- Push tooth gently but firmly into socket.
- Non-rigid functional splint for 7-10 days.
- Check occlusion.
- Baseline radiographs: periapical or anterior occlusal. Any other teeth injured?
- Antibiotics, chlorhexidine mouthwash, soft diet as previously.
- Check tetanus immunization status.
REVIEW
- Radiograph⎯prior to splint removal at 7-10 days.
- Remove splint 7-10 days.
- Endodontics⎯commence prior to splint removal for categories (b) and (c):
(a) open apex. e.a.t. <30-45 min. Observe.
(b) open apex. e.a.t. >30-45 min. Endodontics.
(i) initial intracanal dressing⎯antibiotic/steroid (Ledermix, Lederle) paste.
(ii) subsequent intracanal dressings⎯non-setting calcium hydroxide paste.
(iii) replace calcium hydroxide 3 monthly until apical barrier (up to maximum of
2 years.
(iv) obturate canal with GP
(c) Closed apex. Endodontics.
(i) initial intracanal dressing antibiotic/steroid (Ledermix, Lederle) paste;
(ii) subsequent intracanal dressing with non-setting calcium hydroxide paste;
(iii) obturate with gutta percha at 6 months as long as no progressive resorption.
- Radiographic review: 1, 3, and 6 monthly for 2 years then annually.
- If resorption is progressing unhalted keep non-setting calcium hydroxide in the
tooth until exfoliation, changing it 6 monthly.
The immature tooth with an e.a.t. of less than 30-45 min may undergo pulp
revascularization (743HTable 12.2). However, these teeth require regular clinical and
radiographic review because once e.i.r. occurs it progresses rapidly.
Replantation of teeth with a dry storage time of greater than 1 h
The consenus opinion is that teeth with very immature apices should not be replanted.
The incidence of resorption, ankylosis, and subsequent loss is high due to the high
rate of bone remodelling in this age group.
Mature teeth with a dry storage time of greater than 1 h will have a non-vital p.l. The
necrotic p.l. and the pulp should be removed at chairside with pumice and water on a
bristle brush prior to rinsing with normal saline. The root canal is then obturated with
gutta percha and the tooth replanted and splinted for a longer period of up to 6 weeks.