EMERGENCY ENDODONTICS

These treatment suggestions were published as part of an avulsed tooth compaign that took place in South Australia. The rest of the article appears on page 425.

TREATMENT OF AVULSED PERMANENT TEETH Excellent long-term success can be expected if an avulsed tooth is reimplanted immediately, but success decreases rapidly every minute the tooth is out of the socket. However, reimplantation should be performed even if the tooth has been avulsed for hours, and it may last in the mouth for a few years.

Reimplant tooth with digital pressure. After reimplantation: Hold tooth firmly in correct position. Splint tooth. Suture any soft tissue laceration. Provide tetanus and antibiotic prophylaxis if any contact was made with soil.

Splinting should be carried out as soon as possible

Splinting methods include acid-etch composite resin, acidetch composite resin plus wire, and acrylic resin. (Methods are listed in order of preference and usefulness). If these are unavailable, temporary splinting can be achieved with Koepak, aluminum foil, or wire. Advise the patient of the importance of strict oral hygiene measures during the next three weeks.

resorption occurs in 95% of cases. Inflammatory root resorption can be readily controlled by endodontic techniques, whereas replacement resorption (ankylosis) cannot be controlled. Replacement resorption will usually have commenced by 12 months after injury if it is going to occur at all. Before continuing treatment, consider potential orthodontic implications and alternatives.

Telephone advice
Advise the caller to replace the tooth in the socket as soon as possible providing it is clean. If there is obvious contamination the patient should suck it clean. If replantation is not possible, place the tooth in the patient's labial sulcus, and ask that the patient be brought to the surgery immediately.

Follow-up treatment
If the tooth is reimplanted within two hours, no treatment is necessary with the open apex unless there is clinical or radiographic evidence of pathologic conditions. Endodontic therapy, including the use of calcium hydroxide paste to aid in apical closure should be performed. In teeth with closed apex, commence endodontic therapy ten to 14 days after reimplantation, debride, and dress with calcium hydroxide paste. Close access cavity with a sealer and zinc cement or other nonstaining durable material. Complete endodontic treatment two to three months after reimplantation. The teeth should be reviewed with radiographs at three-month intervals for the first year and at least annually thereafter. If the tooth is reimplanted after two hours, it should be reviewed annually with radiographs.

At the surgery
If the tooth has not been reimplanted: Rinse the tooth in normal saline or anesthetic solution (not tap water). Remove the blood clot' in socket with irrigation. If time since avulsion is less than two hours do not carry out endodontic procedures. If time since avulsion is greater than two hours, prepare and fill the root canal with gutta-percha and sealer, extraorally.

Period of splinting
Where bone fractures are not present, splint for two to three weeks. If bone fractures are evident, splint for six weeks.

Prognosis
Andreasen has shown that when teeth are reimplanted within 30 minutes, only 10% show resorption. When the extraoral period exceeds two hours,