Avulsion Reimplantation Caroline Nx (1)

7/29/2019 Avulsion Reimplantation Caroline Nx (1)

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Reimplantation of primary avulsed

teeth.

Why not discuss it?

Libyan International Medical University

Preventive and Community

D. Caroline Piske de A. MohamedD. Caroline Mohamed 1


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A question:

Is dental trauma common inprimary dentition?

D. Caroline Mohamed 2


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Yes it is...

Indeed, it is more common than in permanentdentition because the motor coordination is

still developing.



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Dental Trauma prevalence in primary

dentition

Author Year Sample Age/ Prevalence

Mestrinho et all. 1998 1853 1-5 years 30%

Zembruski et al. 2002 1545 0-6 years 35.5%

Zarzar et al. 2008 519 1-3 years

41.6%



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Dental trauma

Risk Factors

Caries lesions

Overjet > 3 mm Class II Type I

Inexistence of labial protection Obesity

Epileptic disorders

Dentinogenesis imperfecta

Etiologicy Factors

Falls

Traffic accidents

Sports accidents Violence ( Battled child)

(Kramer, Feldens, 2005, Simes et al, 2004)



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Risk for Trauma

Boys > girls ( almost 2 X more)

Upper central incisive (57,58%)

Commonest lesions:

subluxation ( 21,45% - 50% )lateral luxation ( 16,66%)

Intrusion ( 6% )

avulsion ( 4% to 17,18%)

Simes et al, 2004. (1310 patients with 2234 traumatized teeth)

(ANDREASEN & ANDREASEN, 1994) Molina , J. Et al. Dental Trauma 24: 503-509, 2008



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Why does avulsion happen more in

children than in adults?



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The chance of avulsion occurring in primarydentition is greater, a fact attributed to the

greater resilience of bone at this age,whereas in permanent dentition there is agreater prevalence of fractures.

Borum MK & Andreasen JO. 1998. Sequelae of trauma to primary maxillary incisors. I. Complications in theprimary dentition. Endod Dent Traumatol,14(1): 3144D. Caroline Mohamed 8


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Primary teeth trauma brings great injury risk

for the permanent teeth germ.



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Determinants factors for the presence of

lesions on pre erupted permanent teeth after

deciduous trauma

Age of patient at the time of trauma

( The younger the worse) The Nolla s Stage of development of the

permanent tooth germ ( around stage 6)

Type of trauma (degree and direction of themalposition of the primary teeth)



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Severity of injury

Energy of impact.

Resilience of impacting object.

Shape of impacting object. Angle of direction of impacting force.


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Link between Age of the patient /The Nolla s

Stage of development of the permanent

tooth germ



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13D. Caroline Mohamed


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Classification of teeth injury

Concussion ( no bleeding/ no displacement)


Subluxation Lateral luxation Extrusive luxation

AvulsionIntrusion


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Traumatic injuries to the primary dentition

affects the tooth itself:

Coronal discoloration

Pulpal necrosis

Pulpal canal obliteration Root resorption

Abcess or cellulitis formation



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Possible alterations related to dental trauma on

deciduous teeth ( trauma infection)

D. Caroline Mohamed Trauma-FOUSP- Brazil

Root fracture Cystic lesion

Calcification Internal reabsortion

External radicularreabsortion andperiapical lesion


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Speculative effects of trauma to the

primary teeth on permanent teeth buds.a) Position of traumatic

force

b) Buccal intrusio of the

primary tooth damages

the enamel and enamel

organ during formation

c) Malformation of the

crown and hypoplasia of

the enamel are due to

vertical force on C early

in development

d) Ande) Bending and deformity

of the crown tooth germ

it is bent between B

and E

f) Bending and deformity

of the root tooh germ

bent on Fg) Lack of root

developmentdamage

to Hertwigs epithelial

root sheath ( entire

germ pushed apically)


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Possible effects on permanent teeth after trauma/

reimplantation of avulsed deciduous teeth


Enamel Hypoplasia

Root bending-dilaceration

http://www.ortodontiaspo.com.br/SPO-V.40-n.3/V.40-n.3%20(6).pdf

Cystic lesion

Teeth discoloration


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Traumatic injuries to the primary dentition

effecting succedaneous permanent dentition:

White or yellow-brown discoloration of enamel White or yellow-brown discoloration of enamel with circular enamel

hypoplasia

Crown dilacerations

Odontoma-like malformation

Root duplication

Vestibular root angulation

Lateral root angulation or dilacerations

Partial or complete arrest of root formation

Sequestration of permanent tooth germs

Disturbance in eruption

The Journal of Contemporary Dental Practice, November-December 2011;12(6):511-5Rakesh K Agarwal et al15 1. Carvalho JC, Vinker F, Declerck D. Malocclusion, dental injuries and dental anomalies in the primarydentition of Belgian children. Int J Paediatr Dent 1998;8:137-41. Lenzi AR, Medeiros PJ. Severe sequelae of acute dental trauma in the primary dentition--a case report. Dent Traumatol 2006;22:334-6. Jcomo D, Campos V.Prevalence of sequelae in the permanent anterior teeth after trauma in their predecessors: a longitudinal study of 8 years. Dent Traumatol 2009;doi: 10.1111/j.1600-9657.2009.00764.x.. von Arx T. Developmentaldisturbances of permanent teeth following trauma to the primary dentition. Aust Dent J 1993;38:1-10.. Tzoglu S, Yolcu U, Tozoglu U. Developmental disturbance of maxillary lateral incisor after trauma. Dent Traumatol2007;23:85-6.. Andreasen J, Andreasen, FM. Textbook and color atlas of traumatic injuries to the teeth. Copenhagen: Munksgaard; 1991. von Gool AV. Injury to the permanent tooth germ after trauma to the deciduouspredecessor. Oral Surg Oral Med Oral Pathol 1973;35:2-12. Jafarzadeh H, Abbott PV. Dilaceration: review of an endodontic challenge. J Endod 2007;33:1025-30.. Flores MT, Malmgren B, Andersson L. Guidelines for themanagement of traumatic dental injuries. III. Primary teeth. Dent TChristophersen P, Freund M, Harild L. Avulsion of primary teeth and sequelae on the permanent successors. Dent Traumatol 2005;21:320-3. Zilberman Y, Fuks CD, Bassat YB, Brin I, Lustmann JL. Effect of trauma to primaryincisors on root development of their permanent sucessors. Pediatr Dent 1986;8:289-93. Assuno L, Ferelle A, Iwakura M, Cunha R. Effects on permanent teeth after luxation injuries to the primary predecessors: a study inchildren assisted at an emergency service. Dent Traumatol 2009;25:165-70.. Tewari N, Pandey RK. Root hypoplasia: an unusual sequela to primary tooth trauma. Dent Traumatol 2010;26:115-7.. Sakai VT, Moretti AB,

Oliveira TM. Replantation of an avulsed maxillary primary central incisor and management of df dilaceration as a sequel on the permanent successor. DentTraumatol 2008;24:569-73.D. Caroline Mohamed 19


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The common treatment for lateral

luxation in primary teeth is

repositioning, splinting and maybeRCT



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The common treatment after deciduous intrusion is

wait - follow up maybe RCT or extraction in cases

of germ proximity or involvment


Fig. 2 Initial oral color photo (a) and radiograph (b)(1y2m, female) An oral color photo at 3 monthsafter the injury (c) A radiograph at 6 months

after the injury (d)


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And in cases of deciduous avulsion?

Most of the parents dont look for treatment...

Who looks for...will have ...



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Maybe sutures, antibiotic therapy,

sometimes space mantainers...



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Remember...

Avulsion in primary dentition is more

frequent than in permanent dentition.(Andreassen, 1997, Marzola et al., 2006)

If you work with children you will have a good

chance to care of child with avulsed teeth.



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There are many articles about injuries to germsof permanent teeth after avulsion of deciduous

teeth with and without treatment. These problems, may occur regardless of the

treatment of the traumatized primary teeth.

Torriani, Dione Dias; Baldisseira, Elaine de Fatima Zanchin and Goettems, Marilia Leo. Managment of root dilaceration in acentral incisor after avulsion of primary tooth: a case report witha 6 year follow up. Rev. Odonto cinc. (online). 2011,vol.26, n.4, pp. 355-358.



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If you don't reimplant after avulsion to avoid

damage to the successor, you may not reposition

any dislocated tooth, since damage can happen inany type ofdislocation. (Dr. Yango Pohl)



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WHAT ?

27D. Caroline Mohamed


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I will explain.....



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Observe theproximity between

the deciduous teethand the permanent

germs

HTTP://WWW.ORTODONTIACONTEMPORANEA.COM/2011_09_01_ARCHIVE.HTML


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Imagem: Andreasen JO, Andreasen FM. Textbook and color atlas of traumatic injuries

to the teeth. Oxford: Blackwell Munksgaard 2001pD. Caroline Mohamed 30


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Trauma on

deciduous



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Movement of

the crown of the

tooth to palatineand the tip of

the root buccally



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Production of a

coagulum that

may stifens by

the time...



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Repositioning thetooth.....may

pressure the

coagulum to thepermanent tooth

germ



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If you don't reimplant after avulsion to avoid

damage from the coagulum to the successor,you may not reposition any dislocated tooth,

since this would add much more damage.

But we still take our chances and repositionate

lateral luxations and mild dislocations



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And about the avulsed tooth?



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What do the guides indicates about

reimplantation of deciduous teeth?

The American Academy of pediatric Dentistrycontra indicate the reimplant of avulsed

primary teeth to prevent necrosis of thepulp, infection, inflamation and injury for the

permanent germ.



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The British Society of Pediatric Dentistry indicates that The deciduous teeth should not be reimplantedbecause the high possibility of danger that can

happen on the time of the implantation by the

pressure that the coagulum can exert on the

folicullum, can lead to alterations on the development

of the germ of the permanent tooth.



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But, if I.....

....... could prevent the necrose of the pulp andthe possible injury to the permanent germ?

....... wash out ( irrigate) the coagulum?

...... and if I cut off the tip ( apicectomy) of thedeciduous root....?

Could I be safe???(Filippi A, Pohl Y, Kirschner H., 2007)



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Before replantation you could (and should)

remove the coagulum that has filled the

alveolus, by irrigation.. and be free from thedamage related to the coagulum

(Filippi A, Pohl Y, Kirschner H., 2007)



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We can reimplant deciduous - but we need special

indications and a method that promises to not harm

the permanent germ.



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Key factors for the recommendation of primaryavulsed traumatized tooth reimplantation.

UFSC-Brazil:

(a) the strategic value of the primary tooth, that is, the time the tooth will be present

in the dental arch before the natural physiologic exfoliation;

(b) the period of time the tooth was kept out of the alveolus (maximum 30 min);

(c) the storage means of the avulsed tooth (wet);

(d) the contamination level of the location where the tooth fell;

(e) the presence of contiguous teeth to splint; and

(f) the presence of nutritious or nonnutritious habits in the childs routine, which

may affect the stability of the reimplanted tooth.

When these factors are associated, the reimplantation isrecommended. Similar to that proposed for permanent teeth,

the sooner the better the outcome.


P i


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Prognosis

The prognosis of a reimplanted tooth depends on theindications for reimplantation :

Childs good general health condition/ dentist skills leading with child /Parents permission

Childs age/ The stage of deciduous root formation ( < 4 years)/ no rootsurface manipulation

Alveolus integrity/ management of the socket

Extra oral time ( < 30 min)

Extra oral environment - Hanks Balanced Salt Solution (HBSS) solution (70%of PDL cells can remain viable for as long as 4 days - proper osmolality, ph and nutritionalmetabolites and glucose) / cold milk / physiologic saline

Treatment and stabilization - RCT / splint/

Consider tetanus prophylaxis and antibiotic coverage.

Fried I, Erickson P. Anterior tooth trauma in the primary dentition: incidence, classification, treatment methods, and sequelae: a review of the literature. J Dent Child 1995;62:25661. 2. Matsson L, Andreasen JO, Cvek M, et al. Ankylosis of experimentally reimplanted teeth related to extra-alveolar periodand storage environment. Pediatr Dent. 1982;4:327-9. 6. Andreasen J.O, Reinholdt I, Dybdahl R, et al. Periodontal and pulpal healing o f monkey incisors preserved in tissue culture before replantation. Int J Oral Surg. 1978;7:104-112. Trope M, Friedman S. Periodontal healing of replanted dog teeth stored inViaSpan, milk and Hanks Balanced Salt Solution. Endod Dent Traumatol. 1992;8:183-8. 4. Cvek M, Cleaton-Jones P, Austin J, et al. Effect of topical ap plication of doxycycline on pulp revascularization and periodontal healing in reimplanted monkey incisors. Endod Dent Traumatol. 1990;6:170-6.

Mohamed43


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1) You should avoid possible causes fordamage at the successor such as:

mechanical trauma during the replantation -by root tip or coagulum, and

infection - deriving from an infection of thenecrotic pulp tissues.



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A) Remove the root tip before replantation

If the root tip is resected before replantation for

about 3 mm, then there is a safe distance of atleast 3mm to the permanent germ...

No chance at all for damaging it.

(Filippi A, Pohl Y, Kirschner H., 2007)



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B) Immediate (before replantation) endodontictreatment from a retrograde direction andobturation of the canal with a resorbable sealer.

( Calcium hydroxide + zinc oxide + propylene glycol).

C) Splint of the teeth

The immediate RCT prevents any microorganisms fromentering the canal, thus there is minor risk of aninfection coming from the root canal.(Filippi A, Pohl Y, Kirschner H., 2007)



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And what about ankylosis?

Deciduous teeth avulsed /kept dry for more than30 min should not be reimplanted!

( incidence 1.3 9.9% all etiologies, Miller et al., 1983)No data about prevalence of ankylosis after reimplant of avulseddeciduous teeth few cases literature )

Trope M. Clinical maagment of the avulsed tooth: Present strategie and future directions. Dental Traumatology 2002;18(1) : 1-11)


P ibl i di i


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Possible contraindications to

replantation:

Near time for normal eruption

Compliance

Compromising integrity of the avulsed tooth

or supporting tissues. Lack of alveolar integrity.

Compromised medical condition

:Immunocompromised health, severe congenital cardiacanomalies, severe uncontrolled seizure disorder, severemental disability, severe uncontrolled diabetes, and



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And about the literature on

deciduous reimplantation?



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Yes, many researchers and faculties aroundthe world are indicating reimplantation of

avulsed deciduous as part of their protocol ofpedodontic trauma treatment in specialcases.

(Fried I, Erickson P. Anterior tooth trauma in the primary dentition: incidence, classification, treatmentmethods, and sequelae: a review of the literature. J Dent Child 1995;62:25661.)



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The literature demonstrated that an avulsedprimary tooth incisor can be preservedwithout causing damage to the developingpermanent successor.

Filippi A, Pohl Y, Kirschner H. Replantation of avulsed primary anterior teeth: treatment and limitations. J Dent Child 1997;64:2725. Gatewood JC, Thornton JB. Successful replantation and splinting of a maxillary segment fracture in the primary dentition.Pediatr Dent 1995;17:1246. Hill CJ. Oral trauma to the pre-school child. Dent Clin North Am 1984;28:17786. Joho JO,Marechaux SC. Trauma in the primary dentition: a clinical presentation. ASDC J Dent Child 1980;47:16774..Kawashima Z, PinedaLF. Replanting avulsed primary teeth. JADA 1992;123:902. Mueller BH, Whitsett BD. Management of na avulsed deciduousincisor. Oral Med Oral Pathol 1978;46:4426.


f l d i i i


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Case reports of replanted primary incisorsReplantation of Avulsed Primary Incisors: A RiskBenefit Assessment .

Erica L. Zamon, B.Sc. David J. Kenny, B.Sc., DDS, PhD.

Author(s)Tooth replanted in

each patient

Follow-up

monthsSplinted

Root canal

treatment

Extra-alveolar time

(min.)Outcomes

Kinoshitaand others4 71 27 Yes No 30 Primary tooth still present81

82

60 Yes No 60 Exfoliated. Permanent incisor had enamel

defect

52 36 Yes Yes 120 Exfoliated, normal

81 2 Yes No N/A Extraction due to abscess

72 42 Yes No 30 Extraction due to root resorption

71

72

17 Yes No 60 Extractions due to gingival abscesses

Tsukiboshi8 71

81

46 Yes No 15 Exfoliated.Permanent incisor had enamel

defect

Weiger and Heuchert16 61 24 Yes Yes 30 Extraction due to abscess. Permanent

incisor had discolouration

Filippi and others18 51

61

3 Yes Yes N/A N/A

Zerman and others9 51

61

N/A N/A N/A N/A N/A

Kawashima and Pineda10 71

81

N/A No No 60 Exfoliated

Pefaur17 62 60 No Yes 60 Exfoliated

Mueller and Whitsett11 61 N/A Yes No 1 Exfoliated. Permanent incisor had Turners

hypoplasia

Crabb and Crabb20 51 60 No No < 1 Exfoliated

Ravn21 N/A 8 Yes No N/A Mobility and advanced resorption

N/A 10 Yes No N/A Mobility and advanced resorption

N/A 12 Yes No N/A Premature exfoliation

N/A 27 Yes No N/A Extraction due to ankylosis

Eisenberg19 62 36 No Yes N/A Exfoliated

Sakellariou22 51 48 No No < 1 Exfoliated



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But...

Why mantain a tooth that will beany way in the future exfoliated?



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Benefits from reimplantation of avulsed

deciduous teeth

Mantainence of a complete dentition

Decrease the parents fear and guilt from their childtooth loss.

Better social acceptance and auto estim.

Prevention of functional problems in the masticationand phonetics.( in cases of multiple teeth loss)

Space mantainence for child of less than 3 years that myhave difficult to use removable space mantainers

Zamon EL, Kenny DJ. Replantation of avulsed primary incisors: a risk benefit assessment. J Can Dent Assoc.2001;67(7):386.Prevention . Gable TO, Kummer AW, Lee L, Creaghead NA, Moore LJ. Premature loss of the maxillary primaryincisors: effect on speech production. ASDC J Dent Child 1995; 62(3):173-9.The etiology of orthodontic problems. In:Proffit WR, Fields HR, editors. Contemporary orthodontics. 2nd ed. Toronto: Mosby-Year Book Inc; 1993. p. 128-9.



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If the primary incisors are lost before the child hasmastered speech, his speech development may beaffected temporarily until the permanent incisors come

in affecting their social life. Oral diseases present not only biological sequelae, but

also emotional and psychosocial consequences.

Cortes MI, Marcenes W & Sheiham A. 2002. Impact of traumatic injuries to the permanent teeth on the oral health-relatedquality of life in 12-14-year-old children. Community Dent Oral Epidemiol, 30(3): 1938. Fakhruddin KS, Lawrence HP, KennyDJ & Locker D. 2008. Impact of treated and untreated dental injuries on the quality of life of Ontario school children. DentTraumatol, 24(3): 30913. Ramos-Jorge ML, Bosco VL, Peres MA & Nunes AC. 2007. The impact of treatment of dentaltrauma on the quality of life of adolescents a case-control study in southern Brazil. Dent Traumatol, 23(2): 1149.



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Some cases:



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D. Caroline Mohamed 57Mitsuhiro Tsukiboshi, Treatment Planning forTraumatized Teeth, Quintessence books.


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Case report

A patient, 2 years and 6months of age, sufferedthe avulsion of tooth 61.

The girl was assisted in lessthan 30 min and, duringthis time, the tooth was

stored in milk.



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Fig. 8. Physiological root resorption of the

right and left upperincisor.

60


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Fig. 9. Right and left permanent upper incisor without alteration.

Maria Jose de Carvalho Rocha,Mariane Cardoso. Dental Traumatology 2008; Reimplantation of primary tooth case report24: e4e10; doi: 10.1111/j.1600-9657.2008.00557.x

Prevention of trauma gives the best


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Prevention of trauma gives the best

success rate

The prevention of dental trauma is ourresponsability as health professionals



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CONCLUSION

Tooth avulsion must be managed properly and the

dentist must be prepared to decide the bestapproach to minimize the biological and psychosocialconsequences in the patient.

In primary dentition, clinical and radiographiccontrol of patients with a history of avulsion shouldbe performed until the eruption of a permanentsuccessor.



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Thank you!!



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References:

Borum MK & Andreasen JO. 1998. Sequelae of trauma to primary maxillary incisors. I.Complications in the primary dentition. Endod Dent Traumatol,14(1): 3144BrazillianCongress of Dental Traumatollogy 2 nd CBTD- So Paulo, May 2009.

Tsukiboshi Mitsuhiro. Treatment Planning for Traumatized Teeth. Atlases. WU 17 tBB25g20DOa RK490. t7513 2000. Quintessence Publishing Co, Inc. Japan.

SIMES, F.G.; LEONARDI, D. P.; BARATTO FILHO, F. et al. Fatores etiolgicos relacionadosao traumatismo alvolo-dentrio de pacientes atendidos no pronto socorroodontolgico do Hospital Universitrio Cajuru. Revista Sul-Brasileira de Odontologia. v.1, n. 1, p. 50-55, 2004.

ANDREASEN, J.O., ANDREASEN, F.M. Textbook and color atlas of traumatic injuries tothe teeth. 3.ed. Copenhagen: Munksgaard, 1994. Cap.3: Classification, Etiology andEpidemiology, p.151-180.

Nolla CM. The development of the permanent teeth. J Dent Child. 1960;27:254-66.[ Links ]


Carlos EstrelaI; Jos Valladares NetoII; Mike Reis BuenoIII; Orlando Aguirre GuedesIV; Olavo Cesar LyraPortoIV; Jesus Djalma PcoraV Linear measurements of human permanent dental development stages


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PortoIV; Jesus Djalma PcoraV.Linear measurements of human permanent dental development stagesusing Cone-Beam Computed Tomography: a preliminary study. Dental Press Journal of Orthodontics On-line version ISSN 2176-9451. Dental Press J. Orthod. vol.15 no.5 Maring Sept./Oct. 2010

The Journal of Contemporary Dental Practice, November-December 2011;12(6):511-5Rakesh K Agarwal etal15 1. Carvalho JC, Vinker F, Declerck D. Malocclusion, dental injuries and dental anomalies in the primarydentition of Belgian children. Int J Paediatr Dent 1998;8:137-41. Lenzi AR, Medeiros PJ. Severe sequelae of

acute dental trauma in the primary dentition--a case report. Dent Traumatol 2006;22:334-6. Jcomo D,Campos V. Prevalence of sequelae in the permanent anterior teeth after trauma in their predecessors: alongitudinal study of 8 years. Dent Traumatol 2009;doi: 10.1111/j.1600-9657.2009.00764.x.. von Arx T.Developmental disturbances of permanent teeth following trauma to the primary dentition. Aust Dent J1993;38:1-10.. Tzoglu S, Yolcu U, Tozoglu U. Developmental disturbance of maxillary lateral incisor aftertrauma. Dent Traumatol 2007;23:85-6.. Andreasen J, Andreasen, FM. Textbook and color atlas of traumaticinjuries to the teeth. Copenhagen: Munksgaard; 1991. von Gool AV. Injury to the permanent tooth germafter trauma to the deciduous predecessor. Oral Surg Oral Med Oral Pathol 1973;35:2-12. Jafarzadeh H,Abbott PV. Dilaceration: review of an endodontic challenge. J Endod 2007;33:1025-30.. Flores MT,Malmgren B, Andersson L. Guidelines for the management of traumatic dental injuries. III. Primary teeth.Dent T

Christophersen P, Freund M, Harild L. Avulsion of primary teeth and sequelae on the permanentsuccessors. Dent Traumatol 2005;21:320-3. Zilberman Y, Fuks CD, Bassat YB, Brin I, Lustmann JL. Effect oftrauma to primary incisors on root development of their permanent sucessors. Pediatr Dent 1986;8:289-93. Assuno L, Ferelle A, Iwakura M, Cunha R. Effects on permanent teeth after luxation injuries to theprimary predecessors: a study in children assisted at an emergency service. Dent Traumatol 2009;25:165-70.. Tewari N, Pandey RK. Root hypoplasia: an unusual sequela to primary tooth trauma. Dent Traumatol2010;26:115-7.. Sakai VT, Moretti AB, Oliveira TM. Replantation of an avulsed maxillary primary centralincisor and management of df dilaceration as a sequel on the permanent successor. DentTraumatol2008;24:569-73. Torriani, Dione Dias; Baldisseira, Elaine de Fatima Zanchin and Goettems, Marilia Leo.Managment of root dilaceration in a central incisor after avulsion of primary tooth: a case report witha 6year followup. Rev. Odonto cinc. (online). 2011, vol.26, n.4, pp. 355-358.


Filippi A Pohl Y Kirschner H Replantation of avulsed primary anterior teeth: treatment and limitations J Dent


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Filippi A, Pohl Y, Kirschner H. Replantation of avulsed primary anterior teeth: treatment and limitations. J DentChild 1997;64:2725. Gatewood JC, Thornton JB. Successful replantation and splinting of a maxillary segmentfracture in the primary dentition. Pediatr Dent 1995;17:1246. Hill CJ. Oral trauma to the pre-school child. DentClin North Am 1984;28:17786. Joho JO, Marechaux SC. Trauma in the primary dentition: a clinical presentation.ASDC J Dent Child 1980;47:16774..Kawashima Z, Pineda LF. Replanting avulsed primary teeth. JADA 1992;123:902.Mueller BH, Whitsett BD. Management of na avulsed deciduous incisor. Oral Med Oral Pathol 1978;46:4426.

2. Matsson L, Andreasen JO, Cvek M, et al. Ankylosis of experimentally reimplanted teeth related to extra-alveolar periodand storage environment. Pediatr Dent. 1982;4:327-9. Andreasen J.O, Reinholdt I, Dybdahl R, et al. Periodontal and pulpalhealing of monkey incisors preserved in tissue culture before replantation. Int J Oral Surg. 1978;7:104-112.. Trope M,Friedman S. Periodontal healing of replanted dog teeth stored in ViaSpan, milk and Hanks Balanced Salt Solution. Endod

Dent Traumatol. 1992;8:183-8.

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