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    Decision Trees For Management of An Avulsed Permanent Tooth

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    Abhi Thakkar
    This document provides decision trees for managing an avulsed permanent tooth with either an open apex (apex greater than 1 mm) or closed apex (apex less than 1 mm). For both cases, the tooth should be immediately replanted if possible. Otherwise, it should be stored in Hank's Balanced Salt Solution or milk and replanted within 60 minutes. Follow-up care includes splinting, antibiotics, monitoring for healing over 12-18 months, and potential root canal therapy or other procedures if healing does not occur.

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    Decision Trees For Management of An Avulsed Permanent Tooth

    Uploaded by

    Abhi Thakkar
    345 views2 pages
    This document provides decision trees for managing an avulsed permanent tooth with either an open apex (apex greater than 1 mm) or closed apex (apex less than 1 mm). For both cases, the tooth should be immediately replanted if possible. Otherwise, it should be stored in Hank's Balanced Salt Solution or milk and replanted within 60 minutes. Follow-up care includes splinting, antibiotics, monitoring for healing over 12-18 months, and potential root canal therapy or other procedures if healing does not occur.

    Original Title

    AVULSION

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    This document provides decision trees for managing an avulsed permanent tooth with either an open apex (apex greater than 1 mm) or closed apex (apex less than 1 mm). For both cases, the tooth should be immediately replanted if possible. Otherwise, it should be stored in Hank's Balanced Salt Solution or milk and replanted within 60 minutes. Follow-up care includes splinting, antibiotics, monitoring for healing over 12-18 months, and potential root canal therapy or other procedures if healing does not occur.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    345 views2 pages

    Decision Trees For Management of An Avulsed Permanent Tooth

    Uploaded by

    Abhi Thakkar
    This document provides decision trees for managing an avulsed permanent tooth with either an open apex (apex greater than 1 mm) or closed apex (apex less than 1 mm). For both cases, the tooth should be immediately replanted if possible. Otherwise, it should be stored in Hank's Balanced Salt Solution or milk and replanted within 60 minutes. Follow-up care includes splinting, antibiotics, monitoring for healing over 12-18 months, and potential root canal therapy or other procedures if healing does not occur.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    RESOURCES: AVULSED PERMANENT TOOTH

    Decision Trees for Management of an Avulsed


    Permanent Tooth

    Management of an Avulsed Assess medical history and rule out any neurologic and nondental injuries.
    Permanent Incisor with an Diagnostic tests:
    • Rule out alveolar fracture.
    Open Apex (Apex ≥ 1 mm)* • 3 radiographs angulated differently to rule out root fractures.
    • Pulp vitality test maxillary and mandibular anteriors.

    ↓ OR: ↓ OR: ↓ OR: OR: ↓


    Immediately Extraoral dry storage If tooth was kept moist 20 to 60 minutes >60 minutes extraoral
    time <20 minutes and (in water, saliva or other dry time/storage.
    replanted at the extraoral dry
    tooth was transported non-physiologic media)
    accident site. for 20 to 60 minutes. time/storage.
    in Hank’s Balanced
    Salt Solution (HBSS)
    or milk for 20 minutes Debride with soft pum-
    to 6 hours. ice prophylaxis, gauze,
    gentle scaling/root plan-
    ing, or 3% citric acid for
    3 minutes, and rinse well
    Change transport to HBSS. If HBSS to remove periodontal
    is not available, place in cold milk. ligament.

    Place in 1.23% sodium


    fluoride (e.g., acidulat-
    Soak in doxycycline or ArestinTM solution for 5 minutes. ed phosphate fluoride)
    for 5 to 20 minutes.

    • Replant and/or reposition.


    • Obtain periapical radiographs to verify position.
    • Place flexible splint for approximately 2 weeks; 4 weeks for dry time >60 minutes.
    • Rx: Antibiotics (eg, doxycyline or penicillin V potassium for non-allergic patients) for 7 days;
    Chlorhexidine rinse for 1 week.
    • Assess tetanus vaccination: if needed, get booster within 48 hours.
    • Provide post-operative instructions; inform of prognosis.
    • Follow up in 7 to 10 days.

    • 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.

    * Adapted with permission from: McIntyre J, Lee J, Trope M, Vann WJ, Permanent tooth replantation following avulsion:
    Using a decision tree to achieve the best outcome. Pediatr Dent 2009;31(2):137-44.

    534 THE REFERENCE MANUAL OF PEDIATRIC DENTISTRY


    RESOURCES: AVULSED PERMANENT TOOTH

    Management of an Avulsed
    Assess medical history and rule out any neurologic and nondental injuries.
    Permanent Incisor with an Diagnostic tests:
    Closed Apex (Apex < 1 mm)* • Rule out alveolar fracture.
    • 3 radiographs angulated differently to rule out root fractures.
    • Pulp vitality test maxillary and mandibular anteriors.

    ↓ OR: ↓ OR: ↓ OR: ↓ OR: ↓


    Extraoral dry storage time If tooth was kept moist 20 to 60 minutes >60 minutes extraoral dry
    Immediately
    was <20 minutes and tooth (in water, saliva or other extraoral dry time/storage.
    replanted at the
    accident site. was transported in Hank’s non-physiologic media) time/storage.
    Balanced Salt Solution for 20 to 60 minutes.
    (HBSS) or milk for 20
    minutes to 6 hours.

    Debride with soft pumice


    prophylaxis, gauze, gentle
    scaling/root planing, or 3%
    citric acid for 3 minutes,
    and rinse well to remove
    periodontal ligament.

    Change transport to HBSS. If HBSS is not


    available, place in cold milk. Place in 1.23% sodium
    fluoride (eg, acidulated
    phosphate fluoride) for
    5 to 20 minutes.

    • Replant and/or reposition.


    • Obtain periapical radiographs to verify position.
    • Place flexible splint for approximately 2 weeks; 4 weeks for dry time >60 minutes.
    • Rx: Antibiotics (eg, doxycyline or penicillin V potassium for non-allergic patients) for 7 days; Chlorhexidine rinse for 1 week.
    • Assess tetanus vaccination: if needed, get booster within 48 hours.
    • Provide post-operative instructions; inform of prognosis.
    • Follow up in 7 to 10 days.
    • Initiate pulpectomy/debridement on all teeth within 7 to 10 days.

    If root canal therapy was initiated, complete within 1 month.


    OR
    If patient does not present until >2 weeks after trauma and/or if radiographic resorption is present:
    • Pulpectomy/debridement as soon as possible.
    • Long-term calcium hydroxide therapy/slurry and change every 3 months.
    • Complete root canal therapy when periodontal ligament/lamina dura is observed/healthy.
    Follow-up: 1 week, 1 month, 3 months, 6 months, 12 months, and annually for 5 years.

    * Adapted with permission from: McIntyre J, Lee J, Trope M, Vann WJ, Permanent tooth replantation following avulsion:
    Using a decision tree to achieve the best outcome. Pediatr Dent 2009;31(2):137-44.

    THE REFERENCE MANUAL OF PEDIATRIC DENTISTRY 535

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