Avulsion of permanent teeth（traumatic）
2022-06-20 10:17:48 0 举报AI智能生成
2020年指南
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Introduction
0.5-16% of all dental injuries
Treatment: replantation
First aid at the place of accident
Replantation
permanent tooth！
pick it up by the crown
rinse it gently in milk, saline, patient's saliva
return it to its original position
bite on gauze, a handkerchief or a napkin to hold it in place
Keep the tooth/teeth in a storage medium：milk＞HBSS＞saliva (after spitting into a glass for instance)＞saline＞water
Treatment guidelines
Assess the condition of the PDL cells by day time
most likely viable: be replanted within 15min
may be viable: be kept in a storage medium + total day time <60min
likely to be non-viable: the total day time ≥60min
Closed apex
Been replanted
Clean the injured area with water, saline, or chlorhexidine
Local anesthesia
Verify the position
Right place: Leave the tooth/teeth in place
Malposition: correct the position using slight digital pressure
Wrong socket or Rotated: reposition within 48h
Stabilize for 2 weeks or 4 weeks (alveolar or jawbone fracture)
Suture gingival lacerations
RCT within 2 weeks
Systemic antibiotics
Check tetanus status
Patient instructions
Follow up
Been kept in a storage medium + total day time <60min
Remove debris
Keep the tooth in a storage medium
Local anesthesia
Irrigate the socket with sterile saline
Reposition the fractured fragment
Remove the coagulum with a saline stream
Replant
Verify the position
后续步骤同上
Total day time ≥60 min: 同“保存于介质+干燥时间＜60min”
Open apex: 将上述RCT换成Pulp revascularization，随访异常及时处理
apexification
pulp revitalization/revascularization
RCT
Anesthetics
Infiltration anesthesia
Block/Regional anesthesia: severe injury cases
Systemic antibiotics: recommended
Why
prevent infection-related reactions
decrease the occurrence of inflammatory root resorption
patient's medical status or concomitant injuries
Dosage: patient's age and weight
First choices: Amoxicillin or penicillin
effectiveness on oral flora
low incidence of side effects
Others: Tetracycline, Specifically doxycycline
Effects: Antimicrobial, anti-inflammatory, anti-resorptive
Side effect: discoloration【Not for patients under 12 years of age】
Topical antibiotics: controversial
Tetanus: physician' evaluation
Stabilization(splinting)
Short-term
2 weeks: depending on the length and degree of maturation of the root
2 weeks→remove the splint and check the occlusion→1 additional week
4 weeks: alveolar or jawbone fracture
Passive and flexible splints
stainless steel wire up to a diameter of 0.016” or 0.4 mm
nylon fishing line (0.13-0.25 mm)
Labial surfaces
avoid occlusal interference
enable palatal/lingual access for endodontic procedures
Away from the marginal gingiva and interproximal areas
avoid plaque retention and secondary infection
easy cleaning
Patient instructions
Avoid participation in contact sports.
Maintain a soft diet for up to 2 weeks
Brush their teeth with a soft toothbrush
Use a chlorhexidine (0.12%) mouth rinse twice a day for 2 weeks
Endodontic considerations
Closed apex
Endodontic treatment within 2 weeks
Intracanal medicament before root canal filling
Calcium hydroxide: 1 month
Corticosteroid or corticosteroid/antibiotic mixture: 6 weeks
Open apex
Spontaneous pulp space revascularization
Risk of infection-related (inflammatory) root resorption
Follow-up. If pulp necrosis and infection
RCT
apexification
pulp space revascularization/revitalization
Follow-up procedures: Clinical and radiographic examination
Closed apex: 2, 4 weeks, 3, 6 months, 1, 2, 3, 4, 5 year at least
Open apex: 2 weeks, 1, 2, 3, 6 months, 1, 2, 3, 4, 5 year at least
Infection-related (inflammatory) resorption: root/bone resorption
Ankylosis-related (replacement) resorption
Radiographic absence of periodontal ligament space
Radiographic replacement of root structure by bone
A metallic sound to percussion
Outcomes
Core outcome set
Periodontal healing
Pulp space healing (for open apex teeth)
Pain
Discoloration
Tooth loss
Quality of life
Esthetics (patient perception)
Trauma-related dental anxiety
Number of clinic visits
Injury-specific outcomes: Infra-occlusion
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