31: The avulsed incisor

31 The avulsed incisor

Summary

Kathryn is 9 years old. She was playing with her friends at a brownie camp with a skipping rope, when the rope caught behind one of her upper central incisors and avulsed it. Her teacher has got the tooth. How would you manage this problem?

image Kathryn’s teacher phones your surgery for advice. She has the tooth in a handkerchief. The accident occurred 10 minutes ago. What is your advice?

Check Kathryn has no other injuries, i.e. head injuries that require referral to an accident and emergency department.
Check for any known medical history.
Hold tooth by crown, wash gently under cold water to remove any debris for 10 seconds.
Replant in socket ideally.
Hold tooth in socket by biting on a handkerchief. Come to surgery.
If replantation not possible, place tooth in either milk or normal saline (first aid box) and bring to surgery with Kathryn.

image The tooth is brought to the surgery in milk. How would you proceed?

1 Check medical history. Heart defects, immunosuppression and a history of rheumatic fever are not reasons to deny replantation.
2 Place tooth in normal saline. Remove any foreign bodies. Check state of root development.
3 Give labial and palatal local anaesthesia.
4 Irrigate socket with normal saline.
5 Recontour labial plate with flat plastic instrument or Couplands elevator, if required.
6 Gently but firmly reposition avulsed tooth.
7 Bend a 0.6 mm stainless steel wire to include one tooth either side of avulsed tooth.
8 Follow guidelines in Chapter 30 for placement of the splint.
9 Prescribe chlorhexidine mouthwash and antibiotics. Amoxicillin 125 mg three times daily for 5 days is an appropriate antibiotic. If patient is allergic to amoxicillin, use erythromycin 125 mg four times daily for 5 days. Chlorhexidine 0.2% should be used twice daily to help normal oral hygiene.
10 Arrange a review appointment for 14 days.

image What factors are important when deciding whether root canal treatment is necessary in Kathryn’s case?

Apical development.
The time that the tooth was out of the mouth (extra-alveolar time).
A tooth that has a mature apex will rarely undergo revascularization. The only tooth that has a chance of revascularization is the immature tooth with an open apex that is replanted within 30–45 minutes. All other teeth should be extirpated prior to splint removal at 7–10 days.

image What intracanal medicament should be placed in the extirpated tooth?

There has been some in vitro work that has shown that if non-setting calcium hydroxide is inadvertently spun through the apex of a tooth with a dama/>

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  5. 30: The fractured permanent incisor root
  6. 38: Dentinogenesis imperfecta

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Jan 2, 2015 | Posted by in Orthodontics | Comments Off on 31: The avulsed incisor

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