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AVULSION
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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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Neurological Assessment
- Obtain information : loss of consciousness, neck or head pain, and numbness - Ask about the event…. amnesia? - Other signs: nausea, vomiting, drowsiness, blurred vision
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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,
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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 teeth 5 teeth Saliva (23c) MEM (+4c) 5 teeth Per condition Milk Saliva HBSS MEM (+4c) One-half of PL tissue explanted from premolar(cells released and analyzed for clonogenic capacity)
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RESULTS
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CONCLUSION Immediate storage of a avulsed teeth in autologous saliva , a followed by transfer to chilled milk , preserves the presence of sufficient progenitor cells in the PL to warrant replantation and the possibility of PL healing at 60 min extra-alveolar duration.
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Any Questions?
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Thanks for your attention
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REFERENCES Peter J. Robinson,Louis H. Grernsey: Clinical Transplantation in Dental Specialties.C.V.Mostby,Missouri,1980 G.J.Robert,P.Longhurst: Oral and Dental Trauma in Children and Adolestcents,Oxford university press Inc. New York, 1996 Mitsuhiro Tsukiboshi: Autotransplantation of Teeth,Quintessence,Tokyo,2001 J.O.Andreasen,F.M.Andreasen,L.K.Bakland, et al: Traumatic Dental Injury.Munksgaard.Copenhagen,1999 M.E.J.Curzon: Handbook of Dental Trauma,Wrigth,Jordan Hill,Oxford,1999
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Special thanks อ.ทพ.ชยารพ สุพรรณชาติ
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