The best treatment for avulsed permanent teeth

Abstract

The Cochrane Oral Health Group's Trials Register, Cochrane CENTRAL, Medline and Embase were consulted, along with the websites www.clinicaltrials.gov and www.controlled-trials.com and reference lists of identified articles. There were no language restrictions. Only randomised controlled trials that included a minimum followup period of 12 months for interventions dealing with avulsed and replanted permanent teeth were considered. Two review authors independently extracted data and assessed trial quality and the risk of bias in studies to be included. Three studies (involving, in total, 162 patients and 231 teeth) were included. Study one (high risk of bias) investigated the effect of extra-oral endodontics. This showed no significant difference in radiographic resorption compared with intra-oral endodontics provided at week 1 for teeth avulsed for longer than 60 min dry time. Study two (moderate risk of bias) investigated a 10-min soaking in thymosin alpha 1 prior to replantation and then its further use as a daily gingival injection for the first 7 days. They reported a strong benefit at 48 months (14% with periodontal healing in the control group versus 77% for the experimental group). Study three (high risk of bias) investigated a 20-min soaking with gentamycin sulphate for both groups prior to replantation and then the use of hyperbaric oxygen daily in the experimental group for 80 min for the first 10 days. They reported a strong benefit at 12 months (43% periodontal healing versus 88% for the experimental group). There was no formal reporting of adverse events. The available evidence suggests that extra-oral endodontic treatment is not detrimental for teeth replanted after more than 60 min dry time. Studies with moderate/ high risk of bias indicate that soaking in thymosin alpha 1 and gentamycin sulphate followed by hyperbaric oxygen may be advantageous but these strategies have not previously been reported as interventions for avulsed teeth and await further validation. More evidence with low risk of bias is required and, with the low incidence of avulsed teeth, collaborative multicentre trials are indicated.