Avulsion.pptxabu hussein m
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Transcript of Avulsion.pptxabu hussein m
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AVULSION
Abu-Hussein M.
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AVULSION
( EXARTICULATION OR
TOTAL LUXATION )
DEFINITION : The tooth is
displaced totally out of it’s socket.
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CLINICAL APPEARANCE
The socket is found empty or filled with coagulum.
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EPIDEMIOLOGY
• Rare injuries(1.6% of dental injury)
• Primary dentition > secondary
dentition
• Boys > girls
• The teeth most commonly damaged
are upper central incisor
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ETIOLOGY
• Cause: accident
contact sports
fighting
• Predisposing factor :
Cl II malocclusion
Periodontal disease
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HISTORY TAKING
• When did the injury take place ?
• Where did the injury take place ?
• How did the injury take place ?
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HISTORY TAKING
• Has treatment been provided elsewhere ?
• Has there been previous
trauma ?
• Has avulsed tooth been
accounted for ?
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HISTORY TAKING
» MEDICAL HISTORY
» DENTAL HISTORY
» SOCIAL HISTORY
» FAMILY HISTORY
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- Obtain information : loss of
consciousness, neck or head pain, and numbness
- Ask about the event….
amnesia?
- Other signs: nausea, vomiting,
drowsiness, blurred vision
Neurological Assessment
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EXTRAORAL EXAMINATION
• Facial wound
• Fracture of mandible / maxilla
• Occlusion
• Mandibular movement
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INTRAORAL EXAMINATION
• Solf tissue
• Foreign body
• Alveolar bone fracture
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RADIOGRAPHIC EXAMINATION
• Are routinely to determine the
socket
• Check for supporting
structure and adjacent tooth
• Compare with the future radiographs
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RADIOGRAPHIC EXAMINATION
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TREATMENT OF AVULSED TOOTH
Success of treatment depend on
»Extraoral time
»Storage media
»Stage of tooth development
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EXTRAORAL TIME
• After 60 minutes of dry
storage media very few PL
cells remain viable.
• 120 minutes - complete PL cells necrosis.
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STORAGE MEDIA
– Hank’s balance salt
solution (HBSS)
– Milk
– Saliva
– Water
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TREATMENT OF AVULSED TOOTH
• Preparation of the avulsed tooth
• Preparation of the socket
• Replantation
• Splinting
• Follow up
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PREPARATION OF THE AVULSED TOOTH
• Saline to remove foreign bodies
• Avoid scraping the root surface
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PREPARATION OF THE SOCKET
• The region should be anesthetized
• Gently clean with NSS to
remove clotted blood and foreign materials
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PREPARATION OF THE SOCKET
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REPLANTATION
• Press the tooth gently
into the socket
• Compress buccal and
lingual plate of bone
• Take radiograph immediately
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REPLANTATION
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SPLINTING
Requirements of splint
• Provide stabilization for the replanted tooth
• Slight physiologic movement
• Hygienically designed
• Not leave the replanted tooth in traumatic occlusion
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SPLINTING
• Wire composite splint
• Composite splint
• Removable flexible
acrylic splint
• Orthodontics wire
• Etc.
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SPLINTING
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SPLINTING
How long?
the fixation period should
be sufficient to allow the
reattachment of PDL. This will take from 1 – 3 weeks.
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FOLLOW UP
A well designed follow up procedure is diagnose complication.
• 1 week.
• 2 weeks.
• 3 weeks. A radiographic examination is able to demonstrate periapical radiolucency
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FOLLOW UP
• 6 weeks. A clinical and
radiographic examination
A clinical and radiographic
examination is able to
demonstrate most case of inflammatory resorption
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FOLLOW UP
• 2 and 6 months. Optional
for cases with questionable
healing
• 1 year. A clinical and
radiographic examination
can ascertain the long –term prognosis
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WOUND HEALING AFTER REPLANTATION
• Surface resorption
• Replacement resorption
• Inflammatory root resorption
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Surface resorption
Surface resorption is
manifested as a excavations
on the root surface without
associated breakdown of the lamina dura.
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Surface resorption
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Replacement resorption
Replacement resorption
(ankylosis) is initially seen
as a disappearance of PDL
space, later follow by a substitution with bone.
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Replacement resorption
• PDL injury -> inflammation -> osteoclastic activity -> fusion
between bone and root surface
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Inflammatory resorption
Inflammatory resorption is
seen as bowl shaped cavities
on the root surface with an
associate radiolucency affecting the lamina dura.
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Inflammatory resorption
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Summary
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The influence of storage
conditions on the clonogenic capacity of periodontal cell :
implication for tooth replantation
P.C. Lekic , D.J. Kenny & E.J. Barrett
International Endodontic Journal (1998)31,137-140
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INTRODUCTION
• Viable periodontal ligament
(PL) cells are required for the healing of avulsed teeth after
replantation.
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INTRODUCTION
• The viability of PL cells in
extra- alveolar conditions may
be extended by incubating the
avulsed tooth in a physiologic storage medium.
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INTRODUCTION
• Regeneration of PL following
replantation is closely related
to preservation of the viability PL cells that adhere
to avulsed teeth
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OBJECTIVES
• To investigate the effects of
combinations of storage media
on the clonogenic capacity of
human PL cells at two different extra alveolar period.
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MATERIALS AND METHODS
• 20 human premolar teeth were
extracted
• Aged 11 – 14 years
• 4 storage media (saliva , milk ,
HBSS , MEM)
• All teeth were assayed at 30
and 60 min
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MATERIALS AND METHODS
Twenty extracted human premolars
Time
0 min
15 min
30 min
Saliva (23c) MEM (+4c)
Milk MEM (+4c)
One-half of PL tissue explanted from premolar(cells released and
analyzed for clonogenic capacity)
Saliva HBSS
15 teeth 5 teeth
5 teeth
Per condition
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RESULTS
0
5
10
15
20
25%
of
ce
lls
wit
h c
lon
og
en
ic
ca
pa
cit
y
30 60Time (min)
Results of clonogenic capacity assay
MEM
Milk
HBSS
Saliva
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