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Avulsion
The document provides guidelines for the management of avulsed permanent teeth, dividing it into two main stages: emergency treatment and definitive treatment. For emergency treatment, it outlines steps like keeping the patient calm, finding and cleaning the tooth if dirty, and seeking immediate dental treatment. Definitive treatment involves clinical and radiographic examination, sensibility testing, and treatment based on the apex status and extraoral dry time of the tooth. It details protocols for teeth with open or closed apices that were replanted immediately, stored in media, or dry for over 60 minutes. The guidelines emphasize the importance of this area in pediatric dentistry.
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Avulsion
- 1. GUIDELINES FOR THEMANAGEMENT OF TRAUMATIC DENTAL INJURIES.II.AVULSION OF PERMENANT TEETH (JOURNAL CLUB) Flores MT, Andersson L, Andreasen JO, Bakland LK, Malmgren B, Barnett F, Bourguignon C, DiAngelis A, Hicks L, Sigurdsson A, Trope M, Tsukiboshi M, von Arx T Dent Traumatol.2007 Jun;23(3):130-6 DR.TINET MARY AUGUSTINE.BDS.MDS 1
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- 3. FIRST AID FORAVULSED TEETH • Keep patient calm • Find the tooth • If dirty,wash it,try to reposition • If not storage medium • Seek emergency dental treatment DR.TINET MARY AUGUSTINE.BDS.MDS 3
- 4. SAVE A TOOTH DR.TINETMARY AUGUSTINE.BDS.MDS 4
- 5. GUIDELINES FOR THECLINICIAN • Clinical Examination • Radiographic Examination • Sensibility Test • Patient Instructions DR.TINET MARY AUGUSTINE.BDS.MDS 5
- 6. TREATMENT GUIDELINES FOR AVULSEDPERMENANT TEETH WITH CLOSED APEX • Clinical Situation:replanted Prior To Patient Arrives • Inspect • Administer Systemic Antibiotics • Tetanus Coverage • RCT • Patient Instructions • Follow Up DR.TINET MARY AUGUSTINE.BDS.MDS 6
- 7. • Clinical Situation:tooth Kept In storage media • Clean • Systemic Antibiotics • Tetanus Coverage • RCT • Patient Instructions • Follow Up DR.TINET MARY AUGUSTINE.BDS.MDS 7
- 8. Extra oral drytime more than 60 min • Prognosis • Technique Cleaning RCT Examine the alveolar socket Immerse in 2% sodium flouride for 20 min Replant Stabilize 4 weeks • Antibiotics • Patient instruction • Follow up DR.TINET MARY AUGUSTINE.BDS.MDS 8
- 9. TREATMENT GUIDELINES FOR AVULSEDPERMANENT TEETH WITH OPEN APEX • Clinical Condition: Already Replanted • Clean The Area • Antibiotics • Physician Referal • Procedure • Patient Instructions • Follow Up DR.TINET MARY AUGUSTINE.BDS.MDS 9
- 10. TOOTH KEPT INSTORAGE MEDIUM • Clean The Tooth • Examine The Socket • Treatment Procedure • Antibiotic Coverage • Physician Referal • Procedure • Patient Instructions • Follow Up DR.TINET MARY AUGUSTINE.BDS.MDS 10
- 11. EXTRA ORAL TIMELONGER THAN 60 MIN • Prognosis • Technique: • Cleaning • Rct • Immerse In 2% NaF • Stabilize 4 weeks • Antibiotic Coverage • Patient Instruction • Follow Up DR.TINET MARY AUGUSTINE.BDS.MDS 11
- 12. FOLLOW UP PROCEDUREFOR AVULSED PERMENAT TEETH • RCT • Clinical Control Monitored 1,3,6,12 months,yearly) • Favourable Outcome • Unfavourable Outcome • Splinting DR.TINET MARY AUGUSTINE.BDS.MDS 12
- 13. Closed Apex Satisfactory outcome •Clinical : asymptomatic, normal mobility, normal sound on percussion. • Radiographic : no periradicular radiolucencies indicative of progressive external inflammatory root resorption Unsatisfactory outcome • Clinical : symptomatic and/or high pitch percussion sound. • Radiographic : Periradicular radiolucencies in the root and bone or radiographic replacement of the root with bone DR.TINET MARY AUGUSTINE.BDS.MDS 13
- 14. Open Apex Satisfactory outcome •Clinical : asymptomatic, normal mobility and eruption pattern, normal sound on percussion. Positive sensitivity test. • Radiographic : Continued root development, Unsatisfactory Outcome • Clinical : symptomatic and / or high pitched percussion sound. Tooth in infra occlusion. • Radiographic : As with closed apex. Root fails to develop, the pulpal lumen does not change in size. DR.TINET MARY AUGUSTINE.BDS.MDS 14
- 15. CRITICAL EVALUATION POSITIVE: • Agood outline about the management of the avulsed condition • Will be useful for even general dental practioners NEGATIVES: • Complete explanation couldn’t be done as it is a guidelines DR.TINET MARY AUGUSTINE.BDS.MDS 15
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- 19. Treatment of avulsedteeth is divided in 2 main stages: • 1. emergency treatment that should be provided as soon as possible; • 2. definitive treatment based on a clinical and radiographic follow-up examination. DR.TINET MARY AUGUSTINE.BDS.MDS 19
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- 22. • Saline- PileggiEt Al 1995,Lauer Et Al 1997 • Gatorade- Harkacz Et Al,1981 • Saliva- Sangappa,2014 • Coconut Water- Gopikrishna 2008, Moreira-neto 2009 • Milk- Moreire-Neto 2009,Souza Et al 2011 • Egg White- Siddiqui 2014,Poi Wr 2013, Adnan,2014 • Morusrubra- Malhotran 2011 • Saliva Offinalis(herb)- Adnan,2014 • Custodial- Alacam Et Al 1996 DR.TINET MARY AUGUSTINE.BDS.MDS 22
- 23. • Honey Milk-Siddiqui 2014(better Than Fresh Milk), Nozari A 2013(HBSS) • Probiotics- Gopikrishna 2008 • Patients Own Serum- Thonner-Sangappa 2014 • Ascorbic Acid- Bazmi Ba 2013, Ishikawa 2004 • Culture Medium- Lekic Et Al-1998 • Conditioned Medium- Udoye Ci 2012 • HBSS- John H Hanks 1975-Siddique 2014,Krasner 1992 • Emdogain- Mc Donald 2011,Scilean2007 • Viaspan- Trope 1997,Hupp JG1998 DR.TINET MARY AUGUSTINE.BDS.MDS 23
- 24. • Green TeaExtracts- Hwang And Jung Et Al • Growth Factors- Ashkenazi M 2000 • Milk- Thomas T 2008 ,Blomlof 1981 • Milk Powder- Siddique E 2014 • Propolis- Martin and Pileggi 2004 • Tap water-unacceptable- Mackie 1992 • Normal saline- Cvek 1974 DR.TINET MARY AUGUSTINE.BDS.MDS 24
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- 35. CLINICAL MANAGEMENT OPEN APEXC;LOSED APEX 20M IN 20- 60MIN >60 MIN 20M IN 20- 60MIN >60 MIN DISINFEC TION & REIMPLA NTATION HBSS DISINFECTIO N REIMPLANT ENDODONTIC TREATMENT SODIUM FLOURIDE HBSS DISINFECTION REIMPLANT REIMPLA NTATION HBSS DISINFECTIO N REIMPLANT ENDODONTIC TREATMENT SODIUM FLOURIDE HBSS DISINFECTION REIMPLANT VIABLE VIABLE/COMPRO MISED NON -VIABLE VIABLE VIABLE/COMPRO MISED NON- VIABLE RE- IMPL ANTE D RE- IMPL ANTE D FLEXIBLE SPLINTING SYSTEMIC ANTIBIOTICS TETANUS PROTECTION PATIENT INSTRUCTION ROOT CANAL TREATMENT ANESTHESIA ANTIBIOTICS PATIENT INSTRUCTIONS ENDODONTIC CONSIDERATIONS FOLLOW UP-4W,3M,6M,1Y TOOTH LOSSDR.TINET MARY AUGUSTINE.BDS.MDS 35
- 36. IMPORTANCE IN PEDIATRIC DENTISTRY •Always expect the unexpected DR.TINET MARY AUGUSTINE.BDS.MDS 36
- 37. THANK YOU DR.TINET MARYAUGUSTINE.BDS.MDS 37