The risk of pulpal necrosis in these injuries is high, especially in the closed apex
(741HTable 12.2). The incidence of resorption and ankylosis sequelae is also high (742HTable
12.3)
Key Point
In p.l.injuries
- The incidence of pulpal necrosis is higher in closed apex teeth;
- The incidence of resorption increases with severity of injury.
Avulsion and replantation
Replantation should nearly always be attempted even though it may offer only a
temporary solution due to the frequent occurrence of external inflammatory resorption
(e.i.r.). Even when resorption occurs the tooth may be retained for years acting as a
natural space maintainer and preserving the height and width of the alveolus to
facilitate later implant placement.
Successful healing after replantation can only occur if there is minimal damage to the
pulp and the p.l. The extra-alveloar dry time (e.a.d.t.), the type of extra-alveolar
storage medium, and the total extra-alveolar time (e.a.t.), that is, the time the tooth has
been out of the mouth are critical factors. The first question that must be known is
'what is the e.a.d.t. of the tooth? If the e.a.d.t. is not greater than 1 h then the
suggested protocol for replantation can be divided into: advice on phone; immediate
treatment in surgery; and review.
Replantation of teeth with a dry storage time of less than 1 h
ADVICE ON PHONE (TO TEACHER, PARENT, ETC.)
- Don't touch root⎯hold by crown.
- If tooth is dirty, wash briefly (10 s) under cold running water.
- Replace into socket or transport in milk to surgery.
- If replaced bite gently on a handkerchief to retain it and come to surgery.
The best transport medium is the tooth's own socket. Understandably non-dentists
may be unhappy to replant the tooth and milk is an effective iso-osmolar medium.
Saliva, the patient's buccal sulcus, or normal saline are alternatives.
IMMEDIATE SURGERY TREATMENT
- Do not handle root. If replanted remove tooth from socket.
- Rinse tooth with normal saline. Note state of root development. Store in saline.
- Local analgesia.
- Irrigate socket with saline and remove clot and any foreign material.