Abstract
Many storage mediums are available for the storage of avulsed teeth to preserve the viability of periodontal ligament (PDL) cells before replantation; however, it is unclear which medium is the optimal option. We performed this network meta-analysis to answer this question. A comprehensive search was conducted in PubMed, EMBASE, and the Cochrane library to capture eligible studies investigating the comparative efficacy of Hank's balanced salt solution (HBSS), aloe vera gel (AVG), oral rehydration solution (ORS), coconut water, egg white, green tea, propolis, saline, milk, and water. Statistical analysis was conducted using Review Manager v5.3 and ADDIS v1.16.8. In total, 20 RCTs involving 31 reports were included finally. Direct meta-analysis suggested that HBSS was superior to ORS, milk, saline, and water, ORS was superior to milk but inferior to coconut water and propolis, egg white was superior to milk but inferior to AVG and propolis, propolis was superior to AVG, milk, and saline, and coconut water and water was inferior to saline and milk, respectively. Network meta-analysis suggested that AVG was inferior to the other nine mediums, and propolis was superior to HBSS (SMD, −5260.24; 95% CrI, −10447.39 to −70.37) and milk (SMD, −5461.11; 95% CrI, −10574.99 to −328.51). Moreover, ranking probabilities indicated the highest probability for propolis, followed by saline, ORS, HBSS, milk, egg white, water, green tea, and AVG successively. Propolis may be the optimal media for storing avulsed teeth before replantation. However, given the availability of propolis and HBSS and the hypotonic properties of saline, ORS or milk should also be preferentially selected.
Highlights
Avulsion or exarticulation is defined as a result of traumatic injuries, such as traffic accidents, where a tooth is dislodged from its alveolar socket [1]
In 2020, a systematic review and meta-analysis was conducted to compare the available mediums with milk or saliva in storing avulsed teeth prior to replantation, and the study suggested that Hank’s balanced salt solution (HBSS), propolis, oral rehydration solution (ORS), or cling film exhibit benefits compared to milk before replantation [7]
Among 31 reports from 20 eligible studies, 5, 23, 1, and 5 report(s) compared HBSS with ORS, milk, saline, and water, respectively, and pooled results suggested that HBSS was superior to ORS (SMD, 1.03; 95% confidence interval (CI), 0.26–1.80), milk (SMD, 2.63; 95% CI, 1.62–3.64), saline (SMD, 1.62; 95% CI, 0.72–2.52), and water (SMD, 4.23; 95% CI, 3.04–5.41) in preserving the viability of periodontal ligament (PDL) cells (Supplementary Table 4)
Summary
Avulsion or exarticulation is defined as a result of traumatic injuries, such as traffic accidents, where a tooth is dislodged from its alveolar socket [1]. An avulsed tooth is suggested to be immediately replanted in order to prevent further damage to the PDL cells from desiccation when people suffered from traumatic injuries [4, 5]. In 2020, a systematic review and meta-analysis was conducted to compare the available mediums with milk or saliva in storing avulsed teeth prior to replantation, and the study suggested that HBSS, propolis, ORS, or cling film exhibit benefits compared to milk before replantation [7]. Considering the advantages, we performed the current network metaanalysis to estimate the comparative efficacy of 10s common storage mediums—HBSS, aloe vera gel (AVG), ORS, coconut water, egg white, green tea, propolis, saline, milk, and water—in preserving the viability of PDL cells before replantation in order to further determine which medium should be preferentially selected to store avulsed teeth in clinical practice
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