Factors affecting the timing of pulp extirpation in a sample of 66 replanted avulsed teeth in children and adolescents

Abstract

The management of 66 replanted avulsed permanent teeth in 46 patients over a 4-year period was studied. Treatment was compared with the recommendations in published guidelines for the management of avulsed permanent teeth. For total extra-alveolar times longer than 45 min, the pulps were extirpated in 96% of teeth. Extra-alveolar times longer than 45 min were associated with earlier pulp extirpation (median 16 days) compared with teeth with shorter extra-alveolar times (median 25 days). Endodontic treatment was postponed in teeth with open apices (median 27 days) compared with closed apices (median 15 days). Teeth in which pulps were removed within 10 days post-trauma had a lower prevalence of inflammatory root resorption compared with teeth in which pulps were removed later. Where inflammatory root resorption did occur, onset was significantly delayed when the pulp had been removed within the first 10 days. This study indicates that clinicians are following the guidelines in key areas of endodontic management of traumatized incisors resulting in more favourable outcomes.

International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth

“…Endodontic considerations (62,(84)(85)(86)(87)(88)(89)(90)(91)(92)(93) If root canal treatment is indicated (teeth with closed apex), the ideal time to begin treatment is 7-10 days postreplantation. Calcium hydroxide is recommended as an intra-canal medication for up to 1 month followed by root canal filling with an acceptable material.…”

Complications and survival rates of teeth after dental trauma over a 5-year period

“…To date, two studies have reported therapy outcomes for avulsions that were treated based on IADT recommendations. Stewart et al showed that following the endodontic treatment recommendations of the IADT guidelines for avulsed teeth may lead to a more favourable outcome, whereas Roskamp et al reported that immunological factors may play a larger role in treatment outcome than adherence to the guidelines [11,12]. However, there is no information about survival rates for other types of injuries in relation to IADT treatment recommendations.…”

Treatment of multiple traumatized anterior teeth associated with an alveolar bone fracture in a 15-year-old schoolboy: a 2.5-year follow up

“…This process is common and requires complex interactions of inflammatory and resorbing cells, hard tissue, cytokines, and enzymes (22,23). It has been reported that Treatment of multiple traumatized anterior teeth inflammatory resorption was usually detected after 1 month (19), with a higher prevalence in teeth in which pulps were removed after 10 days (24). Thus, endodontic treatment should be performed within 7-10 days (11,25).…”