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Taken from: Dental Traumatology, Oct. 2001.


Guidelines

 

Table 1: Treatment Guidelines for avulsed permanent teeth with Closed Apex.

Diagnosis ,Clinical situation

The tooth has already been replanted

The tooth has been kept in special
storage media, milk, saline or saliva.
The extra-oral
dry time is less than
60 min

Extra-oral dry time >60 min

 

Treatment

Clean affected area with water spray, saline or chlorhexidine
Do not extract the tooth (x)

 

 

 

 

 

 

 

 

If contaminated, clean the root surface and apical foramen with a stream of saline.
Remove the coagulum from the socket with a stream of saline. Examine the alveolar socket. If there is a fracture in the socket wall, reposition it with a suitable instrument.
Replant slowly with slight digital pressure (x)

Remove debris and necrotic periodontal ligament (xx) Remove the coagulum from the socket with a stream of saline. Examine the alveolar socket. If there is a fracture of the socket wall, reposition it with a suitable instrument.
Immerse the tooth in a 2.4% sodium fluoride solution acidulated to a pH 5.5 for a minimum of 5 min or, if available, fill the socket with Emdogain~.
Replant slowly with slight digital pressure (xx)

 

 

Suture gingival laceration, especially in the cervical area
Verify normal position of the replanted tooth radiographically
Apply a flexible splint for 1 week (x)

 

Administer systemic antibiotics: Doxycycline 2x per day for 7 days at appropriate dose for patient age and weight (xx).
Refer to physician to evaluate need for a tetanus booster if avulsed tooth has come into contact with soil or tetarus
coverage is uncertain
Initiate endodontic treatment after 710 days. Place calcium hydroxide as an intra-canal medicament (x)


Patient instruction

Soft diet for 2 weeks

Brush teeth with a soft toothbrush after each meal

Use a chlorhexidine mouthrinse (0.1%) twice a day for 1 week

Follow-up (See Table 3)

 

Courtesy: Fred Barnett, www.rxroots.com