Traumatic dental injuries are relatively common among children with boys being affected twice as often as girls. Upper anterior teeth tend to be the most at risk for traumatic injuries. These injuries are often attributed to accidental falls, sporting injuries, cycling accidents, and unfortunately in some cases assault. A systematic review published in 2019 in the Cochrane Database aimed to “find out which treatment for managing knocked out and replanted permanent front teeth was the most effective.”1
Prognosis is dependent on multiple factors including, damage to the periodontal ligament and adjacent cementum, condition of the tooth, subsequent storage of the tooth, and the duration of time that passes prior to replantation. The PDL cells quickly become dried out making replanting the tooth as quickly as possible necessary for the best outcome. PDL healing is the primary measure for success upon replanting an avulsed tooth. Evidence indicates an avulsed tooth with proper PDL healing can be expected to “survive as long as any other tooth.”
Reducing inflammation and infection around the avulsed tooth is critical to support proper PDL healing, therefore multiple techniques have been investigated to determine the best course of action. Some of these techniques were included in this systematic review. The techniques highlighted in the review include hyperbaric oxygen versus control, Ledermix versus Ultracel, extra-oral endodontics versus intra-oral endodontics, and Thymosin alpha 1 versus saline.
All of these methods showed very low-quality evidence to support their use when treating an avulsed tooth. According to the authors, “The evidence was of very low quality for all reported outcomes.” Multiple studies included in the systematic review were at high risk of bias and therefore were interpreted with caution. Additionally, some of the treatments reviewed are unlikely to be available to many primary or emergency care facilities.
Considering this information the authors conclude by stating, “Based on the results of the included studies, there is insufficient evidence to support or refute the effectiveness of different interventions for avulsed and replanted permanent front teeth. The overall quality of existing evidence was very low and therefore great caution should be exercised when generalizing the results of the included trials. There is an urgent need for further well-designed randomized controlled trials. Until more evidence becomes available clinicians should continue to base their treatment decisions on current expert-based guidelines in combination with their own clinical experience and the individual circumstances and preferences of their patients or their parent or guardian, or both.”
- Day PF, Duggal M, Nazzal H. Interventions for treating traumatised permanent front teeth: avulsed (knocked out) and replanted. Cochrane Database Syst Rev. 2019 Feb 5;2(2):CD006542. doi: 10.1002/14651858.CD006542.pub3. PMID: 30720860; PMCID: PMC6363052.