2. CLASSIFICATION:
ELLISAND DAVIES (1960)
- Class 5: Tooth loss due to trauma
PULVER’S Classification
• Class V
– Division II: PartialAvulsion
– Division III: Complete avulsion
WHO Classification
Exarticulation (CompleteAvulsion) N 873. 68
4. Tooth kept in storage media and
<60min
CLEANING
TOOTH IMMERSED
IN SALINE ADMINISTER LA
IRRIGATE SOCKET
WITH SALINE
REPLANTATION WITH
SLIGHT DIGITAL PRESSURE
1. Suture gingival lacerations
2. Verify the normal position of
replanted tooth
3. Apply flexible splint
4. Administer systemic
antibiotics
5. Check tetanus protection
6. Give patient instructions
7. Initiate RCT 7-10 days after
replantation and before splint
removal
8. Follow up
5. PROCEDURE
REMOV
AL OF
CONTAMINA
TED
COAGULUM
1. Administer LA
2. Irrigate Socket with saline
3. Examination OfAlveolar Socket
RCT
FLUORIDE
TREATMENT4. Replantation Of Tooth
2% NaF for 2
50
. m
Siu
nt
sure Gingival Lacerations
6. Verify Normal Position Of The Tooth
7. Stabilize The Tooth For 4 Weeks
Using Flexible Splint
8. Administration Of Systemic
Antibiotics
9. Check Tetanus Protection
10.Give Patients Instruction
11.Follow Up
6. OPEN APEX
1. Leave the tooth in place
2. Clean the area
3. Suture gingival lacerations
4. Verify the normal position of
replanted tooth
5. Apply flexible splint(2 weeks)
6. Administer systemic antibiotics
7. Check tetanus protection
8. Give patient instructions
9. Revascularization. If not then RCT
10. Follow up
TOOTH HAS BEEN REPLANTED BEFORE THE PATIENTSARRIVALATTHE
CLINIC
7. • Monitor every 4 weeks + pulp test + radiographs.
•Ideal outcome: revascularization and/or apexogenesis occurs
over the next 12 to 18 months.
• Alternative outcomes:
–Initiate apexification with mineral trioxide aggregate (MTA) or
calcium hydroxide or root canal therapy if clinical and/or
radiographic pathology presents.
–Consider decoronation procedure when clinical infraposition of the
tooth appears and/or clinical and radiographic findings of ankylosis
manifest.
• Follow-up: 1 week, 1 month, 3 months, 6 months, 12 months,
and annually for 5 years.
8. Tooth kept in storage media and
<60min
Clean the root surface and apical foramen with stream of saline
Topical application of antibiotics
Administer LA
Examine the alveolar socket
Remove the coagulum in the socket and replant the tooth slowly with slight
digital pressure
9. Suture gingival lacerations
Verify normal position of replanted tooth
Apply flexible splint (2wks)
Administer systemic antibiotics
Check tetanus protection
Give patient instructions
Follow up
10. DIFFERENT HEALING MODALITIES
IN PDL
Healing
with normal
PDL
Healing
with surface
resorption
Healing
with
ankylosis
Healing with
inflammatory
resorption
16. TAP WATER
•Shorter Period
Of Time
•NoAlternative
•Hypotonic
•Rapid Lysis Of
Cells
Pileggi R, Dumsha TC, Nor JE. Assessment of post traumatic PDL cell viability by a novel
collagenase assay. Dent Traumatol 2002;18:186-189
17. SALINE SOLUTION
• Similar
Osmolality
(280mOsm/Kg)
•No Growth Products
•Unable to maintain
metabolism of
Fibroblasts
•Storage Period:
•Upto 30 Mins With 80%
Cell Viability
Bazmi BA, Singh AK, Kar S, Mubtasum H. Storage media for avulsed tooth – a review. Ind J
Multidis Dent 2013;3(3):741-749.
18. SALIVA
•Shorter period of time
•Immediately avaliable
•Better than dry storage or
tap water
•osmolality (60-70 mOsm/kg)
•Damage to pdl cells
•Presence of microorganisms
Vineet IS Khinda, Gurpreet Kaur, Gurlal S Brar, Shiminder Kallar, Heena Khurana. Clinical and Practical Implications of
Storage Media used for ToothAvulsion. International Journal of Clinical Pediatric Dentistry,April-June 2017;10(2):158-165
19. MILK
CONTENTS OF SIGNIFICANCE:
•Amino acids
•Carbohydrates
•Essential nutrients
Low fat milk preferrable
Better than saliva and tap water
Vineet IS Khinda, Gurpreet Kaur, Gurlal S Brar, Shiminder Kallar, Heena Khurana. Clinical and
Practical Implications of Storage Media used for ToothAvulsion. International Journal of Clinical
Pediatric Dentistry,April-June 2017;10(2):158-165
20. COCONUT WATER
CONTENTS OF SIGNIFICANCE:
Vitamins, Minerals,Amino Acids,
Carbohydrates, Enzymes,Antioxidants
Similalr osmolality to body fluids
Increases mitogenicity
Economical & easily available
STORAGE PERIOD LIMIT:
Upto 8 hrs with pdl cell viability
comparable to HBSS
21. CONTACT LENS SOLUTION
• Essentially saline solution
• Osmolarity is damaging to pdl
• Cannot be preferred
HANK’S BALANCED SALT SOLUTION
CONTENTS OF SIGNIFICANCE:
• NaCl, glucose, KCl, NaHCO3,
NaPO4, CaCl, MgCl, MgSO4
• Recommended byAAE
• Preserves and reconstitutes PDl cells
• Not easily available
STORAGE PERIOD LIMIT:
• Extensive – upto 72 to 96 hrs with
maximum cell viability
22. PROPOLIS
CONTENTS OF SIGNIFICANCE:
Resin(55%)
Essential oils
Amino acids, minerals, ethanol, vitA, B complex, E and bioflavon
Better
preservation
of root
cementum
layer
STORAGE PERIOD
LIMIT:
Upto 45 mins with
90% viability
23. EAGLE’S MEDIUM
• Contents of significance:
Amino acids, vitamins, bicarbonates
• Pdl cells proliferated
• Not practical
• Storage period limit:
Upto 60 mins after transfering from
primary media with 90% viability
