Abrams, Richard A.

English

epublications@Marquette

Marquette Universitye-Publications@MarquetteSchool of Dentistry Faculty Research andPublications Dentistry, School of11-1-1978Replantation of an Avulsed Incisor: Case ReportRichard A. AbramsMarquette UniversityPublished version. Quintessence International, No. 11 (November 1978): 85-87. Publisher link. ©Quintessence Publishing 1978. Used with permission.' I IX Miscellaneous Original article: Number 11 November1 978 Report 1700 Page 1 Replantation of an avulsed incisor: case report Richard A. Abrams, D.D.S., M.P.H. Assistant Professor, Head, Division of Community Dentistry, School of Dentistry, Marquette University Address: 604 North 16th Street, Milwaukee, Wisconsin 53233 Background Replantation of intact avulsed teeth can be one of the most conserv-ative proce-dures in dentistry. If it is successful, the patient is "ahead of the game"-if it is not, nothing has been sacrificed. After evaluating seventy-one replanted teeth, Kemp et al. concluded that treat-ment of avulsed teeth by replantation is justified, despite the fact that it is usually not a permanent procedure.l Rabinowitch evaluated twenty-one re-planted teeth for a six year period. Three of the twenty-one ultimately had to be extracted due to root resorption.2 Other individuals have studied replanta-tion of avulsed teeth, and the consensus is firmly in favor· of attempting the procedure.s,4, s, s, 1 Case report On July 9, 1973, a 21 year old well developed, well nourished, Caucasian male presented at the Dental Clinic on board .the aircraft carrier USS John F . Kennedy. The patient presented with moderate oral hemorrhage, and report-ed that he "fell and lost his front tooth" about ten minutes ago. Upon clinical examination of the patient, it was determined that there was a small (1/2 em) laceration of the inner aspect of the upper lip, and a missing maxillary left central incisor. Radiographic ex-"Quintessence International" 11/1978 amination (Fig. 1) revealed an empty alveolus, with no apparent fracture. No other pathology was observed. Upon questioning, the patient related that he and several of his friends has looked around the room for the missing tooth, but were unable to locate it. Several of his friends were sent back to the scene of the accident to search for the tooth, and the patient was informed that if it were located, replantation could be attempted. In the mean time, the area of the maxillary left central incisor was infiltrated with 1.8 cc lido-caine HCl (2 % with epinephrine 1 : 50,000), flushed with normal saline solution, and a gauze pack was placed to control hemorrhage. After forty-five minutes, the avulsed tooth was located, and brought to the Dental Clinic. It was found to be intact, and was placed in a solution of normal saline for ten minutes. Holding the tooth with a 2 X 2 gauze sponge mois-tened with normal saline solution, the apical foramen was slightly enlarged and undercut using 331/ 3 bur in a high speed handpiece. Amalgam was then placed in the apical foramen to obtain a seal. To shorten the working time to facilitate replantation, no other endo-dontic procedure was performed at this time. The maxillary left central incisor was then replaced in the a.Jveolus, and 85 Number11 November1978 Report 1700 Page 2 Fig. 1 Radiographic picture reveals an empty alveolus, with no apparent fracture of either alveolar bone or adjacent teeth ligated in positiOn with stainless steel ligature wire (Fig. 2). Slight adjustment of the maxillary left central incisor was necessary to remove the tooth from occlusion. The patient was then placed on V-Cillin K (400,000 units, qid for ten days), Ananase (100,000 units, qid for four days) , and Empirin No. 3 (prn pain). The patient was observed frequently over a six week period, after which it was decided to remove the ligature wires. At that time, the area in question was completely asymptomatic. Clini-cally, no mobility, nor discoloration of the tooth was observed, and no patho-logy was noted on the X-ray. Shortly after the ligature wires were removed, endodontic procedures were started. After the tooth was isolated with the rubber dam, an access opening was made on the lingual surface of the 86 IX Fig. 2 Maxillary left central incisor was ligated in position with stainless steel liga-ture wire. The apex was sealed with amal-gam, however no other endodontic proce-dures were performed at this time incisor. The necrotic pulpal tissue was removed, and the canal was flushed with hydrogen peroxide. The canal was instrumented until <the appearance of clean, white dentin was noted. Then, the canal was dried with paper points, and filled with gutta percha (lateral condensation technique) and Kerr root canal cement. The access opening. was sealed with amalgam. Results This patient bas been followed routinely, and was last examined in March 1977. At that time, the tooth appeared clini-cally normal, with no discoloration evident, no mobility, and no periodontal problems. Radiographic examination (Fig. 3) confirms the clinical observa-tions, revealing a normal appearance after three and one-half years, with no apparent pathology. " Quintessence International" 11/1978 ( IX Fig. 3 After more than 31/2 years, the radiographic picture confirms the clinical observation: a maxillary left central incisor, normal in appearance, with no apparent pathology present Summary This report of a case demonstrates an avulsed maxillary central incisor which had been absent from the alveolus for approximately one and one-half hours, and was successfully replanted. There is a lack of visual, tactile, and radio-graphic evidence of pathosis after more than three and one-half years. Bibliography 1. Kemp, W. B., Grossman, L. , and Phillips, J. Evaluation of 71 replanted teeth. Journal of Endodontics 3(1):30-35, Jan. 1977. 2. Rabinowitch, B. Z. Replanta tion of teeth and management of root fractures. Dental Clinics of North America, July 1962, p . 555. 3. Heithersay, G. S. Number11 November1978 Report 1700 Page 3 Replantation of avulsed teeth. A review. Australian Dental Journal 20(2):63-72, April 1975. 4. Weine, F. Case reports - replantations. Illinois Dental Journal 42:657--662, Oct. 1973. 5. Wiedeman, C. L. Case report tooth replantation treatment after oral injury. D ental Survey 50:28-30, Febr. 1974. 6. Bellizzi, R. Replantation of avulsed anterior teeth: an un-usual technique. Oral Surgery, Oral Medicine, Oral Pathology 38(4):614--617, Oct. 1974. 7. Boyne, P. J. Implants and transplants: review of recent re-search in this a rea of oral surgery. The Journal of the American Dental Association 87:1074 to 1080, Oct. 1973. D Wlsll® cobalt-chromium KRUPP DENTAL ~ alloy POSTFACH 6903·D-4300 ESSEN 1 "Quintessence International" 11 /1978 87 

Replantation of an Avulsed Incisor: Case Report

https://epublications.marquette.edu/cgi/viewcontent.cgi?article=1081&amp;context=dentistry_fac

Replantation of an Avulsed Incisor: Case Report

Abstract

Similar works

Full text

Available Versions

epublications@Marquette