Image: Avulsed two front teeth.

Avulsion is defined as complete displacement of a tooth out of its socket. The periodontal ligament is severed and fracture of the alveolus may occur. Clinical examination and radiographic examinations reveal that the tooth is not present in the socket. Radiographic examination is necessary to rule out intrusion, if the avulsed tooth is not found. Treatment consists of:

  • Primary teeth: Avulsed primary teeth are not replanted because of the potential for subsequent damage to the developing permanent tooth and the increased frequency of pulpal necrosis. This treatment approach will be disconcerting to some parents who will urge the dentist to replant the tooth so as not to compromise the child's appearance. The dentist should emphasize the advantage of sacrificing the primary teeth so as not to compromise the development of the permanent teeth. Parents are advised of primary teeth replacement alternatives.
Image: Avulsed teeth bridge.
Image: Results of avulsed teeth bridge.
Image: Results of avulsed teeth bridge.
  • Permanent teeth: The sooner avulsed permanent teeth are replanted the greater chance for a favorable outcome. However, before attempting replantation:

    • Assess the patient's medical status. Replantation is contraindicated in patients that are immunocompromised or suffer from severe congenital cardiac anomalies, severe uncontrolled seizure disorders, severe mental disability and severe uncontrolled diabetes.

    • Assess the integrity of the tooth and the supporting structures. Compromised integrity of the tooth (extensive decay) or supporting structures (alveolar fracture, bone recession due to periodontal disease) will reduce replantation success.

Image: Replantation of an avulsed tooth.

Replantation of an avulsed tooth is preferably done at the injury site to minimize extra-alveolar time. The tooth is rinsed with cold tap water for ten seconds to remove any gross contaminants and then immediately replanted in its socket. The patient is referred to the dental care facility for stabilization and antibiotic prophylaxis.