Traumatic Injuries to the Teeth

Traumatic Injuries Traumatic Injuries

to the Teethto the Teeth

Scott A. Schwartz, Colonel, USAF, DCScott A. Schwartz, Colonel, USAF, DC

Traumatic Injuries to the TeethTraumatic Injuries to the Teeth

Crown FracturesCrown Fractures

CrownCrown--Root FracturesRoot Fractures

Root FracturesRoot Fractures

Luxation InjuriesLuxation Injuries

AvulsionAvulsion


Root Fracture UpdateRoot Fracture Update



Management of the Management of the

Avulsed ToothAvulsed Tooth


Clinical examinationClinical examination

–– Tooth usually slightly extrudedTooth usually slightly extruded

–– Tooth frequently displaced Tooth frequently displaced

linguallylingually



–– Tooth usually slightly extrudedTooth usually slightly extruded

–– Tooth frequently displaced Tooth frequently displaced

linguallylingually



–– Diagnosis entirely Diagnosis entirely

dependent upon dependent upon

radiographic radiographic

examinationexamination

Emergency ManagementEmergency Management

Periapical radiographsPeriapical radiographs

–– Standard XCP radiographStandard XCP radiograph

–– Increased vertical angulationIncreased vertical angulation


Periapical radiographsPeriapical radiographs

–– Standard XCP radiographStandard XCP radiograph

–– Increased vertical angulationIncreased vertical angulation


Reposition coronal Reposition coronal

fragmentfragment


Previous Previous

recommendationrecommendation

–– Rigid splinting for 2Rigid splinting for 2--3 3

monthsmonths


Previous Previous

recommendationrecommendation

–– Rigid splinting for 2Rigid splinting for 2--3 3

monthsmonths

New recommendationNew recommendation

–– Splinting for 3 weeksSplinting for 3 weeks

Root Fracture HealingRoot Fracture Healing

Root Fracture ComplicationsRoot Fracture Complications

Pulp necrosisPulp necrosis

–– Coronal segment Coronal segment 20 to 20 to

44%44%




44%44%

–– Apical segment Apical segment 0%0%




44%44%





44%44%


Pulp canal obliteration Pulp canal obliteration

69%69%




44%44%


Pulp canal obliteration Pulp canal obliteration

69%69%

Root resorption Root resorption 60%60%

Root Fracture TreatmentRoot Fracture Treatment

SummarySummary

–– Reposition and splint for Reposition and splint for 3 weeks3 weeks !!!!


SummarySummary


–– Monitor with pulp tests and Monitor with pulp tests and

radiographsradiographs


SummarySummary


–– Monitor with pulp tests and Monitor with pulp tests and

radiographsradiographs

–– Do not initiate endodontic treatment Do not initiate endodontic treatment

unless there are signs of pulp unless there are signs of pulp

necrosisnecrosis

Management of the Avulsed Management of the Avulsed

ToothTooth



OverviewOverview

Periodontal Ligament Responses Periodontal Ligament Responses

Treatment ConsiderationsTreatment Considerations

Pulpal Prognosis/ Endodontic RationalePulpal Prognosis/ Endodontic Rationale

Treatment RegimenTreatment Regimen

Avulsed Permanent TeethAvulsed Permanent Teeth

Incidence Incidence

–– 0.5% to 16% of 0.5% to 16% of

traumatic injuriestraumatic injuries

Main etiologic Main etiologic

factorsfactors

–– FightsFights

–– Sports injuriesSports injuries

–– Automobile Automobile

accidentsaccidents


Maxillary central incisor Maxillary central incisor

–– Most commonly avulsed Most commonly avulsed

toothtooth

Mandibular teethMandibular teeth

–– Seldom affectedSeldom affected

Most frequently involves a Most frequently involves a

single toothsingle tooth


Most common age Most common age -- 7 to 117 to 11

–– Permanent incisors eruptingPermanent incisors erupting

–– Loosely structured PDLLoosely structured PDL


Associated injuriesAssociated injuries

–– Fracture of alveolar Fracture of alveolar

socket wallsocket wall


Associated injuriesAssociated injuries

–– Fracture of alveolar Fracture of alveolar

socket wallsocket wall

–– Injuries to the lips Injuries to the lips

and gingivaand gingiva

Management of theManagement of the


What tissue should What tissue should

be our primary be our primary

concern?concern?

–– Pulp?Pulp?





concern?concern?

–– Pulp?Pulp?

–– Socket?Socket?





concern?concern?

–– Pulp?Pulp?

–– Socket?Socket?

–– PDL?PDL?



Ultimate goalUltimate goal

–– PDL healing without PDL healing without

root resorptionroot resorption



Ultimate goalUltimate goal

–– PDL healing without PDL healing without

root resorptionroot resorption

Most critical factorMost critical factor

–– Maintaining an intact Maintaining an intact

and viable PDL on and viable PDL on

the root surfacethe root surface

Periodontal Ligament Periodontal Ligament

ResponsesResponses

Surface ResorptionSurface Resorption

Replacement Resorption (Ankylosis)Replacement Resorption (Ankylosis)

Inflammatory ResorptionInflammatory Resorption

Andreasen JO, HjortingAndreasen JO, Hjorting--Hansen E.Hansen E.

Replantation of teeth II. Histological study Replantation of teeth II. Histological study of 22 replanted anterior teeth in humans.of 22 replanted anterior teeth in humans.

Acta Odontol Scand 1966;24:287Acta Odontol Scand 1966;24:287--306.306.


ResponsesResponses

Surface resorptionSurface resorption

–– Superficial resorption Superficial resorption

cavitiescavities

–– Mainly in cementumMainly in cementum

–– Complete repair of Complete repair of

PDLPDL


ResponsesResponses

Replacement Replacement resorption resorption

(Ankylosis)(Ankylosis)–– Direct union of bone Direct union of bone

and rootand root

–– Resorption of root Resorption of root --Replacement with Replacement with bonebone

–– Direct result of loss of Direct result of loss of vital PDLvital PDL


ResponsesResponses

Inflammatory resorptionInflammatory resorption

–– Resorption of cementum Resorption of cementum

and dentinand dentin

–– Inflammatory reaction in Inflammatory reaction in

the periodontal ligamentthe periodontal ligament

EtiologyEtiology

Inflammatory Inflammatory

resorptionresorption

–– Surface resorption of Surface resorption of

cementum exposing cementum exposing

dentinal tubulesdentinal tubules

EtiologyEtiology






–– Pulp necrosisPulp necrosis

EtiologyEtiology






–– Pulp necrosisPulp necrosis

–– Toxic products from Toxic products from

the pulp provoke an the pulp provoke an

inflammatory inflammatory

response in the PDLresponse in the PDL

Periodontal Ligament ResponsesPeriodontal Ligament Responses




Replacement resorption (Ankylosis)Replacement resorption (Ankylosis)



Replacement resorption (Ankylosis)Replacement resorption (Ankylosis)

Inflammatory resorptionInflammatory resorption

Treatment ConsiderationsTreatment Considerations

Extraoral timeExtraoral time

Extraoral environmentExtraoral environment

Root surface manipulationRoot surface manipulation

Management of the socketManagement of the socket

StabilizationStabilization

Extraoral TimeExtraoral Time

Shorter time = Better prognosisShorter time = Better prognosis**< 30 min < 30 min 10% resorption10% resorption

> 90 min > 90 min 90% resorption90% resorption


Replantation of teeth I. Radiographic and clinical study Replantation of teeth I. Radiographic and clinical study of 110 human teeth replanted after accidental loss.of 110 human teeth replanted after accidental loss.


Extraoral TimeExtraoral Time

Shorter time = Better prognosisShorter time = Better prognosis**< 30 min < 30 min 10% resorption10% resorption

> 90 min > 90 min 90% resorption90% resorption

**depending on storage mediumdepending on storage medium


Replantation of teeth I. Radiographic and clinical study Replantation of teeth I. Radiographic and clinical study of 110 human teeth replanted after accidental loss.of 110 human teeth replanted after accidental loss.


Extraoral EnvironmentExtraoral Environment

Viability of PDL cells is Viability of PDL cells is

criticalcritical

Storage MediaStorage Media

Tap WaterTap Water

DryDry

Saliva Saliva

SalineSaline

Andreasen JO.Andreasen JO.

Effect of extraEffect of extra--alveolar period and storage media alveolar period and storage media

upon periodontal and pulpal healing after replantation upon periodontal and pulpal healing after replantation

of mature permanent incisors in monkeys.of mature permanent incisors in monkeys.

Int J Oral Surg 1981;10:43Int J Oral Surg 1981;10:43--53.53.

Poor Poor resultsresults


Tap WaterTap Water

DryDry

Saliva Saliva

SalineSaline


Effect of extraEffect of extra--alveolar period and storage media upon alveolar period and storage media upon

periodontal and pulpal healing after replantation periodontal and pulpal healing after replantation

of mature permanent incisors in monkeys.of mature permanent incisors in monkeys.

Int J Oral Surg 1981;10:43Int J Oral Surg 1981;10:43--53.53.

GoodGood protection protection for 2 hrsfor 2 hrs

Poor resultsPoor results

Milk As A Storage MediumMilk As A Storage Medium

Physiologic Physiologic

osmolalityosmolality

Markedly fewer Markedly fewer

bacteria than salivabacteria than saliva

Readily availableReadily available

Storage Media Storage Media -- Milk vs. SalivaMilk vs. Saliva

Storage for 2 hrsStorage for 2 hrs–– Periodontal healing almost as good as immediate Periodontal healing almost as good as immediate

replantationreplantation

Blomlof L, et al.Blomlof L, et al.

Storage of experimentally avulsed teeth in milk Storage of experimentally avulsed teeth in milk prior to replantation.prior to replantation.

J Dent Res 1983;62:912J Dent Res 1983;62:912--6.6.

Storage Media Storage Media -- Milk vs. SalivaMilk vs. Saliva

Storage for 2 hrsStorage for 2 hrs–– Periodontal healing almost as good as immediate Periodontal healing almost as good as immediate

replantationreplantation

Storage for 6 hrsStorage for 6 hrs–– Saliva Saliva extensive replacement resorptionextensive replacement resorption

–– Milk Milk healing almost as good as immediate healing almost as good as immediate replantreplant

Blomlof L, et al.Blomlof L, et al.

Storage of experimentally avulsed teeth in milk Storage of experimentally avulsed teeth in milk prior to replantation.prior to replantation.

J Dent Res 1983;62:912J Dent Res 1983;62:912--6.6.

Cell Culture MediaCell Culture Media

Eagle’s MediumEagle’s Medium

Hank’s Balanced Salt Solution Hank’s Balanced Salt Solution

Hank’s Balanced Salt SolutionHank’s Balanced Salt Solution

Proper pH and osmolalityProper pH and osmolality

Reconstitutes depleted cellular metabolitesReconstitutes depleted cellular metabolites

Washes toxic breakdown products from the Washes toxic breakdown products from the

root surfaceroot surface

Organ Transplant Storage MediaOrgan Transplant Storage Media

ViaspanViaspan

–– Dramatically prolongs the storage of human Dramatically prolongs the storage of human

organsorgans

–– ExpensiveExpensive

–– Not readily availableNot readily available

Storage Media ComparisonStorage Media Comparison

ViaspanViaspan–– Complete healing after 6 and 12 hrsComplete healing after 6 and 12 hrs

–– Good for extended storage periods (72 and 96 Good for extended storage periods (72 and 96 hrs)hrs)

Trope M, Friedman S.Trope M, Friedman S.

Periodontal healing of replanted dog teeth stored Periodontal healing of replanted dog teeth stored in Viaspan, milk and Hank’s balanced salt solution.in Viaspan, milk and Hank’s balanced salt solution.

Endod Dent Traumatol 1992;8:183Endod Dent Traumatol 1992;8:183--8.8.

Storage Media ComparisonStorage Media Comparison

ViaspanViaspan–– Complete healing after 6 and 12 hrsComplete healing after 6 and 12 hrs

–– Good for extended storage periods (72 and 96 Good for extended storage periods (72 and 96 hrs)hrs)

Hank’s balanced salt solutionHank’s balanced salt solution–– Healing results similar to ViaspanHealing results similar to Viaspan

Trope M, Friedman S.Trope M, Friedman S.

Periodontal healing of replanted dog teeth stored Periodontal healing of replanted dog teeth stored in Viaspan, milk and Hank’s balanced salt solution.in Viaspan, milk and Hank’s balanced salt solution.


Recommended Storage MediaRecommended Storage Media

1. Socket (immediate 1. Socket (immediate

replantation)replantation)

2. Cell culture 2. Cell culture

mediummedium

3. Milk3. Milk

4. Physiologic saline4. Physiologic saline

5. Saliva5. Saliva

Root Surface ManipulationRoot Surface Manipulation

Attempt to retain PDL cell viabilityAttempt to retain PDL cell viability–– Do not curette root surfaceDo not curette root surface

–– Avoid caustic chemicalsAvoid caustic chemicals

Van Hassel HJ, Oswald RJ, Harrington GW.Van Hassel HJ, Oswald RJ, Harrington GW.

Replantation 2. The role of the periodontal Replantation 2. The role of the periodontal ligament.ligament.

J Endodon 1980;6:506J Endodon 1980;6:506--8.8.


Extraoral dry timeExtraoral dry time determines handlingdetermines handling


Extraoral Extraoral drydry time time << 1 hr1 hr

–– PDL healing is still possiblePDL healing is still possible

–– Handling recommendationsHandling recommendations

»» Keep root moistKeep root moist

»» Do not handle root surfaceDo not handle root surface

»» Gentle debridementGentle debridement


Extraoral Extraoral drydry time > 1 hrtime > 1 hr

–– Loss of PDL cell viability Loss of PDL cell viability

inevitable inevitable

–– Treatment recommendationsTreatment recommendations

»» Remove tissue tagsRemove tissue tags

»» Soak in accepted dental Soak in accepted dental

fluoride solution for 20 minfluoride solution for 20 min

Fluoride TreatmentFluoride Treatment

1.01.0--2.4% topical 2.4% topical

fluoride solutionfluoride solution

–– Sodium fluoride Sodium fluoride

(Andreasen)(Andreasen)

–– Stannous fluoride Stannous fluoride

(Krasner)(Krasner)

20 minute soak20 minute soak

Management of the SocketManagement of the Socket

Remove contaminated coagulum in Remove contaminated coagulum in

socketsocket

–– Irrigate with sterile saline Irrigate with sterile saline


Examine socket Examine socket If fracture is evidentIf fracture is evident

–– Reposition fractured bone with a blunt Reposition fractured bone with a blunt

instrumentinstrument


Replant using light digital pressureReplant using light digital pressure

StabilizationStabilization

Splint Splint

–– Definition Definition a a rigidrigid or or flexibleflexible device used to device used to

support, protect, or immobilize teeth, preventing support, protect, or immobilize teeth, preventing

further injuryfurther injury

–– TypesTypes

•• Acid etch compositeAcid etch composite

•• CrossCross--suturesuture

Acid Etch Composite SplintsAcid Etch Composite Splints

Interproximal compositeInterproximal composite


Composite with arch wireComposite with arch wire


Composite with monofilament nylonComposite with monofilament nylon


Functional SplintFunctional Splint–– 2020--30 lb 30 lb

monofilament nylonmonofilament nylon

–– Bonded with Bonded with compositecomposite

–– Allows physiologic Allows physiologic movementmovement

Antrim DD, Ostrowski JS.Antrim DD, Ostrowski JS.

A functional splint for traumatized A functional splint for traumatized teeth.teeth.


CrossCross--Suture SplintSuture Splint

IndicationsIndications

–– No adjacent teeth to No adjacent teeth to

splint tosplint to

–– Unmanageable Unmanageable

traumatized childrentraumatized children

CrossCross--Suture SplintSuture Splint

Splinting TimeSplinting Time

Effect of splinting timeEffect of splinting time–– 7 days7 days

–– 30 days30 days

Nasjleti CE, Castelli WA, Nasjleti CE, Castelli WA, Caffesse RG.Caffesse RG.

The effects of different splinting The effects of different splinting times on replantation of teeth in times on replantation of teeth in monkeys.monkeys.

Oral Surg 1982;53:557Oral Surg 1982;53:557--66.66.

Splinting TimeSplinting Time

Recommended timeRecommended time–– 7 to 10 days7 to 10 days

Nasjleti CE, Castelli WA, Nasjleti CE, Castelli WA, Caffesse RG.Caffesse RG.

The effects of different splinting The effects of different splinting times on replantation of teeth in times on replantation of teeth in monkeys.monkeys.

Oral Surg 1982;53:557Oral Surg 1982;53:557--66.66.

Pulpal PrognosisPulpal Prognosis

Stage of root developmentStage of root development

Dry storage timeDry storage time

Storage mediaStorage media

AntibioticsAntibiotics

Stage of Root DevelopmentStage of Root Development

Mature roots (Mature roots (<< 1.0 mm) 1.0 mm) –– Revascularization 0%Revascularization 0%

Kling M, et al. Endod Dent Traumatol 1986;2:83Kling M, et al. Endod Dent Traumatol 1986;2:83--9. 9.

Andreasen JO, et al. Endod Dent Traumatol Andreasen JO, et al. Endod Dent Traumatol 1995;11:511995;11:51--8.8.

Stage of Root DevelopmentStage of Root Development

Mature roots (Mature roots (<< 1.0 mm) 1.0 mm) –– Revascularization 0%Revascularization 0%

Immature roots (> 1.0 mm)Immature roots (> 1.0 mm)–– Revascularization 18Revascularization 18--34%34%

Kling M, et al. Endod Dent Traumatol 1986;2:83Kling M, et al. Endod Dent Traumatol 1986;2:83--9. 9.

Andreasen JO, et al. Endod Dent Traumatol Andreasen JO, et al. Endod Dent Traumatol 1995;11:511995;11:51--8.8.

RevascularizationRevascularization

Loss of blood Loss of blood

supply to pulpsupply to pulp

Revascularization Revascularization –– Day 4Day 4

Coronal pulpCoronal pulp

–– Extensive ischemic Extensive ischemic

injuryinjury

Revascularization Revascularization –– Day 4Day 4

Coronal pulpCoronal pulp

–– Extensive ischemic Extensive ischemic

injuryinjury

Apical pulpApical pulp

–– Initial revascularizationInitial revascularization

Revascularization Revascularization –– 4 Weeks4 Weeks

Pulp statusPulp status

–– RevascularizationRevascularization

–– ReinnervationReinnervation

–– New odontoblastic layerNew odontoblastic layer

RevascularizationRevascularization

Typical sequelaTypical sequela

–– Pulp canal obliterationPulp canal obliteration

Dry Storage TimeDry Storage Time

As dry storage time increasesAs dry storage time increases

Pulp survival decreasesPulp survival decreases

Andreasen JO, Borum MK, Jacobsen HL, Andreasen JO, Borum MK, Jacobsen HL, Andreasen FM.Andreasen FM.

Endod Dent Traumatol 1995;11;59Endod Dent Traumatol 1995;11;59--68.68.


Nonphysiologic storageNonphysiologic storage–– Minimal chance of pulp Minimal chance of pulp

revascularizationrevascularization






Nonphysiologic storageNonphysiologic storage–– Minimal chance of pulp Minimal chance of pulp


Physiologic storagePhysiologic storage–– HBSS, milk, saline, salivaHBSS, milk, saline, saliva

–– Improved chance of pulp Improved chance of pulp revascularizationrevascularization





Pulpal Prognosis Pulpal Prognosis -- AntibioticsAntibiotics

Systemic antibioticsSystemic antibiotics

–– Pulp Pulp

revascularization is revascularization is

not increasednot increased

Cvek M, CleatonCvek M, Cleaton--Jones P, Austin J, Lowni J, Kling Jones P, Austin J, Lowni J, Kling M, Fatti P. M, Fatti P.


Cvek M, CleatonCvek M, Cleaton--Jones P, Austin J, Lowni J, Kling Jones P, Austin J, Lowni J, Kling M, Fatti P. M, Fatti P.



Systemic antibioticsSystemic antibiotics

–– Pulp Pulp

revascularization is revascularization is

not increasednot increased

Topical antibioticsTopical antibiotics

–– Beneficial effectBeneficial effect

Cvek M, CleatonCvek M, Cleaton--Jones P, Austin J, Kling M, Lowni J, Jones P, Austin J, Kling M, Lowni J, Fatti P. Fatti P.





Topical DoxycyclineTopical Doxycycline

–– Decreased microorganisms in Decreased microorganisms in

pulpal lumenpulpal lumen

–– Increased pulp Increased pulp







RecommendationRecommendation

–– Topical DoxycyclineTopical Doxycycline

»» 1 mg in 20 ml physiologic saline1 mg in 20 ml physiologic saline

»» 5 minute soak5 minute soak





Endodontic RationaleEndodontic Rationale

Mature root Mature root -- 4 weeks4 weeks

–– Very limited Very limited


Endodontic RationaleEndodontic Rationale

Mature root Mature root -- 4 weeks4 weeks

–– Very limited Very limited


–– Ischemic coronal pulp with Ischemic coronal pulp with

great risk of infection !!!great risk of infection !!!

Endodontic Rationale Endodontic Rationale –– Mature Mature

RootRoot

Pulpectomy Pulpectomy 77--14 days14 days


RootRoot

Calcium hydroxideCalcium hydroxide

placementplacement


RootRoot

Calcium hydroxideCalcium hydroxide–– AntibacterialAntibacterial

–– Increases pH in dentinIncreases pH in dentin

–– Favors mineralization over resorptionFavors mineralization over resorption

Tronstad L, Andreasen JO, et al.Tronstad L, Andreasen JO, et al.

pH changes in dental tissues after pH changes in dental tissues after root canal filling with calcium root canal filling with calcium hydroxide.hydroxide.



RootRoot Treatment recommendationTreatment recommendation

–– Ca(OH)Ca(OH)22 therapy for as long as therapy for as long as

practical, usually 6practical, usually 6--12 months12 months

Treatment of the Avulsed Permanent Treatment of the Avulsed Permanent Tooth.Tooth.

Recommended Guidelines of the Recommended Guidelines of the American Association of American Association of Endodontists, 1995.Endodontists, 1995.



Specific Treatment RegimenSpecific Treatment Regimen



Specific Treatment RegimenSpecific Treatment Regimen

Root DevelopmentRoot Development

Closed apexClosed apex

Open apexOpen apex

Extraoral Extraoral DryDry TimeTime

One hour or lessOne hour or less

More than one hourMore than one hour





Treatment FlowchartTreatment Flowchart

<< 1 hr1 hr > 1 hr> 1 hr

ExtraoralExtraoral Dry Dry TimeTime

Apex MaturityApex MaturityClosedClosed OpenOpen Open or ClosedOpen or Closed

PulpectomyPulpectomy77--14 days14 days

ObserveObserve

OptionOption: :

Extraoral Extraoral RCTRCT

Pulpectomy Pulpectomy 77--14 days14 days

Emergency TreatmentEmergency Treatment

Replantation Replantation

techniquetechnique

–– Local anesthetic, if Local anesthetic, if

necessarynecessary

–– Radiograph to verify Radiograph to verify

positionposition

–– Check occlusionCheck occlusion

–– Physiologic splintPhysiologic splint


Additional Additional

ConsiderationsConsiderations

–– AnalgesicsAnalgesics


Additional Additional

ConsiderationsConsiderations


–– ChlorhexidineChlorhexidine


Additional ConsiderationsAdditional Considerations



–– TetanusTetanus

»» Refer to physician for tetanus prophylaxis prnRefer to physician for tetanus prophylaxis prn

Rothstein RJ, Baker FJ.Rothstein RJ, Baker FJ.

Tetanus: Prevention and treatment.Tetanus: Prevention and treatment.

J Am Med Assoc 1978;240:675J Am Med Assoc 1978;240:675--6.6.

Rothstein RJ, Baker FJ.Rothstein RJ, Baker FJ.

Tetanus: Prevention and treatment.Tetanus: Prevention and treatment.

J Am Med Assoc 1978;240:675J Am Med Assoc 1978;240:675--6.6.


Additional ConsiderationsAdditional Considerations



–– TetanusTetanus

–– AntibioticsAntibiotics


PenicillinPenicillin–– 500 mg qid for 4500 mg qid for 4--7 days7 days


Atlas of replantation and transplantation of Atlas of replantation and transplantation of teeth.teeth.

Philadelphia: W.B. Saunders Co., 1992;57Philadelphia: W.B. Saunders Co., 1992;57--92.92.


Tetracycline vs. amoxicillin Tetracycline vs. amoxicillin

in a replacement resorption modelin a replacement resorption model

–– Tetracycline had better antiTetracycline had better anti--resorptive propertiesresorptive properties

SaeSae--Lim V, Wang CY, Choi GW, Trope M.Lim V, Wang CY, Choi GW, Trope M.

The effect of systemic tetracycline on resorption of The effect of systemic tetracycline on resorption of

dried replanted dogs’ teeth.dried replanted dogs’ teeth.



Tetracycline vs. amoxicillin Tetracycline vs. amoxicillin

in an inflammatory root resorption modelin an inflammatory root resorption model

–– Tetracycline had better antiTetracycline had better anti--bacterial propertiesbacterial properties

SaeSae--Lim V, Wang CY, Trope M.Lim V, Wang CY, Trope M.

Effect of systemic tetracycline and amoxicillin on Effect of systemic tetracycline and amoxicillin on

inflammatory root resorption of replanted dogs’ teeth.inflammatory root resorption of replanted dogs’ teeth.



RecommendationRecommendation

–– “Tetracycline could be considered as an alternative “Tetracycline could be considered as an alternative

to amoxicillin after avulsion injuries.”to amoxicillin after avulsion injuries.”


Effect of systemic tetracycline and amoxicillin on Effect of systemic tetracycline and amoxicillin on

inflammatory root resorption of replanted dogs teeth.inflammatory root resorption of replanted dogs teeth.


Tetracycline Use In Young Tetracycline Use In Young

ChildrenChildren

Tetracycline stainingTetracycline staining–– Not a problem since avulsed maxillary anteriors Not a problem since avulsed maxillary anteriors

have already erupted and are not susceptible to have already erupted and are not susceptible to stainingstaining

–– At worst, posterior teeth might be stainedAt worst, posterior teeth might be stained»» Remote possibility with 7Remote possibility with 7--10 day prescription10 day prescription


Effect of systemic tetracycline and amoxicillin on Effect of systemic tetracycline and amoxicillin on inflammatory root resorption of replanted dogs’ teeth.inflammatory root resorption of replanted dogs’ teeth.


Avulsion SequelaeAvulsion Sequelae

Closed ApexClosed Apex

Extraoral dry time Extraoral dry time

1 hour or less1 hour or less


Closed ApexClosed Apex


more than 1 hourmore than 1 hour


Open ApexOpen Apex


1 hour or less1 hour or less


Open ApexOpen Apex


more than 1 hourmore than 1 hour

Avulsion ManagementAvulsion Management

Be prepared Be prepared --

Dental Trauma KitDental Trauma Kit

Immerse tooth in a Immerse tooth in a

physiologic storage medium physiologic storage medium

to “buy time”to “buy time”

Determine extraoral Determine extraoral drydry timetime

Follow AAE GuidelinesFollow AAE Guidelines

Documents

Traumatic Injuries to the Teeth