AVULSION

AVULSION

( EXARTICULATION OR

TOTAL LUXATION )

DEFINITION : The tooth is displaced totally out of it’s socket.

CLINICAL APPEARANCE

The socket is found empty or filled with coagulum.

EPIDEMIOLOGY• Rare injuries(1.6% of dental injury)

• Primary dentition > secondary dentition

• Boys > girls

• The teeth most commonly damaged are upper central incisor

ETIOLOGY

• Cause: accident

contact sports

fighting

• Predisposing factor :

Cl II malocclusion

Periodontal disease

HISTORY TAKING

• When did the injury take place ?

• Where did the injury take place ?

• How did the injury take place ?

HISTORY TAKING

• Has treatment been provided elsewhere ?

• Has there been previous trauma ?

• Has avulsed tooth been accounted for ?

HISTORY TAKING

» MEDICAL HISTORY

» DENTAL HISTORY

» SOCIAL HISTORY

» FAMILY HISTORY

- Obtain information : loss of consciousness, neck or head pain, and numbness - Ask about the event…. amnesia? - Other signs: nausea, vomiting, drowsiness, blurred vision

Neurological Assessment

EXTRAORAL EXAMINATION

• Facial wound

• Fracture of mandible / maxilla

• Occlusion

• Mandibular movement

INTRAORAL EXAMINATION

• Solf tissue

• Foreign body

• Alveolar bone fracture

RADIOGRAPHIC EXAMINATION

• Are routinely to determine the socket

• Check for supporting structure and adjacent tooth

• Compare with the future radiographs

RADIOGRAPHIC EXAMINATION

TREATMENT OF AVULSED TOOTH

Success of treatment depend on

»Extraoral time

»Storage media

»Stage of tooth development

EXTRAORAL TIME

• After 60 minutes of dry storage media very few PL cells remain viable.

• 120 minutes - complete PL cells necrosis.

STORAGE MEDIA

– Hank’s balance salt

solution (HBSS)

– Milk

– Saliva

– Water

TREATMENT OF AVULSED TOOTH

• Preparation of the avulsed tooth

• Preparation of the socket

• Replantation

• Splinting

• Follow up

PREPARATION OF THE AVULSED TOOTH

• Saline to remove foreign bodies

• Avoid scraping the root surface

PREPARATION OF THE SOCKET

• The region should be anesthetized

• Gently clean with NSS to remove clotted blood and foreign materials

PREPARATION OF THE SOCKET

REPLANTATION

• Press the tooth gently into the socket

• Compress buccal and lingual plate of bone

• Take radiograph immediately

REPLANTATION

SPLINTINGRequirements of splint• Provide stabilization for the

replanted tooth• Slight physiologic

movement• Hygienically designed• Not leave the replanted

tooth in traumatic occlusion

SPLINTING

• Wire composite splint

• Composite splint

• Removable flexible

acrylic splint

• Orthodontics wire

• Etc.

SPLINTING

SPLINTING

How long?

the fixation period should be sufficient to allow the reattachment of PDL. This will take from 1 – 3 weeks.

FOLLOW UPA well designed follow up procedure

is diagnose complication.• 1 week. • 2 weeks.• 3 weeks. A radiographic

examination is able to demonstrate periapical radiolucency

FOLLOW UP

• 6 weeks. A clinical and radiographic examination A clinical and radiographic examination is able to demonstrate most case of inflammatory resorption

FOLLOW UP

• 2 and 6 months. Optional for cases with questionable healing

• 1 year. A clinical and radiographic examination can ascertain the long – term prognosis

WOUND HEALING AFTER REPLANTATION

• Surface resorption

• Replacement resorption

• Inflammatory root resorption

Surface resorption

Surface resorption is manifested as a excavations on the root surface without associated breakdown of the lamina dura.

Surface resorption

Replacement resorption

Replacement resorption (ankylosis) is initially seen as a disappearance of PDL space, later follow by a substitution with bone.

Replacement resorption

• PDL injury -> inflammation -> osteoclastic activity -> fusion between bone and root surface

Inflammatory resorption

Inflammatory resorption is seen as bowl shaped cavities on the root surface with an associate radiolucency affecting the lamina dura.

Inflammatory resorption

Summary

The influence of storage conditions on the clonogenic capacity of periodontal cell : implication for tooth replantation

P.C. Lekic , D.J. Kenny & E.J. Barrett

International Endodontic Journal (1998)31,137-140

INTRODUCTION

• Viable periodontal ligament (PL) cells are required for the healing of avulsed teeth after replantation.

INTRODUCTION

• The viability of PL cells in extra- alveolar conditions may be extended by incubating the avulsed tooth in a physiologic storage medium.

INTRODUCTION

• Regeneration of PL following replantation is closely related to preservation of the viability PL cells that adhere to avulsed teeth

OBJECTIVES

• To investigate the effects of combinations of storage media on the clonogenic capacity of human PL cells at two different extra alveolar period.

MATERIALS AND METHODS

• 20 human premolar teeth were extracted

• Aged 11 – 14 years• 4 storage media (saliva , milk ,

HBSS , MEM)• All teeth were assayed at 30 and

60 min

MATERIALS AND METHODSTwenty extracted human premolars

Time

0 min

15 min

30 min

Saliva (23c) MEM

(+4c)

Milk

MEM

(+4c)

One-half of PL tissue explanted from premolar(cells released and analyzed for clonogenic capacity)

Saliva HBSS

15 teeth 5 teeth

5 teeth

Per condition

RESULTS

0

5

10

15

20

25%

of

ce

lls

wit

h c

lon

og

en

ic

ca

pa

cit

y

30 60Time (min)

Results of clonogenic capacity assay

MEM

Milk

HBSS

Saliva

CONCLUSION• Immediate storage of a avulsed

teeth in autologous saliva , a followed by transfer to chilled milk , preserves the presence of sufficient progenitor cells in the PL to warrant replantation and the possibility of PL healing at 60 min extra-alveolar duration.

AnyQuestions?

Thanks for your attention

REFERENCES• Peter J. Robinson,Louis H. Grernsey: Clinical

Transplantation in Dental Specialties.C.V.Mostby,Missouri,1980

• G.J.Robert,P.Longhurst: Oral and Dental Trauma in Children and Adolestcents,Oxford university press Inc. New York, 1996

• Mitsuhiro Tsukiboshi: Autotransplantation of Teeth,Quintessence,Tokyo,2001

• J.O.Andreasen,F.M.Andreasen,L.K.Bakland, et al: Traumatic Dental Injury.Munksgaard.Copenhagen,1999

• M.E.J.Curzon: Handbook of Dental Trauma,Wrigth,Jordan Hill,Oxford,1999