Dental Avulsions: If Immediate Replantation was Impossible

Traumatic dental injuries represents a serious dental health problem especially among children and young adults. One of them is tooth avulsion, “Avulsion” is used to describe a situation in which a tooth has been removed from its socket as a result of severe trauma. As well as teeth (the neurovascular bundle at the root apex, the cement layer of the tooth) and environmental support tissues (the periodontal ligament (PDL) fibers, alveolar bone, and the gingiva) are all damaged seriously with tooth avulsion [1]. Incidence of avulsion account for 0.5% to 16% of traumatic injuries in the permanent dentition [2]. Maxillary incisors are most commonly affected. Tooth avulsion has been puzzling for many pediatric dentists. Because the management of avulsion is effected several factors alone either or together. These factors are root development, extra-alveolar period, storage medium, the patient’s age and medical status, development of the dentition, concomitant dentoalveolar injuries and type and duration of splint. Replantation is the only treatment choice, but careful assessment of the cases is most importance for the avulsed tooth to be successfully replanted. The successful treatment outcome after replantation of the avulsed tooth is pulp survival and periodontal healing and minimal bacterial contamination [3]. Especially extra-alveolar period and storage medium determine the success of replantation directly. The time until replantation ranged between 15 minutes and 10 hour in some studies [1,4]. The extra-alveolar period should ideally be a maximum of 20 minutes to 30 minutes for the best prognosis for replantation [2,5]. However, ideal timing for immediate replantation is not always possible, thus late replantation is applied. Some factors such as lack of knowledge of the people about management of an avulsed tooth, unavailability of finding appropriate storage medium and bleeding due to soft tissue injury mask the loss of teeth have not allow this situation always.