and obturation of a canal with gutta percha and sealer versus a tooth that had to be treated by apexification first. The tooth with RCT was 4.2 times as likely to survive than a tooth that underwent a process for apexification before RCT. 77% of the teeth that were reimplanted were brought to the dentist in some form of a physiologic storage medium such as milk or saliva. 13% were not brought in any form of storage medium and 10 percent were brought in water. These assessment were not factored into the overall success rate of a tooth for this study.

Assessment: Interesting and I would like to see comparison studies, especially involving open and closed apices.

An analysis of 58 traumatically intruded and surgically extruded permanent teeth

Department of Pediatric Dentistry
Resident’s Name: Murphy Program: Lutheran Medical Center - Providence
Article title: An analysis of 58 traumatically intruded and surgically extruded permanent teeth
Author(s): Santler Ebeldeseder KA, et al.
Journal: Endodontics and Dental Traumatology
Year. Volume (number). Page #’s: 2000. 16. 34-39
Major topic: Management of Intruded teeth and their outcomes
Minor topic(s): Short term vs long term success/failure rates
Main Purpose: To compare short term with mid term results and to find out the influence of different co-factors such as intrusion depth, root development stage, concomitant crown fracture, and surgical manipulation on the healing results.
Overview of method of research: Review of cases

Findings:
58 intruded teeth from 1990-1997 were treated at the Dental Clinic of the University of Graz. Factors taken into account were the age of the person, their gender, the stage of root development, the cause of the injury, the amount of crown fracture, and if there was an injury to the gingival or alveolar bone. Of the 58 teeth, 48 were repositioned surgically and splinted with wire and composite, 9 were allowed to re-erupt, and 1 was extruded orthodontically. In 9 of the cases, the teeth were exarticulated during repositioning, and in 6 they were taken out because the socket needed to be repaired.
-Chlorhexidine rinse was given for 2 weeks
-Systemic antibiotics, either Pen, a cephalosporin, or erythromycin were given for 8 days.
-The splint was kept in place for 3-4 weeks.
-Any crown fracture was covered with CaOH and later restored 4-12 weeks later.
-Radiographic checks were made at 2,3, and 4 weeks. If there was no sign of pulpal necrosis, FU was done at 6 weeks, then again at 3 months.
-In the case that there was necrosis, periapical pathology, or resorption, the pulp was removed and the canal was filled with CaOh and .1% chlrohexidine. This was changed every 3 months until apical closure. In mature teeth, it was disinfected again in 4-6 weeks and a permanent filling was placed.

Necrotic pulps were found in 61% of all immature teeth and 88% of mature teeth. External RR was found in 68% of immature teeth, and 73% of mature teeth. 3 teeth were lost.
It was found that there was no statistical difference between mid term and short term results, except for tooth discoloration(54% in midterm, 9% in short term). Teeth that had an intact crown, and that were only slightly intruded had the best results. Also, immature teeth did better tan mature teeth. The more a tooth was handled surgically, the more chance there was for complications, including loss of the tooth, ankylosis, and pulpal necrosis.

Key points/Summary:
The article states “The optimal treatment for intrusion injuries has not yet been found”. However, as previously stated, the younger the tooth, the less the surgical manipulation, and the less the intrusion the better chance the tooth has to be OK. The advantage of surgically approaching an intruded tooth is that it can lead to saving a tooth if done the right way. Maybe it’s better to do something rather than nothing… Regardless of which technique is followed, if the tooth survives, lifetime follow up is 100% necessary.

Assessment of Article: Good article. Poorly written and organized. Good knowledge for us to have.