What is the Best Root Surface Treatment for Avulsed Teeth?

Abstract

Dental avulsion is the most severe type of traumatic tooth injuries since it causes damage to several structures and results in avulsion of the tooth from its socket. Management protocols for avulsed teeth should include management of the pulp and periodontal ligament (PDL) cells in order to improve the long-term prognosis and survival of these teeth. The prognosis of the treatment as well as the survival of an avulsed tooth depends on intrinsic and extrinsic factors, such as the duration of the tooth’s extra-alveolar period, replantation time, the type of storage medium, PDL status and duration of splinting.Recent research has led to the development of storage media. However, there is not yet a single solution that fulfills all requirements to be considered as the ideal medium for temporary storage of avulsed teeth, and research on this field should carry on. On the other hand in case of delayed replantation, due to the great risk of tooth loss after avulsion, different root surface treatments have been proposed to prevent and delay root resorption before replantation. For this purpose, researchers have applied some different root surface treatment modalities in delayed replantation of avulsed teeth. Several protocols have been used to maintain PDL viability; some involve fluorides, steroids, sodium alendronate, enamel matrix derivatives (EMD) and basic fibroblast growth factor (bFGF, FGF-2). Among these applications, bFGF shows promising results in the regeneration of natural tooth structures and tissues. Better understanding of mechanism of bFGF may help to improve new technologies of regeneration of tooth structures.

Effectiveness of decoronation technique in the treatment of ankylosis: A systematic review

“…Geographically, the clinical application of decoronation technique to manage ankylosed teeth, has been poorly popularized worldwide. This in part could be attributed to the lack of scientific evidence documenting its success rate or also possibly due to placing greater emphasis on medicaments to arrest the process of ankylosis. By preconditioning roots of avulsed teeth with Emdogain, possibility of cementogenesis has been reported , consequently eliminating the risk of developing dental ankylosis.…”

Decoronation as an option for ridge preservation prior to implant placement

“…When it comes to bone preservation a variety of different grafting materials have been used for decades. More recently enamel matrix derivate (EMD) has been found to promote complete periodontal tissue regeneration and therefore it is recommended for the treatment of avulsed teeth [7]. However, more artificial materials is used, it is higher the cost.…”

Medios De Conservación De Las Piezas Avulsionadas: Revisión De Literatura Basada en Evidencia

“…En varios estudios experimentales, quedo en evidencia que el medio de almacenamiento es el que determina el pronóstico de la pieza dentaria más que el tiempo extra oral. El mismo también dependerá de factores intrínsecos y extrínsecos, tales como la duración del período extra-alveolar del diente, el estado de LPD y el tiempo de inmovilización (7). Diferentes estudios han dejado demostrado que el mantenimiento de la fisiología y el metabolismo celular del ligamento periodontal, es un factor preponderante para la reducción de la reabsorción por reemplazo luego de la reimplantación del diente avulsionado.…”

“…El almacenamiento en este medio por más de veinte minutos provoca grandes reabsorciones radiculares (14,15,16,17,19,20). La saliva por tener una osmolalidad de 60 -80 mOsm/Kg y pH de 6,76 -7,35 (7,11,13) como por contener bacterias no es aconsejable como medio de trasporte Tanto el agua como esta alteran la estructura del fibroblasto aunque son mejores que hacerlo en seco (11,14). Suero fisiológico: Tiene una osmolalidad de 280 -285 mOsm/ Kg, un pH de 7,0 (8) y es estéril, por lo que es un medio de conservación aceptable a corto plazo, manteniendo la vitalidad celular unas tres horas (11,21,22).…”