Replantion

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Dental Traumatology 2008; 24: 120–123; doi: 10.1111/j.1600-9657.2006.00503.x

Replantation of an avulsed permanent
maxillary incisor with an immature apex:
report of a case
CASE REPORT
Andrew Paul Goldbeck1, Kevin Lee
Haney2
Departments of 1Endodontics and 2Pediatric
Dentistry, College of Dentistry, University of
Oklahoma, Oklahoma City, OK, USA

Abstract – A case is reported of thereplantation of a maxillary incisor with an
immature apex following a traumatic avulsion. A 14-month follow-up clinical
examination revealed the patient to be asymptomatic, the tooth to be still
functional, and a recall radiograph showed no evidence of renewed periradicular
breakdown. The indications for, and limitations of, replantation of an avulsed
permanent incisor with an immature apexare discussed.

Correspondence to: Andrew Goldbeck,
Department of Endodontics, College of
Dentistry, University of Oklahoma, PO Box
26901, Oklahoma City, OK 73190, USA
Tel.: +1 405 271 5550
Fax: +1 405 271 3423
e-mail: andrew-goldbeck@ouhsc.edu
Accepted 22 February, 2006

Avulsion or exarticulation refers to a traumatic injury
that forces a tooth completely out of its socket. Toothavulsion following a traumatic injury is comparatively
rare, comprising 1–16% of traumatic injuries to the
permanent dentition (1). Avulsion in the permanent
dentition most commonly involves a single maxillary
incisor and occurs most frequently during the age of 7–
10 years, while these teeth are still in the eruption process
(2). When avulsion of a tooth with a mature apex occurs,
pulpnecrosis should be anticipated and root canal
therapy should be planned following the replantation of
the tooth. In contrast, when an avulsed tooth with an
immature apex is replanted within 3 h, a chance for
pulpal revascularization exists and root canal therapy
can be delayed (1). Long-term retention of an avulsed
tooth is related to the condition of the periodontal
ligament (PDL) at the time ofreplantation, with key
factors being the amount of time out of the socket and
how the tooth was stored during this time period (3). The
following is a case report describing the avulsion and
replantation of a maxillary central incisor with an
immature apex and its 1-year follow-up.
Case report

A 7-year-old Caucasian female presented to the faculty
clinic after hours on April 3, 2004. Herpermanent left
maxillary incisor and primary left lateral incisor had
been avulsed as a result of a bicycle accident. Dirt on the
teeth had been delicately removed with an alcohol gauze
sponge prior to placing the teeth in a plastic bag with
cold milk for transportation to the clinic. The teeth had
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been out of the mouth approximately 2½ h at the time
of the patient’s arrival. Theprimary lateral incisor was
placed aside and not considered for replantation. The
permanent central incisor had a visibly immature apex
and was placed in a sterile isotonic saline solution while a
health history and personal information were obtained.
The child’s health history was non-contributory; she was
not taking any medications and had no known drug
allergies or systemic illness. Thestatus of her tetanus
immunization was current.
Extra-oral examination showed abrasions on the nose,
chin, forehead, neck and chest as well as a swollen upper
lip. The right permanent maxillary central incisor was
loose with the crown displaced slightly to the lingual. As
the permanent incisors had not fully erupted, it was
difficult to determine whether this tooth had been
intruded.Radiographs of the area showed no remaining
tooth particles in the sockets of the avulsed teeth, and
immature root development on the maxillary right
central incisor. Replantation was carried out under local
anesthesia. The coagulum was gently rinsed from the
socket of the left central incisor and that tooth was
replanted slowly, so as not to force the tooth into place.
A semi-rigid splint was...
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