Contributor: Jarod Scott, MD

Educational Pearls:

• There is a 1-hour window for tooth replantation in ED
• Cold milk is often best transport media unless there is access to specialized solutions (Hank's Balanced Solution)
• Goal is to preserve periodontal ligament
• Soaking in tap water should be avoided as it will lyse cells of periodontal ligament
• If oral surgeon is rapidly available, have them perform replantation
• Do not delay replantation to wait for an oral surgeon to become available
• Steps in tooth reimplantation
• Disturb the socket as little as possible
• Handle tooth only by crown, don't touch root
• Rinse tooth gently with tap water or saline, do not scrub it
• Tooth should click back in place and remain stable
• Don't manipulate after reimplantation
• It may take weeks to determine if the tooth will survive
• Studies have shown that replantation performed within one hour has a significantly better prognosis than those taking place after a greater amount of time has passed

References

Alotaibi S, Haftel A, Wagner ND. Avulsed Tooth. In: StatPearls. Treasure Island (FL): StatPearls Publishing. Copyright © 2022, StatPearls Publishing LLC.; 2022.

Andreasen JO, Andreasen FM, Skeie A, Hjørting-Hansen E, Schwartz O. Effect of treatment delay upon pulp and periodontal healing of traumatic dental injuries – a review article. Dent Traumatol. 2002;18(3):116-128.

De Brier N, O D, Borra V, Singletary EM, Zideman DA, De Buck E. Storage of an avulsed tooth prior to replantation: A systematic review and meta-analysis. Dent Traumatol. 2020;36(5):453-476.

Summarized by Mark O'Brien, MS4 | Edited by John Spartz, MD & Erik Verzemnieks, MD

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