Avulsed Teeth Research Articles

Replantation of young permanent teeth: Techniques and Management of traumatic pulp exposure

Introduction: Dental traumatology is one of the most challenging pediatric treatment aspects. Avulsion of young permanent teeth is a rare and serious traumatic dental injury that needs immediate and complex management. Tooth avulsion is a severe dental trauma defined by complete displacement of the tooth out of its alveolar socket. The primary approach to managing such cases is tooth replantation. The management of replanting the tooth according by the guideline such as the extra oral time which should be very short, the time of pulp removal after replantation, and the appropriate storage medium. Case History: A 9-year-old male presented with history of fall from the slide he played and injuries sustained to the maxillary region. He was referred to the IGD RSKGM-P Airlangga Surabaya and complained that his upper tooth was loose from its socket around 2 hours of trauma. The tooth was soaked in normal saline. Discussion: The optimal treatment option following an avulsion injury is to replant the avulsed tooth immediately. The duration of the extraoral period and the storage conditions of the tooth significantly influence the prognosis. The prognosis for avulsion injuries is highly dependent on timely intervention, appropriate treatment planning and techniques, and effective emergency management. Post-replantation, regular monitoring is essential to assess for ankylosis, resorption, mobility, and vitality of the tooth. Conclusion: Successful replantation of young permanent teeth with traumatic pulp exposure relies on timely intervention, proper technique, and careful postoperative management.

Evaluation of Propolis, Aloe Vera Gel, Noni, Pomegranate Juice Natural Storage Medium for Management of Avulsed Teeth

ABSTRACT Objectives: To ascertain the effectiveness of propolis, aloe vera gel, noni, and pomegranate juice natural storage solution in preserving the vitality of avulsed teeth PDL cells. Materials and Methods: Forty recently extracted human premolars that were recommended for orthodontic purposes were used in the current investigation. Each of the four storage medium groups (N = 10)—Group A: propolis, Group B: pomegranate juice, Group C: aloe vera, and Group D: noni—was assigned to them at random. The teeth were immersed in one of the three experimental media for forty minutes after being dried for twenty-five minutes at room temperature. Each tooth’s root surface was treated with an enzymatic solution containing 1 mL of Collagenase Type II and Dispase Type I in phosphate buffer saline following drying and soaking. Following the application of 0.4% Trypan blue labeling, the cells were counted using a hemocytometer under a 10x light microscope magnification. The obtained data was statistically analyzed. Results: The samples placed in propolis indicated the maximum number of viable PDL cells subsequently pomegranate juice, aloe vera gel, and noni. There was considerable disparity in the amount of viable PDL cells among the groups. Conclusion: The current research findings suggest that propolis, pomegranate juice, aloe vera gel, and non-natural media can be employed to preserve the viability of PDL cells in avulsed teeth.

Evidence-Based Potential of Generative Artificial Intelligence Large Language Models on Dental Avulsion: ChatGPT Versus Gemini.

In this study, the accuracy and comprehensiveness of the answers given to questions about dental avulsion by two artificial intelligence-based language models, ChatGPT and Gemini, were comparatively evaluated. Based on the guidelines of the International Society of Dental Traumatology, a total of 33 questions were prepared, including multiple-choice questions, binary questions, and open-ended questions as technical questions and patient questions about dental avulsion. They were directed to ChatGPT and Gemini. Responses were recorded and scored by four pediatric dentists. Statistical analyses, including ICC analysis, were performed to determine the agreement and accuracy of the responses. The significance level was set as p < 0.050. The mean score of the Gemini model was statistically significantly higher than the ChatGPT (p = 0.001). ChatGPT gave more correct answers to open-ended questions and T/F questions on dental avulsion; it showed the lowest accuracy in the MCQ section. There was no significant difference between the responses of the Gemini model to different types of questions on dental avulsion and the median scores (p = 0.088). ChatGPT and Gemini were analyzed with the Mann-Whitney U test without making a distinction between question types, and Gemini answers were found to be statistically significantly more accurate (p = 0.004). The Gemini and ChatGPT language models based on the IADT guideline for dental avulsion undoubtedly show promise. To guarantee the successful incorporation of LLMs into practice, it is imperative to conduct additional research, clinical validation, and improvements to the models.

Appropriate Terminology for the Time Elapsed From Avulsion of a Permanent Tooth to Replantation: A Scoping Review and Delphi Consensus.

The prognosis of an avulsed permanent tooth depends on the time elapsed from injury to replantation in the injured socket. Wide variability exists in the terminologies used to describe this period. Hence, the aim of this study was to identify and categorize the terminologies related to this aspect of tooth avulsion, grade the explanations provided by the authors, and develop a consensus about the most appropriate terminology through a Delphi approach. This study involved a scoping review to identify and analyze the terminologies. It was performed according to PRISMA-ScR with a systematic search performed in PubMed, Scopus, EMBASE, LILACS, and Web of Science. The terminologies were extracted, categorized, and evaluated for correctness. On the basis of the results of the review and expert group discussion, an ideal terminology was proposed. A Delphi study with 20 global experts in dental traumatology was conducted to develop a consensus for the proposed terminology and its description. A total of 92 studies were included. They were distributed into five categories according to the terminology used: (a) dry period alone, (b) total period with dry and/or wet times, (c) extra-alveolar period, (d) extraoral period, and (e) miscellaneous. The explanations provided were correct in 37.5% of the studies that used an extraoral period. In the Delphi study, the lowest scores were given to the term dry period. There was an agreement of 95% for the proposed terminology. A wide variation in terminologies was observed that could be distributed into five categories. The correctness of explanations was highest in the studies that described total periods with dry and wet times. The Delphi study revealed excellent agreement for the proposed term "total extra-alveolar period," with precise and clear recordings of both nonphysiologic (dry) periods and physiologic (wet) periods.

Replantation of an Avulsed-Tooth by Using Trepanation: A Case Report

Tooth avulsion is one of the common types of orofacial and dental trauma that frequently occurs in sports and requires prompt management and a good treatment plan to achieve satisfactory outcomes. The aim of this case report is to present an overview of the tooth replantation using a trepanation procedure that has not been previously discussed in any formal publication. A clinical case concerning the management of tooth avulsion applying trepanation principles is narratively described along with a follow-up on the periodontal tissue condition after 2 years of treatment. The findings revealed the absence of inflammatory resorption, the most severe form of resorption typically seen within the initial 2 years following the replantation of an avulsed tooth. Nonetheless, caution should still be exercised regarding signs of surface root resorption, which although more favorable than inflammatory resorption and replacement resorption, should not be overlooked. Trepanation has demonstrated its ability to prevent inflammatory resorption for a minimum of 2 years post-replantation with no indication of ankylosis observed. Further investigation into trepanation is warranted to delve into the potential advantages of this procedure.

A comminuted dento-alveolar fracture with premaxillary dental avulsion. Pilot-drill guided implant-prosthetic rehabilitation: a case report and an overview of guided implant placement

In modern dentistry, implantology is widely used; implants have a survival rate of 96.4-96.9% at 10-year follow-up. In order to obtain aesthetic, health, and performance results of implant restorations, virtual pre-surgical prosthetic planning is essential. For proper planning, the patient’s CBCT data is matched to the prosthetic design in order to virtually plan the three-dimensional positioning of the implant before surgery. The patient, following trauma, had avulsion of elements 1.2, 1.1 and 2.1. The fracture is treated conservatively, and after 3 months, three implants are placed with guided Pilot-Drill surgery and prosthetically guided implant design. To achieve a clean transmucosal path and create good aesthetic profiles, the prosthetic connection's depth was adequate. Periodic professional oral hygiene recall has been essential for the long-term maintenance of the implants. At the follow-up of 6 years, perimplant bone stability and aesthetic and functional satisfaction of the patient were detected. In the field of dental implant placement, bone data, and anatomical restrictions can be processed by guided implant software. In combination with wax-up scans, implant planning will improve the predictability of implant placement. The ideal placement of implants in prosthetically guided implantology is not solely determined by bone anatomy but also by the final position and features planned for the prosthesis. A hybrid solution between traditional and total computer-guided surgery is achieved by Pilot-Drill Guided Surgery, which can combine the advantages of fully guided and free-hand approaches. The Pilot Drill Template implantology is a compromise that combines the benefits of fully guided and traditional surgery while also eliminating their limitations.

Perda precoce dos elementos 11 e 12 por trauma dental, com intervenção ortodôntica preventiva na odontopediatria: relato de caso

Dental trauma is one that affects the hard tissues embraced, supporting structures or soft tissues in the oral cavity. It is observed more frequently in male children of school age (07 to 12 years old). The most affected teeth in the trauma taken are central and lateral incisors. With regard to tooth avulsions, the protection of children's bone tissue favors a higher frequency in this population than in the adult population. Dental avulsion occurs after displacement of the element out of its alveolus. There is a break in the blood supply to the pulp of the tooth and when this happens the chance of replantation achieved is totally impossible. Thus bringing several harms to the patient such as difficulty in speech, poor aesthetics, or even mesialize or distalize some other acquired element. Space maintainers are used as removable or fixed appliances to treat malocclusion or esthetic defects. They are braces made of acrylics with two extended teeth. Choosing a removable appliance comes with benefits such as better hygiene, satisfactory aesthetics, low cost, and maintenance of the cervico-occlusal space, in addition to the mesio-distal space. The objective of this study was to report a clinical case of avulsion of element 11 and 12 caused by trauma in childhood with the use of a space maintainer. We conclude that it is possible to treat a patient with dentoalveolar trauma with intervention using a space maintainer, since in the present case success was obtained in the selection of therapy, restoring aesthetics and function to the patient. Thus reducing possible orthodontic problems of the child, with follow-up until his/her old age.

TREATMENT OF TOOTH AVULSION: A CASE REPORT

Dental trauma (DT) refers to injuries caused by impacts to the teeth and/or the hard and soft tissues within or outside the oral cavity. Among the various types of DT, avulsion, characterized by the complete displacement of the tooth from its socket. The success of treatment depends on timely management and proper professional care during and after reimplantation in preserving the tooth in the oral cavity. This study describes a case report of an avulsion of the upper left central incisor (21) that underwent reimplantation. The patient, a 10-year-old boy, had a history of bicycle fall, presenting with extraoral injuries to the cheek and chin, lip abrasions, and avulsion of tooth 21. The tooth was stored in milk and reimplanted 30 minutes after the accident. Clinical and radiographic examinations showed no bone fractures but revealed mobility of teeth 11 and 12 and avulsion of tooth 21. Treatment included cleaning, repositioning of the avulsed tooth, stabilization with a semi-flexible splint, and administration of antibiotics and analgesics. Endodontic therapy with mechanical instrumentation was successfully initiated after 20 days. This case highlights the importance of proper tooth storage and timing of reimplantation, leading to the restoration of patient’s aesthetics, chewing function, and self-esteem.

The Occasional tooth avulsion.

The Occasional tooth avulsion.

Traumatic Dental Injuries: Prevalence, First Aid, and Mouthguard Use in a Sample of Italian Kickboxing Athletes.

Traumatic dental injuries (TDIs) are a common complication in sports, with an overall prevalence ranging from 0.71% to 60%. Kickboxing is a high-risk combat sport for trauma to the facial region. A total of 142 5-to-65-year-old amateur athletes participated in the survey with a questionnaire that was released during their regular practice days. The questionnaire was structured into three parts: (1) questions about age, gender, type, and time of sports practice; (2) questions about dental injuries, personal experience, and awareness of emergency management, particularly about tooth avulsion; (3) questions about wearing a mouthguard for TDI prevention. A total of 13 percent of athletes suffered a TDI while training or fighting. Regarding first aid, 61% of the participants in this survey are aware of the possibility of replanting a tooth after its avulsion; 10% believe that the tooth should be replanted within 15 min, and 37% of athletes believe that it should be kept wet. The mouthguard is known to the majority of athletes (94%), and 66% were informed by the coach; 68% of the athletes use it. Seventy-four percent of the mouthguards were purchased in a sports shop. A relatively low prevalence of TDIs was observed in players in the sample. A lack of information about the emergency management of tooth avulsion and about the type of mouthguard to wear emphasizes the importance of educational training by dentists to athletes and coaches.

Bacterial Contamination as an Important Prognostic Factor in Tooth Avulsion and Replantation - Case Series

Tooth Avulsion is a significant traumatic injury in children, replantation and follow up care is the treatment of choice. Maxillary incisors are most affected and sometimes over treated or left untreated. Aim: To understand the role of bacterial contamination for the survival of permanent maxillary incisors in cases of avulsion in children Case Report: This paper presents 3 case reports outlining the treatment stages for the survival of avulsed permanent incisors. Pulp &amp; periodontal damage and its tissue responses are discussed through various clinical factors responsible for good prognosis. Result &amp; Observations: Preserving alveolar bone width, retaining aesthetics and function even for an interim period is a favorable outcome. It helps in the replacement of tooth at a convenient period of late adolescence or young adult stage. Conclusion: Immediate replantation is always recommended for good prognosis of tooth avulsion in children.

Permanent tooth avulsions: A retrospective analysis of the demographics and aetiology of cases at a tertiary hospital in Sydney, Australia

AbstractThis retrospective analysis reviewed the demographics of patients sustaining dental avulsion injuries at a tertiary dental hospital in Sydney, Australia. Data were extracted from dental records of patients who presented with avulsed permanent anterior teeth and were treated between 1 January 2001 and 30 June 2021. Demographic, clinical and radiographic data from 91 patients with 117 avulsed permanent anterior teeth were available for analysis. The median age of the patients was 12 years (IQR 9.0–17.0). Males accounted for 68.4% of avulsion injuries. Non‐organised sports were the most common cause of injury (42.7%). Maxillary central incisors were the most frequently avulsed tooth (83.3%). Peak prevalence of injuries occurred on the weekend. The findings from this study may reflect regional factors such as climate and participation in sport. Anticipatory guidance should be provided to patients at elevated risk of dental avulsion.

Immediate and Successful Management of Avulsed Teeth: A Case Reports

Avulsion and midroot fractures of teeth present significant challenges in dental trauma management. These case reports outlines the successful management of avulsed after a lapse of 2hrs in 1st case report and 24hrs in 2nd case report and midroot fractured tooth, focusing on immediate steps, long-term strategies, and clinical considerations. Midroot fractures often present with compromised structural integrity, necessitating stabilization and protection of the tooth to prevent further damage. Splinting techniques stabilize the tooth and promote healing of periodontal tissues. However, careful monitoring is crucial to assess for potential complications such as inflammatory root resorption and external root resorption. In both the cases extraoral root canal treatment was done for avulsed tooth and then reimplanted into the socket and stabilisation was done using splinting. Followup up was done at regular intervals of one and 3 months which showed no resorption or perapical changes, lack of clinical symptoms In conclusion, the management of avulsed and midroot fractured teeth requires long-term treatment strategies. Favorable outcomes can be achieved, preserving tooth function, and esthetics in patients with traumatic dental injuries.

Ensuring Viability: The Role of Storage Media for Avulsed Teeth

Ensuring Viability: The Role of Storage Media for Avulsed Teeth

Outcome of regenerative endodontic procedures in delayed replanted immature permanent teeth with apical periodontitis: A retrospective study.

Regenerative endodontic procedures (REPs) is effective for treating young permanent teeth with pulp necrosis. However, its efficacy on delayed replanted avulsed teeth is unclear. This retrospective study aimed to assess the efficacy of REPs in treating delayed replanted immature permanent teeth with apical periodontitis. Avulsed teeth receiving REPs were systematically screened based on predetermined criteria. This study assessed the REP outcomes, postoperative periodontal healing, and overall treatment efficacy. Samples were grouped by REP outcomes and root development stage, with Fisher's exact tests used to compare outcomes among different groups. Among the included 17 teeth, 47.1% exhibited successful REPs and periodontal healing. Another 47.1%, due to replacement resorption or REP failure, were categorized as tooth survival. Healing of periapical lesions was observed in 88.2% of the cases, but only 41.2% demonstrated continued root development. Although differences were not significant (p = 0.05), teeth with continued root development had a higher rate of functional healing (85.7%) compared to those without (30%). Within the limitations of this study, REPs presented reliable outcomes for treating delayed replanted immature permanent teeth with apical periodontitis mainly in periapical lesion healing. Teeth with continued root development after REPs exhibited a higher rate of functional healing. Further investigation is required to explore potential synergies between REP outcomes and periodontal healing.

Replantation After Dental Avulsion: A Scoping Review and Proposal of a Flow Chart.

Dental avulsion, the complete displacement of a tooth from its socket, is a severe dental trauma with a prevalence of 0.5% to 16% of all dental injuries. Replantation of avulsed teeth is common, yet recent studies show high failure rates and unpredictable long-term outcomes. This review examines clinical variables influencing intentional dental replantation decisions and proposes a treatment flow chart. A comprehensive literature search was conducted in PubMed-Medline, Scopus, WoS, and Cochrane databases using the keywords "tooth avulsion," "tooth replantation," and "tooth ankylosis." Inclusion criteria encompassed studies from January 2018 to February 2024. From 752 identified articles, 9 systematic reviews including 3 meta-analyses were selected for this scoping review. Immediate replantation is the gold standard for avulsed teeth, yet delayed replantation is more common in practice, impacting survival rates. Adherence to guidelines from the International Association on Dental Traumatology improves outcomes, especially in paediatric patients. Factors such as multiple caries, severe periodontal disease, advanced age, psychological conditions, immunodeficiency, and lack of cooperation are contraindications for replantation. Despite the high failure rate, replantation remains recommended in literature due to its potential advantages over prosthetic implants. This review highlights the complexities in decision-making for dental replantation, emphasising the need for a comprehensive approach considering individual clinical cases. A proposed treatment flow chart aims to support clinicians in predicting prognosis and making informed decisions. The review also underscores the link between dental trauma, poor oral health, and potential neglect in children, highlighting the importance of preventive measures and parental awareness.

Post-mortem Interval estimate based on dental pulp: A histomorphology approach.

Estimating the post-mortem interval (PMI) of human remains based on the histomorphology of dental pulp parameters is promising, but available evidence is scarce and sometimes contradictory without a scientific model. The aim of the study is to characterise the histomorphological changes of dental pulp associated with the decomposition of human remains by a qualitative and quantitative approach. The main aim is to establish a correlation based on post-mortem (PM) dental pulp histomorphology and the PMI, and whether pulp degradation could be an available medico-legal tool for PMI estimation beyond the first week after death (late PMI). The eligible sample consisted of 27 sound teeth from 16 healthy patients aged 16 to 72 years due to orthodontic or oral surgery treatment, to create PMI's simulating the death of the subject as the time elapsed from tooth avulsion. Data collected from patients (sex, date of birth, tooth position, date and hour of the avulsion, date and hour of pulp extraction) were anonymised in accordance with the requirements of Faculty of Dental Medicine of the University of Lisbon. The sample was divided into 9 groups of 3 teeth according to different PMI sets from T0 (baseline) up to 2 weeks (T0, 7, 12, 24, 36, 48, and 72 hours, 1 and 2 weeks). All the dental samples were stored at room temperature up to the time of pulp extraction and then prepared with haematoxylin and eosin stain. High-resolution microscopy was performed to obtain histological images. An operator performed the qualitative evaluation of blood vessels, collagen fibres, and the extra-cellular matrix (ECM) in PM pulps and measured the variation in cells/nuclei density by counting 6 different ROIs (Regions of Interest) for each pulp manually and automatically (quantitative analysis). Qualitative results showed that the degeneration of dental pulp appears 7 hours after death but histological changes in vessels, fibres, and ECM in PM dental pulp are characterised by high variability, consequently it is not possible to generalise the results for early PMIs. Quantitative measurements proved that cell count cannot be standardised due to the presence of superimposed layers of cells and nuclei fragmentation. Odontoblasts did not demonstrate evidence of cellular or nuclear lysis up to 14 PM suggesting their applicability in late PMIs. Future research will focus on late PMIs and different techniques of tooth preparation.

Best Practices in Avulsion Management - A Review

Dentoalveolar trauma refers to injuries affecting the teeth, palate, mandible, maxilla, and gingiva due to external forces. These injuries can range from minor bruising to complete tooth avulsion, where the tooth is forcibly removed from its socket. Such avulsions typically require significant force and may also cause damage to adjacent structures. This review examines the risk factors, appropriate storage methods, and treatment strategies for dental avulsions, and highlights the importance of preventive measures for individuals at risk of dental injuries.

Engineered Immunomodulatory Nanoparticles Inhibit Root Resorption and Ankylosis

IntroductionExternal root resorption following avulsion injury is a complex process wherein differentiation of macrophages (Mϕ) to multinucleated osteoclasts is temporally regulated by resident periodontal fibroblasts (PDLF). The current study aims to assess the effect of engineered bioactive chitosan nanoparticles (CSNP), sustained released dexamethasone conjugated CSNP (CS-DEX) and CSNP functionalized with photosensitizer Rose Bengal (CSRB) for application in root resorption using an in-vitro PDLF-Mϕ direct coculture model and in-vivo delayed reimplantation model. MethodsPDLF-Mϕ direct coculture system was exposed to lipopolysaccharide (LPS), macrophage colony stimulating factor, receptor activator of nuclear factor kappa β ligand with or without CSNP/CS-DEX for 7 days. Clastic differentiation was assessed by tartrate resistant acid phosphatase (TRAP) staining on day 7. On day 2 and 7, immunofluorescence analysis was conducted to assess the expression of Mϕ polarization markers (CD80, CD206), multinucleation markers (NFATc1, STAT6) in Mϕ and matricellular protein periostin in PDLF and cytokine profiling in cell culture supernatants. Delayed replantation model with extraoral air dry/LPS exposure for 1h followed by root surface treatment with CS-DEX/CSRB was used in Wistar rats. After 21 days, rats were euthanized for histologic and immunofluorescence analysis. Statistical analysis one-way ANOVA with Tukey's multiple comparisons was used to analyze the data (P < .05). ResultsCS-DEX significantly reduced TRAP+ multinucleated cells and CSNP treatment showed no TRAP+ cells. Immunofluorescence analysis showed that CSNP/CS-DEX reduced CD80, NFATc1 and STAT6 expression and increased periostin as expressed by fluorescence intensity. CSNP/CS-DEX significantly reduced TNFα, MMP9 and increased IL10, TGFβ1. Osteoprotegerin was upregulated only by CSNP. Root surface treatment in delayed replantation model showed that CS-DEX and CSRB substantially reduced the degree of resorption and ankylosis. Further, CD80, CD206, and MMP2 expression in groups with root surface treatment with CS-DEX and CSRB was lower than airdry/LPS group and similar to healthy control and NFATc1, STAT6, and MMP9 expressions were lower than healthy control. ConclusionThe engineered nanosized immunomodulatory bioactive materials chitosan nanoparticles functionalized with photosensitizer and dexamethasone effectively reduced the clastic differentiation of Mϕ in in-vitro coculture and minimized the resorption and ankylosis in a delayed reimplantation model. These biomaterials have the potential to serve as root modification agents, promoting favorable healing outcomes in cases of dental avulsion.

Deciphering 3D periodontal fibroblast-macrophage crosstalk in bioactive nanoparticle-guided immunomodulation for treating traumatic dental avulsion

Prolonged extra-oral period in dental avulsion is often associated with loss of viability of Periodontal fibroblasts (PDLF) and increased risk of ankylosis. Root surface treatment with bioactive agents to reduce the risk of ankylosis can be a potential strategy. The objective of the study was to investigate the impact of an engineered chitosan nanoparticles (CSNP), photosensitizer Rose Bengal (RB) functionalized CSNP (CSRB) and sustained dexamethasone (CSDEX) releasing CSNP for application in management of delayed replantation of avulsed teeth. The 3D PDLF-macrophage (Mϕ) collagen model was developed and exposed to LPS, MCSF, RANKL with and without CSDEX/CSNP. Immunofluorescence and cytokine analysis was done at 2 and 7 days to assess cellular interactions. Maxillary right incisors in male Wistar rats were extracted, exposed to extraoral dry or LPS for 1 h and treated with or without CSDEX/CSRB for 1 min before replantation. Rats were euthanized after 21 days for micro-CT, TRAP, and immunofluorescence analysis. CSDEX/CSNP treatment in 3D model significantly reduced CD80, NFATc1, STAT6 and increased CD206 and periostin expression (p < 0.05). TNFα, MMP9 was downregulated and IL10, TGFβ1, MMP2 upregulated with CSDEX/CSNP (p < 0.05). CSDEX/CSRB in animal study significantly reduced resorption, ankylosis, TRAP activity and osteocalcin expression and increased periostin (p<0.05). CSDEX demonstrated higher anti-inflammatory activity by downregulating TNFα, while CSNP upregulated TGFβ1, periostin, and downregulated MMP9. The combination of matrix stabilization with CSRB with periostin upregulation and sustained releasing CSDEX showed potential for hampering root resorption and ankylosis in dental avulsion.