Replantation of an Avulsed Tooth: A Case Report

Abstract

Avulsion is a rare and serious traumatic dental injury that needs immediate and complex management. This case report highlights the successful management of an avulsed maxillary central incisor by replantation after a lapse of 120 minutes of being in an extra-oral environment and preserved in milk. A female patient aged 17 years presented with a traumatic dental injury sustained to the anterior maxillary region due to an accidental fall. Clinical examination revealed an avulsed tooth 21 that was replanted according to the International Association of Dental Traumatology (IADT) guidelines and stabilised in place with splinting. Conventional root canal therapy was initiated one week post-replantation. The root canal treatment was completed two weeks post-replantation followed by removal of the splint. Follow up done at regular intervals of one, three, six, and 12 months showed a lack of clinical signs and symptoms and no resorption on radiographic interpretation.

Keywords: avulsion; extra-oral time; replantation; storage media; traumatic dental injury.

Figure 1. (A) Pre-operative clinical image. (B) Pre-operative radiograph showing empty alveolar socket in 21 region. (C) Avulsed tooth stored in milk. (D) Root surface being rinsed with normal saline.

Figure 2. (A) Root surface treatment with 1.23% acidulated phosphate fluoride (APF) gel. (B) Radiographic verification for correct positioning of 21 in its alveolar socket. (C) Replanted tooth stabilised in place with splinting. (D) Intracanal medicament placed in 21.

Figure 3. (A) Radiograph showing completed root canal therapy with 21. (B) Intra-oral clinical image after completion of root canal therapy and removal of splint.

Figure 4. (A, B) Clinical and radiographic images at one month follow-up. (C) Radiograph at three months follow-up. (D) Radiograph at six months follow-up. (E) Radiograph at 12 months follow-up.