Smiles For Tomorrow

Course Author(s): American Academy of Pediatric Dentistry, Chicago, IL


Avulsion is complete displacement of the tooth from the socket. Avulsedprimary teeth should not be replanted. In the primary dentition, the maxillaryanterior region is at low risk for space loss unless the avulsion occurs prior tothe eruption of the canines or the dentition is crowded. Fixed or removableappliances, while not always necessary, can be fabricated to satisfy parental concernsfor esthetics or to return a loss of oral or phonetic function.

An avulsed permanent tooth should be replanted except when replanting is contraindicatedby the child’s stage of dental development (risk for ankylosis where considerablealveolar growth has to take place) or compromising medical condition or by compromisedintegrity of the avulsed tooth or supporting tissues. Examples of compromisedmedical conditions are severe congenital cardiac anomalies, severe uncontrolledseizure disorder, severe mental disability, severe uncontrolled diabetes, and immunocompromisedstatus.

An avulsed permanent tooth should be replanted as soon as possible. Donot handle the root surface, but do rinse the tooth quickly under running waterto remove foreign material. The reimplanted tooth should be stabilized inits anatomically correct location by a flexible splint for 2 weeks.

Avulsion Site
Splinted Avulsed Tooth
Avulsed Tooth
6 Month Follow-up

If it is not possible to reimplant the tooth within 5 minutes, it should be storedin a medium that will help maintain the vitality of the periodontal ligament fiberson the root’s surface. Transportation media for avulsed teeth include (inorder of preference): Viaspan®, Hank’s Balanced Salt Solution, cold milk,saliva, or physiologic saline. Water is preferable only to dry storage.The risk of ankylosis increases significantly with an extraoral dry time of 20 minutes.An extraoral dry time of 60 minutes is considered the point where survival of theroot periodontal cells is unlikely. Tetanus prophylaxis and antibiotic coverageshould be considered. In permanent avulsed teeth, there is considerable riskfor pulp necrosis, root resorption, and ankylosis following reimplantation.Close monitoring is required following reimplantation and if the avulsed tooth hada closed apex, pulpectomy/debridement should be performed within 7 to 10 days.