AVULSION. ( EXARTICULATION OR TOTAL LUXATION ) DEFINITION : The tooth is displaced totally out of...
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Transcript of AVULSION. ( EXARTICULATION OR TOTAL LUXATION ) DEFINITION : The tooth is displaced totally out of...
AVULSION
( EXARTICULATION OR
TOTAL LUXATION )
DEFINITION : The tooth is displaced totally out of it’s socket.
EPIDEMIOLOGY• Rare injuries(1.6% of dental injury)
• Primary dentition > secondary dentition
• Boys > girls
• The teeth most commonly damaged are upper central incisor
ETIOLOGY
• Cause: accident
contact sports
fighting
• Predisposing factor :
Cl II malocclusion
Periodontal disease
HISTORY TAKING
• When did the injury take place ?
• Where did the injury take place ?
• How did the injury take place ?
HISTORY TAKING
• Has treatment been provided elsewhere ?
• Has there been previous trauma ?
• Has avulsed tooth been accounted for ?
- Obtain information : loss of consciousness, neck or head pain, and numbness - Ask about the event…. amnesia? - Other signs: nausea, vomiting, drowsiness, blurred vision
Neurological Assessment
EXTRAORAL EXAMINATION
• Facial wound
• Fracture of mandible / maxilla
• Occlusion
• Mandibular movement
RADIOGRAPHIC EXAMINATION
• Are routinely to determine the socket
• Check for supporting structure and adjacent tooth
• Compare with the future radiographs
TREATMENT OF AVULSED TOOTH
Success of treatment depend on
»Extraoral time
»Storage media
»Stage of tooth development
EXTRAORAL TIME
• After 60 minutes of dry storage media very few PL cells remain viable.
• 120 minutes - complete PL cells necrosis.
TREATMENT OF AVULSED TOOTH
• Preparation of the avulsed tooth
• Preparation of the socket
• Replantation
• Splinting
• Follow up
PREPARATION OF THE AVULSED TOOTH
• Saline to remove foreign bodies
• Avoid scraping the root surface
PREPARATION OF THE SOCKET
• The region should be anesthetized
• Gently clean with NSS to remove clotted blood and foreign materials
REPLANTATION
• Press the tooth gently into the socket
• Compress buccal and lingual plate of bone
• Take radiograph immediately
SPLINTINGRequirements of splint• Provide stabilization for the
replanted tooth• Slight physiologic
movement• Hygienically designed• Not leave the replanted
tooth in traumatic occlusion
SPLINTING
• Wire composite splint
• Composite splint
• Removable flexible
acrylic splint
• Orthodontics wire
• Etc.
SPLINTING
How long?
the fixation period should be sufficient to allow the reattachment of PDL. This will take from 1 – 3 weeks.
FOLLOW UPA well designed follow up procedure
is diagnose complication.• 1 week. • 2 weeks.• 3 weeks. A radiographic
examination is able to demonstrate periapical radiolucency
FOLLOW UP
• 6 weeks. A clinical and radiographic examination A clinical and radiographic examination is able to demonstrate most case of inflammatory resorption
FOLLOW UP
• 2 and 6 months. Optional for cases with questionable healing
• 1 year. A clinical and radiographic examination can ascertain the long – term prognosis
WOUND HEALING AFTER REPLANTATION
• Surface resorption
• Replacement resorption
• Inflammatory root resorption
Surface resorption
Surface resorption is manifested as a excavations on the root surface without associated breakdown of the lamina dura.
Replacement resorption
Replacement resorption (ankylosis) is initially seen as a disappearance of PDL space, later follow by a substitution with bone.
Replacement resorption
• PDL injury -> inflammation -> osteoclastic activity -> fusion between bone and root surface
Inflammatory resorption
Inflammatory resorption is seen as bowl shaped cavities on the root surface with an associate radiolucency affecting the lamina dura.
The influence of storage conditions on the clonogenic capacity of periodontal cell : implication for tooth replantation
P.C. Lekic , D.J. Kenny & E.J. Barrett
International Endodontic Journal (1998)31,137-140
INTRODUCTION
• Viable periodontal ligament (PL) cells are required for the healing of avulsed teeth after replantation.
INTRODUCTION
• The viability of PL cells in extra- alveolar conditions may be extended by incubating the avulsed tooth in a physiologic storage medium.
INTRODUCTION
• Regeneration of PL following replantation is closely related to preservation of the viability PL cells that adhere to avulsed teeth
OBJECTIVES
• To investigate the effects of combinations of storage media on the clonogenic capacity of human PL cells at two different extra alveolar period.
MATERIALS AND METHODS
• 20 human premolar teeth were extracted
• Aged 11 – 14 years• 4 storage media (saliva , milk ,
HBSS , MEM)• All teeth were assayed at 30 and
60 min
MATERIALS AND METHODSTwenty extracted human premolars
Time
0 min
15 min
30 min
Saliva (23c) MEM
(+4c)
Milk
MEM
(+4c)
One-half of PL tissue explanted from premolar(cells released and analyzed for clonogenic capacity)
Saliva HBSS
15 teeth 5 teeth
5 teeth
Per condition
RESULTS
0
5
10
15
20
25%
of
ce
lls
wit
h c
lon
og
en
ic
ca
pa
cit
y
30 60Time (min)
Results of clonogenic capacity assay
MEM
Milk
HBSS
Saliva
CONCLUSION• Immediate storage of a avulsed
teeth in autologous saliva , a followed by transfer to chilled milk , preserves the presence of sufficient progenitor cells in the PL to warrant replantation and the possibility of PL healing at 60 min extra-alveolar duration.
REFERENCES• Peter J. Robinson,Louis H. Grernsey: Clinical
Transplantation in Dental Specialties.C.V.Mostby,Missouri,1980
• G.J.Robert,P.Longhurst: Oral and Dental Trauma in Children and Adolestcents,Oxford university press Inc. New York, 1996
• Mitsuhiro Tsukiboshi: Autotransplantation of Teeth,Quintessence,Tokyo,2001
• J.O.Andreasen,F.M.Andreasen,L.K.Bakland, et al: Traumatic Dental Injury.Munksgaard.Copenhagen,1999
• M.E.J.Curzon: Handbook of Dental Trauma,Wrigth,Jordan Hill,Oxford,1999