Case report

CASE REPORT

Delayed tooth replantation after traumatic avulsion: A case report
Zohreh Khalilak1* DDS, MS, Mahshid Shikholislami2 DDS, MS, and Ladan Mohajeri1 DDS, MS
1. Assistant Professor of Endodontics, Dental School/Iranian Center for Endodontic Research, Islamic Azad University, Tehran, Iran. 2. Assistant Professor of Endodontics, Dental School, Islamic Azad University, Tehran, Iran.Abstract Avulsion is serious injury cause damage to dental and supportive tissues, ranges from 1-16 % among dental injuries and it mostly occurs in maxillary incisors. This report presents a case of replantation of a traumatically avulsed central incisor. The left central incisor of an 8 yearold boy with open apex was avulsed and was left in unclean and dry conditions. Tooth was replaced after 270min and splinted. After 24 hours, tooth was treated endodontically. The calcium hydroxide paste was applied as intracanal medicament. After one year the calcium hydroxide was not replaced and was maintained in the canal, permanently. The tooth followed for 5 years. During follow up, the tooth kept stable. However, the resulted dentoalveolar ankylosis prevented growth of the alveolar process.Spite of the fact that in children, replacement resorption leads to the loss of ankylosed teeth within 1-5 years; this tooth has remained in a stable, infra-position for 5 year and in functional position after coronal restoration. However, in such cases other treatments such as decoronation should be considered. ;/ƌĂŶŝĂŶŶĚŽĚŽŶƟ Đ:ŽƵƌŶĂů ϮϬϬϴ͖ 86-9) ϯ͗ Keywords: Calcium hydroxide, Replantation,Resorption, Tooth avulsion, Traumatic injury

Introduction

Traumatic injuries to newly erupted permanent anterior teeth are common during childhood and 0.5-16% of the 7-70 year-old group experience tooth avulsion (1). The most preferable management for the avulsed tooth is immediate replantation, within 20-30 min after injury or keeping in storage media until dental visit (2). Viability of theremaining periodontal ligament cell on the root surface of a replanted tooth is the most important factor in determining its prognosis (3). Some studies have found that extended extra-alveolar time is a good predictor of resorption (2-4), while others have not (4). All these studies, however, have shown that those teeth kept dry, eventually developed root resorption. Total extra-alveolar time hasless effect on the outcome provided when the tooth has been stored in a wet medium (4). Andreason has reported that if the tooth has been out of the

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Received December 2007; accepted May 2008 *Correspondence: Dr. Zohreh Khalilak, Endodontics Dept., Dental School, Azad University, No 4, Pasdaran Ave., 10th Niestan St., Tehran, 19468, Iran. E-mail: zohreh268@yahoo.com

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ofmouth for more than 2 hours, there is a 95% chance of external resorption (5). Nevertheless, replantation of an avulsed tooth for a child must be done even if the prognosis is not good. The purpose of this case report was to present the clinical and radiographic condition of an avulsed and replanted maxillary central incisor that was treated with long term calcium hydroxide after an extended dryextra-alveolar period in a growing patient.
Case Report

A healthy 8 year-old boy was referred to the endodontic clinic for the treatment of traumatically avulsed maxillary left central incisor after a car accident. The tooth had been found 4 hours after the accident. The upper right central incisor tooth also suffered from luxation. Thereafter, the tooth was replanted by a general
- Volume 3,Number 3, Summer 2008

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Delayed replantation

Figure1.Toothreplanted and splinted after 4.5 h extraoral dry storage

Figure 2. Radiograph taken one year after avulsion

practitioner after 30 min. The dentist rinsed the socket and tooth with saline and prophylactic antibiotic therapy had been prescribed for one week. The patient was examined clinically and...