The effect of topical treatment with doxycycline compared to saline on 66 avulsed permanent teeth--a retrospective case-control study.

Abstract

Tooth avulsion in young growing individuals is an uncommon but very severe dental trauma. The aim of this retrospective case-control study was to evaluate the effect of topical treatment with doxycycline on avulsed permanent teeth compared with treatment with only saline regarding pulp survival and periodontal healing. Sixty-six avulsed teeth in 50 patients (34 boys and 16 girls) between the ages six and 18years were included in this study. Thirty teeth were soaked in a 0.05mgml(-1) doxycycline solution for 5min, before replantation and 36 teeth in saline solution. Root development was categorized with respect to root formation and development of the apex into three groups, one-half-root formation to full root formation with open apex, full root formation with half-closed apex and full root formation with closed apex. Pulp survival and periodontal healing were assessed as successful when at the end of the observation period no pulp necrosis or ankylosis-related resorption was diagnosed. The mean observation time was 48months. In the doxycycline group, 27 were diagnosed with pulp necrosis, 15 with ankylosis-related resorption and nine were extracted. In the saline group, 30 were diagnosed with pulp necrosis, 23 with ankylosis-related resorption and 11 were extracted. Regarding pulp survival and periodontal healing, no significant differences were found between the two groups. Teeth with immature root development showed significantly less pulp necrosis (P<0.05) compared to teeth with full root formation regardless if treated topically with doxycycline or not. No significant differences were found between the two groups regarding age, storage, root development, splinting duration and observation time although the saline group had significantly longer extra-oral time (P<0.001) than the doxycycline group. This study indicates that avulsed permanent teeth soaked in doxycycline do not show a better treatment outcome regarding pulp survival and periodontal healing compared with avulsed teeth placed only in saline solution. This finding is consistent regardless of root development, storage and extra-oral time.