Storage Media For Avulsed Teeth: A Literature Review

Abstract

Dental avulsion is the most severe type of traumatic tooth injuries because it causes damage to several structures and results in the complete displacement of the tooth from its socket in the alveolar bone. The ideal situation is to replant an exarticulated tooth immediately after avulsion because the extraoral time is a determinant factor for treatment success and for a good prognosis. However, it is not always possible. The success of replantation depends on a number of factors that may contribute to accelerate or minimize the occurrence of root resorption or ankylosis, among which is the type and characteristics of the medium used for temporary storage during the time elapsed between avulsion and replantation. Maintaining the tooth in an adequate wet medium that can preserve, as longer as possible, the vitality of the periodontal ligament cells that remain on root surface is the key to success of replantation. Recent research has led to the development of storage media that produce conditions that closely resemble the original socket environment, with adequate osmolality (cell pressure), pH, nutritional metabolites and glucose, and thus create the best possible conditions for storage. Although these storage media can now be purchased in the form of retail products, the most common scenario is that such a product will not be readily available at the moment of the accident This paper reviews the literature on the different storage media that have been investigated for avulsed teeth based on full-length papers retrieved from PubMed/Medline, Lilacs, BBO and SciELO electronic databases using the key words 'storage medium', 'transportation medium', 'avulsion', 'tooth avulsion', 'replantation', 'tooth replantation', 'milk' and 'propolis'. After application of inclusion and exclusion criteria, 39 papers were selected and critically reviewed with respect to the characteristics, efficacy and ease of access of the storage medium. The review of the literature showed that a wide array of types of wet storage media have been evaluated in laboratory studies and clinical reports, including cell and tissue culture solutions like Hank's Balanced Salt Solution (HBSS); medical/hospital products developed specifically for organ storage purposes, such as Viaspan® and Euro-Collins®; culture media, like Minimum Essential Medium (MEM); saline; natural products like water, saliva, bovine milk and its variations, propolis, green tea, Morus rubra (red mulberry), egg white and coconut water; rehydrating solutions, like Gatorade® and Ricetral, and even contact lens solutions. Based on the literature, it could be stated that, so far, apart from Based on the literature, it could be stated that, so far, apart from solutions designed specifically for storage and culture purposes, regular pasteurized whole milk is the most frequently recommended and with the best prognosis among other solutions that are likely to be available at the scene of an accident, such as water, saline or saliva. Its advantages include its high availability, ready access...

A 12-Year Retrospective Study of Avulsion Cases in a Public Brazilian Dental Trauma Service.

“…The success of the treatment is extremely dependent on how the avulsed teeth were managed prior to replantation (8). Ideally, avulsed teeth should be immediately replanted (10). The rupture of the blood supply causes deterioration in different levels of the pulp and periodontal ligament (PDL) cells (11).…”

Effect of Milk Renewal on Cell Viability In Vitro at Different Time Frames

“…Milk is a proven storage medium for avulsed teeth (6,8,11), but cell culture studies have shown that its effectiveness decreases over time (6)(7)(8), probably because the drop in its pH creates an unsuitable environment for cell survival (3). Thus, it was hypothesized that the renewal of milk for storing the avulsed tooth could prevent the drop in its pH.…”

“…Milk is recommended as a transport medium for avulsed teeth (3)(4)(5)(6)(7)(8)(9)(10)(11). Besides having low bacterial content (3,4), physiologic osmolality (230-270 mOsm/kg) and neutral pH (6.5-6.8), it provides the cells with nutrients (3) and growth factors (12,13).…”

Mokytojų, Bendrosios Praktikos Gydytojų Bei Pediatrų Skubios Pagalbos Žinios Vaikų Dantų Traumų Atveju Ir Jų Palyginimas

“…Išsky-rus specialius tirpalus, skirtus danties saugojimui ir transportavimui, dažniausiai rekomenduojamas pasterizuotas pienas, kuris yra izotoninis skystis, turintis augimo faktorių, būtinų ląstelėms maistingų medžiagų, lengvai prieinamas, nebrangiai kainuojantis, su fiziologine pH verte ir osmotiškumu, o šie parametrai atitinka ant šaknies paviršiaus esančių periodonto raiščio ląstelių parametrus. Įvertinus visas charakteristikas, veiksmingumą ir pasiekiamumą, pienas pripažintas kaip tinkama ir gera terpė laikinam danties patalpinimui iki replantacijos, tuo tarpu išmušto danties laikymas sausai ar vandentiekio vandenyje lemia periodonto raiščio ląstelių, esančių ant danties šaknies paviršiaus, nekrozę [14,15]. Įrodyta, jog ilgas danties laikymas po avulsijos, ne fiziologinėje terpėje, yra vienas iš kritiškiausių faktorių ir sukelia visišką periodonto raiščio nekrozę, todėl gijimas, vykstant pakaitinei šaknies rezorbcijai, tampa vienintele išeitimi [16].…”

“…Išmuštą dantį galima gabenti vaiko burnos ertmėje, jei jis sąmoningas ir tai nesukels jam pavojaus [14]. Tokį atsakymą rinkosi daugelis bendrosios praktikos gydytojų ir pediatrų, kai didžioji dalis mokytojų atsakė priešingai.…”