Extra-oral Time Research Articles

Stereolithography (STL) model in dental autotransplant: A case report

The goal of this case report was to describe the use of the stereolithography (STL) model in dental autotransplantation. This report described autotransplantation of the lower wisdom tooth (48) to replace a missing lower first molar (46) due to caries. This approach used an STL model of 48 fabricated in the laboratory from cone-beam computed tomography (CBCT) images to assist in recipient site preparation before autotransplant. In conclusion, the use of the STL model could potentially increase the success rate of autotransplantation as it can help to preserve the periodontal ligament (PDL) cells on the root surface of the donor tooth, shorten the extraoral time of the donor tooth, and provide optimum contact between the recipient bone and the root surface of the transplanted tooth.

Management of Avulsion tooth within golden period in young permanent tooth

Introduction: Tooth avulsion is described as a displacement of the tooth from its socket. It may occurs due to trauma and most often involves the maxillary teeth. Numerous studies have shown that this injury is one of the most serious dental injuries, so prompt and correct emergency management is essential for attaining the best outcome after this injury. Factors that determine healing after replantation are media storage, periodontal tissue damage, extra-alveolar period and intact alveolar socket. Case History: A 11-years-old male patient was referred from Puskesmas Perak to the Department of Paediatrics Dentistry at RSKGM-P Airlangga Surabaya with complaints that his upper tooth was off from its socket. The incident occurs after his head hit the table around 30 minutes ago. The patient had no history of systemic disease and didn’t have any allergic to food and medicine. The tooth was soaked on normal saline. Discussion: The optimal treatment option following an avulsion injury is to replant avulsed tooth at the earliest. Appropriate emergency management, significant treatment plans, and prompt action influence good prognosis in the management of an avulsion injury. In the past, it was advised to perform root canal therapy extra-orally before replantation. However, the current guidelines recommend root canal therapy be performed intra-orally to minimizes the extra-oral time. After the replantation, we continue to observe the tooth every month to see the vitality, mobility, ankylosis and resorption. Conclusion: Replantation is the treatment of choice following avulsion to facilitates restorative therapy and quality of life.

Development of clobetasol-loaded biodegradable nanoparticles as an endodontic intracanal medicament.

The aim of current study is the development and optimization of biodegradable polymeric nanoparticles (NPs) to be used in the field of Endodontics as intracanal medication in cases of avulsed teeth with extended extra-oral time, utilizing PLGA polymers loaded with the anti-inflammatory drug clobetasol propionate (CP). CP-loaded nanoparticles (CP-NPs) were prepared using the solvent displacement method. CP release profile from CP-NPs was assessed for 48 h against free CP. Using extracted human teeth, the degree of infiltration inside the dentinal tubules was studied for both CP-NPs and CP. The anti-inflammatory capacity of CP-NPs was evaluated invitro measuring their response and reaction against inflammatory cells, in particular against macrophages. The enzyme-linked immunosorbent assay (ELISA) was used to examine the cytokine release of IL-1β and TNF-α. Optimized CP-NPs displayed an average size below 200 nm and a monomodal population. Additionally, spherical morphology and non-aggregation of CP-NPs were confirmed by transmission electron microscopy. Interaction studies showed that CP was encapsulated inside the NPs and no covalent bonds were formed. Moreover, CP-NPs exhibited a prolonged and steady release with only 21% of the encapsulated CP released after 48 h. Using confocal laser scanning microscopy, it was observed that CP-NPs were able to display enhanced penetration into the dentinal tubules. Neither the release of TNF-α nor IL-1β increased in CP-NPs compared to the LPS control, displaying results similar and even less than the TCP after 48 h. Moreover, IL-1β release in LPS-stimulated cells, decreased when macrophages were treated with CP-NPs. In the present work, CP-NPs were prepared, optimized and characterized displaying significant increase in the degree of infiltration inside the dentinal tubules against CP and were able to significantly reduce TNF-α release. Therefore, CP-NPs constitute a promising therapy for the treatment of avulsed teeth with extended extra-oral time.

Midterm outcomes of autogenous mature third molars transplantation into surgically created sockets: A retrospective cohort study.

The purpose of this study was to observe the outcome of mature third molars transplantation into surgically created sockets with the assistance of computer designed three dimensional (3-D) printed replicas and compare its outcome with the conventional fresh socket autotransplantation. This study included total of 96 mature third molars autotransplanted in 96 cases with the guidance of computer designed 3-D printed replicas. Forty-eight teeth autotransplanted into surgically created sockets were enrolled into the surgically created socket group and 48 teeth conventionally autotransplanted into fresh sockets were enrolled into the fresh socket group. In the surgically created socket group, mature third molars were autotransplanted into surgically prepared sockets at the site of previously missed or extracted molars in the alveolar bone and in the fresh socket group, autotransplantation of mature third molars were performed in fresh sockets of extracted diseased molars simultaneously. After transplantation, the visual analogue scale (VAS) score, Landry Wound Healing Index (LWHI), mobility and probing depth (PD) of the transplanted teeth were measured and the patient satisfaction questionnaire were held in both group. All patients underwent clinical and radiographic examinations during the follow-up. During the mean follow-up period of 47.63 ± 16.78 months (range 18-78 months), 92 out of 96 teeth remained insitu without clinical or radiographic complications with overall success rate of 95.83%. No statistically significant differences were found in success and survival rates between the two group. The average extra-oral time of the donor teeth were 60.76 ± 22.41 s and mean positioning trials of the donor teeth were 2.43 ± 1.19. The VAS score at Day 1 in the surgically created socket group was higher than the fresh socket group (p < .05). LWHI scores in the surgically created group were lower than the fresh socket group during the first 2 weeks (p < .05). The degree of mobility of the transplanted teeth in both group showed no statistically significant difference during the first 3 months. PD in the surgically created group were higher than the fresh socket group in the first month but there were no statistically significant difference after 1 month. Twenty-six out of 48 cases in the surgically created group needed crown restoration while only 10 cases went through crown restoration in the fresh socket group. Most patients in both group were satisfied with the treatment. Autogenous mature third molars transplantation into surgically created sockets is as effective as conventional fresh socket transplantation. This technique is worth recommending in carefully selected cases and optimistic results can be achieved.

Retrospective Follow-up Assessment of Risk Variables Influencing the Outcome of Autologous Tooth Transplantation

IntroductionThis retrospective study aimed to identify which patient-, donor tooth–, recipient site–, and surgical procedure–related variables may influence the outcome of tooth autotransplantation. MethodsThe sample included 128 autotransplants performed in 122 patients. Single-visit clinical/imaging examinations were used to define the outcome as successful, survival, or failure. The association of potential indicators with the survival or failure categories was analyzed individually and adjusted for confounders through multivariate logistic regression models. ResultsAfter a follow-up period of 1 to 30.11 years, success was achieved in 71.8% of autotransplants, whereas the survival and failure groups had rates of 14.1% each, and the grouped success/survival rate reached 85.9%. An extraoral time >15 minutes and difficult handling/placement were strong/independent risk covariates for survival and failure categories (odds ratio >1, P < .05). Additionally, unerupted/partially erupted status of the donor tooth was a significant indicator for survival, whereas deficient bone level at the recipient site, surgical extraction, poor initial stability, and lack of prophylactic antibiotics were independently linked to failure (odds ratio > 1, P < .05). The root morphology and socket status acted as modifiers of the effect of the recipient site location on the survival group (P > .05). ConclusionBased on the results of this study, unerupted/partially erupted status of the donor tooth, surgical extraction, total extraoral time >15 minutes, deficient recipient’s bone level, difficult handling/placement of the autotransplant, poor initial stability, and lack of prophylactic antibiotics during the surgical procedure must be considered with caution when performing autotransplantation because of their deleterious influence on the outcome.

Storage medium for avulsed teeth: A narrative review

Dental avulsion is the most severe type of traumatic tooth injury, resulting in the complete displacement of the tooth from its socket in the alveolar bone. Immediate replantation of an avulsed permanent tooth is recommended for successful treatment and a good prognosis. However, replantation is not always feasible. The biological properties of the storage medium, which must preserve the viability, clonogenic capacity, and mitogenic potential of the periodontal ligament (PDL) cells, are crucial for successful reimplantation. If the root surface dries out excessively due to prolonged extraoral time before replantation, the damaged PDL cells can trigger an inflammatory response across the root surface, leading to ankylosis. There are various types of storage media, both synthetic and natural. Therefore, selecting the appropriate storage medium in an emergency is critical for improving the outcome of teeth that cannot be immediately replanted. This review examines research on various storage media for avulsed teeth, focusing on their properties and effectiveness, based on articles from electronic databases. Keywords: Dental Trauma; Periodontal Ligament; Storage media; Tooth Avulsion; Traumatic Dental Injuries

Clinical and radiographic outcomes of regenerative endodontic procedures for traumatized permanent necrotic teeth with apical periodontitis and external root resorption.

This clinical study was undertaken to assess the effect of treatment with regenerative endodontic procedures (REPs) on 20 teeth with pulp necrosis, apical periodontitis, and external root resorption (ERR). Teeth were treated with REPS utilizing the American Association of Endodontists (AAE) protocol. Quantitative assessment of changes in radiographic root area (RRA) were statistically analysed to assess changes in root dimensions after an average follow-up period of 3 years. All 20 teeth survived, 14 teeth (70%) were classified successful, and only 1 tooth (5%) failed throughout the study period. Based on the radiographic examination, all 20 teeth showed complete repair of the periapical lesions and arrested ERR. However, 5 teeth (25%) subsequently developed replacement resorption. The RRA between baseline and 3-year follow-up showed a significant difference for the total 20 teeth (p = .009). An analysis according to the trauma type and the extra-oral time showed the RRA increase was significantly different in the non-avulsion group (p = .015) and for the avulsion group with an extra-oral time less than 60 min (p = .029). The RRA increase was not statistically significant in the avulsion group of extra-oral time more than 60 min (p = .405). Nine teeth (45%) and 10 teeth (50%) responded to cold and electric pulp testing, respectively. Within the limitations of this study, the favourable outcomes of REPs were further confirmed for traumatized permanent necrotic teeth with ERR in terms of periapical lesion healed and a significant increase in RRA. The study contributes further evidence of the role of REPs in arresting ERR.

Delayed Replantation of Avulsed Tooth: A Case Report

This case report presents of delayed replantation of avulsed maxillary central incisor after an extended dry extra-alveolar period. Eight-year-old girl and presented with avulsed maxillary central incisor due to trauma occurring 4 hours earlier. Treatment guidelines for avulsed immature permanent tooth with prolonged extra-oral time was carried out for the teeth and the extra-oral endodontic treatment was completed. After having been repositioned, the teeth were stabilized for 4 weeks and prophylactic antibiotic was prescribed. Clinical and radiographic controls were done after 9 months. During the follow-up periods the tooth reported in the case have remained in a stable, functional position but revealed clinical initial replacement resorption and ankylosis.

Enhanced socket preparation during autotransplantation: a new treatment protocol.

Tooth autotransplantation (AT) is a viable option for the replacement of unrestorable or missing teeth. Recently, the use of a 3D replica of a donor tooth constructed from CBCT scans was described. The model is made to assess the recipient site's size and minimize the required extraoral time of the donor tooth after extraction. The aim of the paper was to describe a new technique for AT using the 3D replica as a socket preparation tool. A 13-year-old boy who presented with hypodontia was referred for consultation and treatment. The treatment plan included combined orthodontic treatment and AT of the mandibular left second premolar into the site of the congenitally missing maxillary right canine. A titanium 3D model of the donor tooth was printed by a direct metal laser 3D printer utilizing the model from the CBCT scan. An intrasulcular flap was elevated, and the edentulous maxillary ridge was prepared using implant trephine burs with increasing diameters. A surgical mallet was utilized to apply vertical forces to the 3D-printed model, which was inserted into the prepared socket to allow a perfect fit for the donor tooth. After atraumatic extraction of the mandibular left second premolar, the donor tooth was inserted into the ready socket and splinted. Follow-up examinations at 1, 3, and 6 months, and 1 year after surgery demonstrated a successful outcome. The titanium replica was successfully used for precise preparation of the recipient site, minimizing the extraoral time of the procedure to 4 minutes, and thereby improving the expected outcome. (Quintessence Int 2023;54:142-148; doi: 10.3290/j.qi.b3649031).

FACTORS INFLUENCING THE TREATMENT OUTCOME OF INTENTIONAL REPLANTATION ON TEETH WITH PERIAPICAL PERIODONTITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS.

The purpose of this review was to appraise the quality of evidence of the existing publications on IR, and to perform a meta-analysis on the treatment outcomes of IR. The specific PIO questions were as follows: Population: Patients with periapical periodontitis either before or after non-surgical endodontic therapy. IR performed with retrograde preparation and retrograde filling. the healing, treatment complications, and the factors influencing these outcomes after IR. Electronic and hand searches were performed in the Web of Science, PubMed, CINAHL, and Cochrane Library databases. Two authors independently screened the titles and abstracts for eligibility. The risk of bias was performed using the NIH Quality Assessment Tool, and each study was rated as "Good", "Fair" or "Poor". The analyses were performed on the treatment outcome (healing and complications), and the factors influencing the outcome of the procedure. Fourteen articles were included in the qualitative and quantitative syntheses. One was a prospective cohort study, and the other 13 were retrospective cohort studies. Overall, the evidence of this review was of poor-to-fair quality. The pooled healing rate was 80.2%, and there was a 21.7% of complication rate. Longer follow-up period, the presence of perio-endo disease, the use of non-bioceramic material as retrograde filling, longer extraoral time, and maxillary molar were found to be associated with lower healing rates. However, the differences between the subgroups were not statistically significant. The present review showed IR yielded a good overall healing rate with a low complication rate. Taking the quality of evidence into account, more high-quality studies are required to evaluate the validity of the factors that may influence the treatment outcome of IR.

Management of 3 Avulsed Permanent Teeth: Case Report of a 3-Year Follow-up

Dental avulsion is one of the most serious dental injuries. When the tooth is knocked out, the blood supply to the pulp is interrupted and the periodontal ligament cells are exposed to injuries caused by the external environment. In recent years, research findings have shown the possibility of complete healing under favorable conditions: replanting the tooth according to the criteria required 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. This set of criteria may lead to a slower progression of the phenomenon of resorption with a better prognosis over time; however, there is a high risk of complications such as external root resorption which lies in late replantation. The research results of many research-groups around the world have given us a better understanding of healing and complications. Nowadays, even teeth that are replanted after a delay can be saved. The dentist remains the key person in the case of dental trauma, namely, dental avulsion as his role is the management of the emergency situations. The objective of this case study is to present a successful management of 3 avulsed permanent incisors, replanted and remained with no complications for over a period of 3 years.

Tooth auto-transplantation to close an oro-sinusal communication using a 3D printed model to adapt the alveolar socket: a case report

Introduction: Tooth auto-transplantation has a high success rate therapy when limiting the extra-oral time of the graft. In this way, printing a 3D model of the germ can be a useful tool in order to prepare the receiving site. Observation: We treated a case of post extractional oro-sinusal communication closure using a 3D pattern to adapt the alveolar socket receiving the wisdom tooth auto-transplantation. Comment: Extra-oral time spent by the graft was under 15 seconds improving the chance of success. After one year follow up, the graft is vital, functional and it continued its root formation. Conclusion: 3D printing seems to be an effective technique to minimize surgical time leading to a higher rate of success for auto-transplantation therapies.

Differential gene expression profiles of periodontal soft tissue from rat teeth after immediate and delayed replantation: a pilot study.

PurposeIn dental avulsion, delayed replantation usually has an uncertain prognosis. After tooth replantation, complex inflammatory responses promote a return to periodontal tissue homeostasis. Various types of cytokines are produced in the inflammatory microenvironment, and these cytokines determine the periodontal tissue response. This study aimed to identify the gene expression profiles of replanted teeth and evaluate the functional differences between immediate and delayed replantation.MethodsMaxillary molars from Sprague-Dawley rats were extracted, exposed to a dry environment, and then replanted. The animals were divided into 2 groups according to the extra-oral time: immediate replantation (dry for 5 minutes) and delayed replantation (dry for 60 minutes). Either 3 or 7 days after replantation, the animals were sacrificed. Periodontal soft tissues were harvested for mRNA sequencing. Hallmark gene set enrichment analysis was performed to predict the function of gene-gene interactions. The normalized enrichment score (NES) was calculated to determine functional differences.ResultsThe hallmark gene sets enriched in delayed replantation at 3 days were oxidative phosphorylation (NES=2.82, Q<0.001) and tumor necrosis factor-alpha (TNF-α) signaling via the nuclear factor kappa light chain enhancer of activated B cells (NF-κB) pathway (NES=1.52, Q=0.034). At 7 days after delayed replantation, TNF-α signaling via the NF-κB pathway (NES=–1.82, Q=0.002), angiogenesis (NES=–1.66, Q=0.01), and the transforming growth factor-beta signaling pathway (NES=–1.46, Q=0.051) were negatively highlighted.ConclusionsDifferentially expressed gene profiles were significantly different between immediate and delayed replantation. TNF-α signaling via the NF-κB pathway was marked during the healing process. However, the enrichment score of this pathway changed in a time-dependent manner between immediate and delayed replantation.

The status of knowledge, attitude and practice towards emergency management of avulsed tooth among dental students: A single center cross-sectional study.

To evaluate the awareness of emergency trauma management and the potential role of dentists in handling tooth avulsion injuries. The cross-sectional study was conducted at the Dental Outpatients Department of Jinnah Medical and Dental College, Karachi, from December 2020 to March 2021, and comprised dentists and final year dental students of either gender. Data was collected using a 17-item questionnaire to assess the awareness level regarding the knowledge of traumatic dental emergencies and the role of a dentist in handling a traumatic tooth injury. Data was analysed using SPSS 20. Of the 170 subjects, 52(30.5%) were males and 118(69.4%) were females. Overall, 139(81.8%) subjects had prior knowledge regarding avulsion, 164(96.5%) were aware of the term avulsed tooth, 106(62.4%) considered milk to be the best transport media for an avulsed tooth, 159(93.5%) knew the significance of extra-oral time, and all 170(100%) subjects said they wanted to study more about dental traumatic injuries. There was adequate knowledge about the term avulsion, transport media and extra-oral time, and there was evidence of interest about learning more among the subjects.

Application of concentrated growth factor to autotransplantation with inflammation in recipient area

ObjectiveThe purpose of this study was to apply concentrated growth factor (CGF) to the transplanted area with inflammation, to observe the clinical effects of CGF on the inflammation area assisted by 3D printing technology.MethodsA total of 52 compromised mandibular first or second molar with chronic periapical lesions were transplanted with mature third molars. The patients were divided into CGF group (n = 26) and control group (n = 26) and transplanted into fresh extraction sockets with or without CGF. All the patients underwent clinical and radiographic examinations during the follow-up.ResultsAverage surgery and extra-oral time were 39 min (± 7.8) and 42 s (± 10.2). The success rates of CGF group and control group were 100% and 92.3% respectively. Most of the periapical lesions in CGF group healed completely within 3 months, which was significantly faster than control group. The initial stability of CGF group was better than control group immediately after operation, and the degree of pain in CGF group was lower than control group on the 1st and 3rd day after operation.ConclusionsThe application of CGF in recipient site with chronic periapical lesions can accelerate the regeneration of alveolar bone and the healing of inflammation, greatly shorten the healing period. Meanwhile, CGF help to reduce postoperative pain and reaction at the early stage of healing and increase the success rate of autogenous tooth transplantation (ATT). Additionally, the use of 3D printing model can greatly reduce the extra-oral time of donor teeth.

Autotransplantation of the Third Molar: A Therapeutic Alternative to the Rehabilitation of a Missing Tooth: A Scoping Review.

Introduction: Tooth autotransplantation is the repositioning of an erupted, partially erupted, or non-erupted autologous tooth from one site to another within the same individual. Several factors influence the success rate of the autotransplant, such as the stage of root development, the morphology of the tooth, the surgical procedure selected, the extraoral time, the shape of the recipient socket, the vascularity of the recipient bed, and the vitality of the cells of the periodontal ligament. The aim of this scoping review was to provide the most up-to-date information and data on the clinical principles of the third-molar autograft and thus provide clinical considerations for its success. Materials and methods: This review was conducted based on PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews). The research was conducted by searching for keywords in three databases—PubMed, Scopus and Google Scholar—by two independent reviewers following the PRISMA protocol, from which 599 records were identified. Conclusions: Third-molar autotransplantation is a valid solution to replace missing teeth. The key to the success of this technique is the surgical procedure, which must be as atraumatic as possible to preserve the periodontal ligament of the tooth to be transplanted. The success rate is also linked to the stage of development of the root, with a worse prognosis in the case of a complete root.

Delayed Replantation of Avulsed Teeth: A Case Report

Introduction: Dental avulsion is a severe injury in which the tooth is totally displaced out of its alveolar socket. Replantation of avulsed teeth is a standard procedure. The success of the treatment of traumatized teeth revolves around the status of periodontium since it is a vital structure. Furthermore, other factors, including extra-alveolar time period, choice of storage media, and contamination of the avulsed tooth, can determine the success of replantation. Delay in the replantation of avulsed incisors increases the risk of dentoalveolar ankylosis and replacement root resorption. Case Presentation: This case report presented a 9-year-old girl with tooth avulsion subjected to a 3-year follow-up after the replantation of avulsed maxillary central incisors kept in dry conditions for seven days. The avulsed mature permanent teeth were managed through the application of treatment guidelines with prolonged extra-oral time. The avulsed teeth were replanted and splinted for four weeks. The canals of both teeth were filled with calcium hydroxide and replaced by mineral trioxide aggregate after six months. Two months after replantation, there were signs of external root resorption in tooth 21. Conclusions: In the third year of follow-up, both teeth were infraoccluded, although they had an acceptable level of functionality and appearance. These ankylosed incisors can be managed successfully with the decoronation technique in the future.

Preservation of the viability and gene expression of human periodontal ligament cells by Thai propolis extract.

Success of tooth replantation depends on the quality and quantity of periodontal ligament (PDL) cells. The aims of this study were to evaluate Thai propolis extract as a storage medium for maintaining PDL cell viability and preserving gene expressions in PDL tissues. PDL cells from human premolars were tested for cytotoxicity of the extract by PrestoBlue assay to determine a non-toxic concentration. Subsequently, 96 freshly extracted premolars were allocated into different treatment groups. Control groups were freshly extracted premolars or they had been stored dry for 12hours. Experimental avulsed teeth were created by leaving them air-dried for 30minutes immediately after extraction, then they were immersed in Thai propolis extract, HBSS or milk for 3, 6 and 12hours. After tooth storage, the remaining PDL cells were determined for their cell viability. RNA isolated from PDL tissues of three premolars treated similarly was analysed for periostin and S100A4 expressions using RT-qPCR. Thai propolis extract at 0.625mgmL-1 promoted the greatest PDL cell viability. Tooth storage in 0.625mgmL-1 Thai propolis extract, HBSS or milk showed no difference in maintaining cell viability. Periostin mRNA level was preserved by Thai propolis extract. Expression of S100A4 mRNA in PDL tissues stored in all tested media was dampened. PDL cells from mock avulsed teeth stored in 0.625mgmL-1 Thai propolis extract for 3, 6 and 12hours remained viable and the expression of periostin was preserved. This study suggests this extract as an alternative for a tooth storage medium for up to 12hours. However, transporting an avulsed tooth in a storage medium for extended extra-oral time might affect the PDL cell phenotypes.

Delayed Replantation of Avulsed Permanent Incisor with 16 H Extra-Oral Time

Delayed Replantation of Avulsed Permanent Incisor with 16 H Extra-Oral Time

Survival of human periodontal ligament fibroblast cells in Cornisol and HBSS for transportation of avulsed teeth: a comparative ex vivo study

Objective Viability of periodontal ligament fibroblast cells (PDFC) is one of the key factors in determining the success of replantation of avulsed teeth. Extra-oral time and transport media are closely related to the same. The present study aims to evaluate and compare the efficiency of Cornisol, Hank’s balanced salt solution (HBSS) and normal saline in preserving the viability of PDFC. Materials and methods The human PDFC were isolated from primary culture from freshly extracted human premolars. Effect of Cornisol, HBSS and normal saline on viability of isolated PDFC was assessed using standard MTT assay. The cells were exposed to the experimental solutions (Cornisol/HBSS/normal saline) for varying time points (30 min, 1 h, 24 h, 48 h and 96 h) and viability was determined by colorimetric MTT method by quantifying the amount of formazan crystal formed (optical density). Experiment was performed in triplicates and the data were subjected to statistical analysis. Results Statistical analysis was performed using the Kruskal–Wallis ANOVA with post hoc Bonferroni’s test with a significance level of p value ≤.05. Cornisol ≥ HBSS > saline. Conclusion Cornisol can be used as a storage media for avulsed teeth and is significantly more effective than HBSS in maintaining the periodontal ligament cell viability at tested time intervals.