Contributor: Jarod Scott, MD
Educational Pearls:
- There is a 1-hour window for tooth replantation in ED
- Cold milk is often best transport media unless there is access to specialized solutions (Hank's Balanced Solution)
- Goal is to preserve periodontal ligament
- Soaking in tap water should be avoided as it will lyse cells of periodontal ligament
- If oral surgeon is rapidly available, have them perform replantation
- Do not delay replantation to wait for an oral surgeon to become available
- Steps in tooth reimplantation
- Disturb the socket as little as possible
- Handle tooth only by crown, don't touch root
- Rinse tooth gently with tap water or saline, do not scrub it
- Tooth should click back in place and remain stable
- Don't manipulate after reimplantation
- It may take weeks to determine if the tooth will survive
- Studies have shown that replantation performed within one hour has a significantly better prognosis than those taking place after a greater amount of time has passed
References
Alotaibi S, Haftel A, Wagner ND. Avulsed Tooth. In: StatPearls. Treasure Island (FL): StatPearls Publishing. Copyright © 2022, StatPearls Publishing LLC.; 2022.
Andreasen JO, Andreasen FM, Skeie A, Hjørting-Hansen E, Schwartz O. Effect of treatment delay upon pulp and periodontal healing of traumatic dental injuries – a review article. Dent Traumatol. 2002;18(3):116-128.
De Brier N, O D, Borra V, Singletary EM, Zideman DA, De Buck E. Storage of an avulsed tooth prior to replantation: A systematic review and meta-analysis. Dent Traumatol. 2020;36(5):453-476.
Summarized by Mark O'Brien, MS4 | Edited by John Spartz, MD & Erik Verzemnieks, MD
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