Avulsion

Question 1

At what age is avulsion most common and why?

Answer 1

In young dentition, where root development is still incomplete and periodontium very resilient

Question 2

What are most important factors determining success of treatment?

Question 3

What conditions are required for optimal healing?

Answer 3

Tooth is out of its socket for as short a period as possible, extraalveolar storage is in a physiologic medium, and contamination of tooth is eliminated/reduced/controlled by antibiotics

Question 4

When is gingival attachment re-established?

Answer 4

1 week after injury

Question 5

When is PDL revascularized?

Answer 5

1 week after injury

Question 6

What is pulp revascularized?

Answer 6

1 week after injury

Question 7

What physiological storage mediums can be used to store an avulsed tooth?

Answer 7

Physiological saline, tissue culture media, saliva, and milk

Question 8

When should you not replant a tooth?

Answer 8

In patients with open apices and a dry extraalvolar period greater than 60 min, as well as patients with severe periodontal conditions and gross, untreated carious lesiosn of involved teeth

Question 9

How long should you splint an avulsed tooth for?

Answer 9

7 days

Question 10

What follow-up schedule would you adopt?

Answer 10

A radiographic examination 3 weeks after replantation, follow-up again at 6 weeks, 3 months and 6 months after injury

Question 11

What follow-up schedule would you adopt if radiographic findings vaguely suggest inflammatory resorption and periapical radiolucency, both indications of infected pulp necrosis?

Answer 11

Further examinations at 1-week intervals should be made

Question 12

Make notes on antibiotic and anti-tetanus therapy

Question 13

When observing teeth with open apices what signs and or symptoms indicate need for endodontic intervention?

Question 14

What three groups should clinician classifying avulsed tooth into before commencing treatment?

Answer 14

PDL cells are most likely viable/PDL cells may be viable but compromised/PDL cells are likely to be non-viable

Question 15

When are PDL cells most likely viable?

Answer 15

Tooth has been replanted immediately/within a very short time (about 15 minutes) at place of accident

Question 16

What may PDL cells be viable but compromised?

Answer 16

Tooth has been kept in a storage medium (eg, milk, HBSS (Save-a-Tooth/similar product)/saliva/saline, and total extra-oral dry time has been <60 minutes).

Question 17

When are PDL cells likely to be non-viable?

Answer 17

Total extra-oral dry time has been more than 60 minutes, regardless of tooth having been stored in a medium/not

Question 18

What is endodontic treatment for an avulsed tooth with closed apices (mature teeth)?

Answer 18

Pulp extirpation should be started no later than 2 weeks after re-implantation

Question 19

What is endodontic treatment for an avulsed tooth with open apices (immature teeth)?

Answer 19

May revascularise but needs to be closely monitored as resorption and pulp death are very common

Question 20

Why should an avulsed tooth with open apices (immature teeth) be review more frequently?

Answer 20

Due to risk of infection-related (inflammatory) re-sorption and rapid loss of tooth and supporting bone when this is not identified quickly

Question 21

What cases require consideration as replantation may not always be advisable?

Answer 21

Gross untreated caries may indicate that commitment to necessary follow up is not there, a patient who cannot tolerate treatment under local and awake, marked anterior crowding, and prolonged dry storage of avulsed tooth

Question 22

What will avulsed incisor with a closed apex need?

Answer 22

Root treatment