Reimplantation of Avulsed Tooth - A Case Study

Journal of Exercise Science and Physiotherapy, Vol. 6, No.
2: 126-129, 2010 126

Reimplantation of Avulsed Tooth A case Study Verma, L. Assistant Professor, Dr. H.S.
Judge Dental College, Punjab University, Chandigarh
The purpose of clinical study is reimplantation technique used in the treatment of an avulsive teeth case. This case
report is related to an avulsed tooth and its management in case of a 17 year old female gymnast player. A 17 year
old girl reported to the dental clinic with swelling of upper lip and displacement of upper right central incisor and
avulsion of left lateral incisor. She got the injury while she was doing gymnastics. She had lost her upper left central
incisor at the gymnastic ground. Clinical examination showed swelling of upper lip, laceration on lower chin,
displaced right upper central incisor, avulsed left lateral incisor and missing left central incisor. Tooth reimplantation
was carried out by rinsing the avulsed tooth carefully with saline and all the contaminants were removed. The socket
was then flushed with saline and the avulsed tooth was slowly reimplanted with digital pressure. Splinting of the
avulsed tooth was done with a semi rigid splint for 4 weeks. Antibiotic coverage was given to the patient. Root canal
treatment of the left lateral incisor and right central incisor was done. Splint was removed after 4 weeks. The avulsed
teeth were placed back into the socket with the help of finger pressure. Patient was advised to avoid biting on the
splinted teeth and continue to brush the other teeth, only soft foods were advised to be eaten and refrain from acidic
beverage consumption. After 4 weeks the splint was removed. The results of the treatment were teeth remained
symptomless and showed no sign of discoloration, gum abscesses, pulp death, teeth pain and root resorption. Key
words: Gymnast player, Avulsed tooth, Incisor, Reimplantation, Splinting
Introduction
Favorable healing subsequent to an avulsion injury requires immediate emergency interference followed
by assessment and possible treatment at crucial times during the healing phase. The urgency of the
emergency visit and the multidisciplinary nature of follow-up evaluations necessitate both the public and
practitioners from different dental disciplines to possess knowledge of the treatment strategies involved.
Dental emergency can take place with anyone. The athletes, both children and adults-are predominantly
prone to injuries, including those on the face, mouth and teeth. An elbow blow on the mouth or a bad fall
can occur all of a sudden, leading to broken teeth, a torn lip, or worse, a broken jaw. When participating
in a sport, particularly contact sports, the risk of sports related dental injury is generally high (Andreasen
et al, 1993). Dental injuries suffered by professional athletes are treated slightly differently than an
average person with the same type of injury. Sports injuries to the mouth and oral environment can be
disfiguring and costly, both financially and in terms of athletes' time away from school, work or training.
Sports-related injuries to the mouth can become expensive, depending upon the nature and extent of the
trauma. Fortunately, many sports-related injuries to the mouth can be easily prevented with properly
designed mouth guard protection (Tuskiboshi, 1996). Sports injuries to the mouth and oral tissues are not
necessarily treated any differently than other traumatic injuries to the oral tissues.
For instance, a sudden mishap while playing basketball could lead to injuries such as biting through the
lip(s) and/or severely fracturing the front teeth. In Reimplantation of Avulsed Tooth A case Study Verma, L. 127
addition, playing football could result in injuries such as losing some of the teeth as a result of blunt
trauma to the face, or fractures to the upper arch of the mouth (American Academy of Paediatric
Dentistry, 2002). When a tooth is avulsed, attachment damage and pulp necrosis occurs. The tooth is
separated from the socket, mainly due to the tearing of the periodontal ligament which leaves viable
periodontal ligament cells on most of the root surface. In addition, due to the crushing of the tooth against
the socket, small localized cemental damage also occurs (Andreasen, 1981). If the periodontal ligament
left attached to the root surface does not dry out, the consequences of tooth avulsion are usually minimal
(Soder et al, 1977; Andreasen, 1981,). The hydrated periodontal ligament cells maintain their viability,
allowing them to reattach on reimplantation with minimal destructive inflammation. In addition, since the
crushing injury is contained within a localized area, inflammation stimulated by the damaged tissues is
correspondingly limited, meaning that healing with new replacement cementum is likely to occur after the
initial inflammation has subsided. Avulsion is defined as displacement of the tooth totally out of the
socket (Andreasen and Andreasen, 1994). Clinically, the tooth socket is found empty or filled with a
coagulum. The treatment of this is reimplantation of the tooth back into the socket with minimum extra-
alveolar time. The patient is required to seek an emergency service or dental treatment, including splinting
and antibiotic prophylaxis. This case report is related to an avulsed tooth and its management in case of a
17 year old female gymnast player. Materials & Methods A 17 year old girl reported to the dental clinic
with swelling of upper lip and displacement of upper right central incisor and avulsion of left lateral
incisor. She got the injury while she was doing gymnastics. She had lost her upper left central incisor at
the gymnastic ground. Clinical examination showed swelling of upper lip, laceration on lower chin,
displaced right upper central incisor, avulsed left lateral incisor and missing left central incisor. (Figs. 1,
2) Figure 1: Extraoral picture of the patient Figure 2: Intraoral picture of the patient Figure 3: Splinting done using semi rigid splint
Journal of Exercise Science and Physiotherapy, Vol. 6, No. 2: 126-129, 2010 128
Figure 4: Patient given periodontal pack Figure 5: Splint removed after 4 weeks Tooth
reimplantation was carried out at
dental department and consisted of the following steps:
(1) The avulsed tooth was rinsed carefully with saline from a syringe. All the contaminants were removed.
(2) The socket was flushed with saline and the avulsed tooth was slowly reimplanted with digital
pressure.
(3) Splinting of the avulsed tooth was done with a semi rigid splint for 4 weeks. (Figure 3)
(4) Antibiotic coverage was given to the patient.
(5) Root canal treatment of the left lateral incisor and right central incisor was done.
(6) Splint was removed after 4 weeks. (Figure 5)
Conclusions
Avulsion is the most common dental injury experienced by the sportspersons. The general public
especially the sportspersons should be educated to know the basic steps to deal with such situations so as
to save the avulsed tooth. The basic steps need to be educated are:
(1) Reimplantation of the avulsed tooth should be preferably done at the site of injury in order to
minimize the extraalveolar time. In these cases, the tooth should be immediately reimplanted in its socket
or, if contaminated, rinsed for 10 seconds in cold running tap water.
If immediate reimplantation is not possible, the avulsed tooth should be restored in milk, or in the oral
vestibule. Recently special storage media have been developed which offer excellent protection to the
tooth (e.g. Vispan) In conclusion, our study suggest that reimplantation of an avulsed tooth as soon as
possible and using appropriate splint for such a case, and follow up after treatment by a dentist show good
prognosis. References Andreasen, J.O., Andreasen, F.M., Andreasen, J.O., Andreasen, F.M. editors. Avulsions. In: Textbook
and colour atlas of traumatic injuries to the teeth. Copenhagen: Munksgaard; 1993. p. 151-177 . Tuskiboshi, M. 1996. If you
know it, you can save the tooth from trauma Tokyo: Quintessence Publishing, 1996
American Academy of Paediatric Dentistry. 2002. Emergency care, http://www.aapd.org/publications Andreasen, J.O. 1981. The effect of
extra-alveolar period and storage media upon periodontal and pulpal healing after replantation of mature permanent incisors in
monkeys. Int J Oral Surg., 10:4351. Soder, P.O., Otteskog, P., Andreasen, J.O., Modeer T. 1977. Effect of drying on viability of
periodontal membrane. Scand. J. Dent. Res., 85:167172 Reimplantation of Avulsed Tooth A case Study Verma, L. 129
Andreasen, J.O., Andreasen, F.M. 1994. Avulsions. In: Andreasen JO, Andreasen FM, editors. Textbook and colour atlas of
traumatic injuries to the teeth. Copenhagen: Munksgaard; p. 383-425.

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Journal of Exercise Science and Physiotherapy, Vol. 6, No.

2: 126-129, 2010 126

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