The document discusses the management of tooth avulsion, focusing on suitable storage media for avulsed teeth and their impact on periodontal ligament cells. Recommendations include milk as the best short-term storage option, while saline solution and tap water are deemed harmful. The document further explains healing processes associated with tooth avulsion, including surface resorption and ankylosis.

1. Endodontic Assignment
Tooth avulsion
Prepared by: Lama El Banna

2. Definition: noisluva htooT
latot seilpmi )noitaxul latot ,noitalucitraxe(
sti fo tuo htoot eht fo tnemecalpsid
tekcos.

3. An 11-raey-A htoot rosicni tnenamrep a desluva sah yobloohcs dlo
tnorf a tuo dekconk dna dnuorgyalp loohcs eht ni deppils sah dlihc
naht ssel deneppah tnedicca ehT .htoot5 minutes ago, the tooth
has been found and it is wrapped in a tissue
Example case

5. What age is the child?
The age will determine whether the tooth is primary or permanent and, if
permanent, the likely stage of root development.
Our patient was 11 years old

6. Where do you store the tooth?

7. ● The saline solution :
provides osmolality of 280 mOsm/kg
and despite being compatible to the
cells of the periodontal ligament, it lacks
essential nutrients necessary to the
normal metabolic needs of the cells of
the periodontal ligament. saline solution
was harmful to the cells of the
periodontal ligament in avulsed teeth if it
is used for longer than two hours.
:

8. Tap Water :
● It is an unacceptable storage media for avulsed
teeth.
● human PDL cells stored in tap water for 1 hour
caused more PDL cell damage than the other
physiological and non physiological storage
media tested.
● They attributed the increased cell damage to the
cells lysis caused by the very low osmolarity of
tap water.

9. Saliva :
● It can be used as a storage medium for a
short period of time, Its osmolality is much
lower than the physiologic saline ( 60–70
mOsm/kg), thus it boosts the harming
effects of bacterial contamination .
● It's only advantage is it availability.

10. ● The American Association of Endodontics
indicate milk desluva rof noitulos a sa
namuh eht fo ytilibaiv eht gnipeek rof ,hteet
tnemagil latnodoirep ralullec.
● Milk is significantly better than other solutions
for its physiological properties, including pH
and osmolality compatible to those of the
cells from the periodontal ligament; but it is
important that it is used in the first 20 minutes
after avulsion.
● The favorable results of milk probably occur
due to the presence of nutritional substances,
such as amino acids, carbohydrates and
vitamins.

11. ● The pasteurization of milk is
responsible for diminishing the
number of bacteria and bacteriostatic
substances, also for the inactive
presence of enzymes, which could be
potentially harmful to the fibroblasts of
the periodontal ligament. milk as an
excellent storing solution for 6 hours,
however, milk cannot revive the
degenerated cells.

12. Hank’s balanced salt solution:
● It is a standard saline solution that is widely used in biomedical
research to support the growth of many cells types. This
solution is nontoxic, it is biocompatible with periodontal ligament
cells It is composed of sodium chloride, D'Glucose; potassium
chloride; sodium bicarbonate;sodium phosphate; potassium
phosphate; calcium chloride, magnesium chloride and
magnesium sulfate.
● It contains ingredients, such as glucose, calcium and
magnesium ions which can sustain the depleted cellular
components of the periodontal ligament cells. It is commercially
available as Save the Tooth which has an inner net to receive
the avulsed tooth and to minimize cell trauma during transport.

14. Radiographic examination
Radiographic Features
• Empty socket or contain sharp object
• Associated bone fractures.

19. Prognosis

20. Healing with Surface
Resorption
● Histologically, this type of healing is
characterized by localized areas along
the root surface, which show superficial
resorption lacunae repaired by new
cementum. This surface resorption
presumably represents localized areas
of damage to PDL or cementum, which
is healed by PDL, derived cells.
Clinically, the tooth is in normal position
and a normal percussion tone can be
heard .

21. Healing with Ankylosis
(Replacement Resorption)
replacement resorption. Following ankylosis,
the tooth becomes fused to bone and is
remodelled and progressively replaced by
bone as part of the process of normal bone
turnover. No treatment

22. Healing with Ankylosis

32. The Last step
Enjoy with your
smile.