Splinting and replantation after traumatic avulsion

A rational approach can be taken in the dental office to avulsion and replantation. Consideration must be given to: Extraoral time. During this critical time, the prognosis for successful replantation noticeably decreases as the out-of-mouth time increases. Transport. Preferably the tooth will be transported in the socket, but milk or water may be used to keep the tooth moist. The buccal vestibule may be recommended for adults and teenagers but not for young children. Root surface. The root surface must not be handled, scraped, brushed, or have any part removed; it can be rinsed with sterile water, saline, or tap water but not with caustic solutions, disinfectants, or medicaments to clean the surface. Endodontic treatment. A tooth with an open apex should be evaluated bimonthly for revitalization. A tooth with a fully formed apex should have the pulp removed in 7 to 14 days after avulsion. Status of the alveolar process. Alveolar fractures may require a modified splint design to provide additional strength for a longer splinting duration. Obturation materials. Calcium hydroxide paste is used for a minimum of 6 to 24 months before filling permanently with gutta-percha. Selection of a splint. Each case is different and should be treated as such. Special consideration must be given to splint design, which will directly influence the desired result. Although any number of splints may be effective, inherent advantages and disadvantages of each should be understood fully by the clinician. This is where the art, the clinical experience, and the common sense of endodontic therapy dictate the proper splint and appropriate duration of splinting for the patient.(ABSTRACT TRUNCATED AT 250 WORDS)