Journal of IMAB - Annual Proceeding (Scientific Papers)
Publisher: Peytchinski, Gospodin Iliev
ISSN: 1312 773X (Online)
Issue: 2016, vol. 22, issue 4
Subject Area: Dental Medicine
Pages: 1392-1402
DOI: 10.5272/jimab.2016224.1392
Published online: 20 December 2016

J of IMAB 2016 Oct-Dec;22(4):1392-1402
Rossitza Kabaktchieva1 Corresponding Autor, Natalia Gateva1, Angela Gusiyska2, Pavel Stanimirov3, Nina Milcheva4,
1) Department of pediatric dentistry, Faculty of Dental medicine, Medical University- Sofia, Bulgaria
2) Department of Conservative Dentistry, Faculty of Dental medicine, Medical University- Sofia, Bulgaria
3) Department of Oral and Maxillo-Facial Surgery, Faculty of Dental medicine, Medical University- Sofia, Bulgaria
4) Department of pediatric dentistry, Faculty of Dental medicine, Medical University-Varna, Bulgaria.

The diagnosis avulsion of permanent tooth/teeth is an emergency situation which has special requirements in respect of proper storage of the avulsed tooth, the need of urgent medical/dental care, time past till replantation and splinting, the need for endodontic treatment and long term follow up period. Those clinical actions depend on three groups: parents/people who are with the child in the moment when trauma happens and give the first aid; dental specialist- surgeon who replants the tooth/teeth; dental specialist- endodontist who takes care of the endodontic treatment and the long period after treatment for follow up and observation of the replanted teeth.
The aim of the paper is to present the dental postoperative care in a couple of cases of children with trauma and replanted avulsed permanent incisors.
Material and methods: We present four clinical cases of children who get 6 permanent upper incisors replanted. Replantation is made by the oral surgeon. Treatment and observation after replantation are made by dental specialists of pediatric dentistry and conservative dentistry. All 4 cases get 3 years follow up period.
Results: After replantation of 2 central incisors with complete root development (first clinical case) the left one has developed a resorption of the root but the right one is in a stable condition. Replantation of 3 teeth with incomplete root development (second and third clinical cases) where the patients refer to specialized surgical care less than 60 minutes after injury and store the teeth in different ways lead to different clinical results. In the case of avulsed upper right incisor (second case), it is stored in milk and we observe revascularization followed by partial root canal obliteration. The tooth is scheduled for endodontic treatment. In the case of upper central incisors, both kept dry till replantation in the alveolus filled up with substitute bone, we observe fast root resorption which going to lead to early tooth loss. After replantation of the first upper incisor with open apex, stored in physiological solution for 5 hours and with delayed endodontic treatment (forth case) healing process is stable and the prognosis is good. Follow up period for all the replanted teeth has continued.
Conclusion: The presented clinical cases show that there is a lack of dental teams for complex treatment of children with avulsed teeth in Bulgaria. Dental specialists have no good information about recommended by IADT protocols (, for the treatment of teeth undergoes avulsion during childhood. Parents of these children have no proper information about how to store the teeth which are avulsed and found immediately after trauma.

Key words: dental trauma, dental avulsion, replantation, permanent teeth,

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Please cite this article in PubMed Style or AMA (American Medical Association) Style:
Kabaktchieva R, Gateva N, Gusiyska A, Stanimirov P, Milcheva N. Dental care for children after replantation of avulsed permanent incisors. J of IMAB. 2016 Oct-Dec;22(4):1392-1402. DOI: 10.5272/jimab.2016224.1392.

Correspondence to: Prof. Rossitza Kabaktchieva, Department of Pediatric Dentistry, Faculty of Dental Medicine, Medical University – Sofia; 1, St. George Sofiisky Str.,1431 Sofia, Bulgaria; E-mail:

1. Andreasen JO, Andreasen FM. Avulsions. In: Textbook and color atlas of traumatic injuries to the teeth. Andreasen JO, Andreasen FM, Andersson L, editors. 4th edn. Wiley Blackwell; 2007. p. 444–88.
2. Andersson L, Andreasen JO, Day P, Heithersay G, Trope M, Diangelis AJ, et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth.  Dent Traumatol. 2012 Apr;28(2):88-96. [PubMed]
3. Andreasen JO. The dental trauma guide. In: Andreasen JO, editor. International Association of Dental Traumatology.  2012. [Internet]
4. American Academy of Pediatric Dentistry Council on Clinical Affairs. Guideline on management of acute dental trauma. Pediatr Dent. 2008-2009; 30(7 Suppl):175-83. [PubMed]
5. Barrett EJ, Kenny DJ. Avulsed permanent teeth: a review of the literature and treatment guidelines. Endod Dent Traumatol. 1997 Aug;13(4):153–63. [PubMed]
6. Petrovic B, Markovic D, Peric T, Blagojevic D. Factors related to treatment and outcomes of avulsed teeth. Dent Traumatol. 2010 Feb;26(1):52-9. [PubMed]
7. Andreasen JO. The effect of extra-alveolar period and storage media upon periodontal and pulpal healing after replantation of mature permanent incisors in monkeys. Int J Oral Surg. 1981 Feb;10(1):43-51. [PubMed]
8. Kargul B, Welbury R. An audit of the time to initial treatment in avulsion injuries. Dent Traumatol. 2009 Feb;25(1):123–5. [PubMed]
9. Ebeleseder KA, Friehs S, Ruda C, Pertl C, Glockner K, Hulla H. A study of replanted permanent teeth in different age groups. Endod Dent Traumatol. 1998 Dec;14(6):274–8. [PubMed]
10. Garcia-Godoy F, Murray PE. Recommendations for using regenerative endodontic procedures in permanent immature traumatized teeth. Dent Traumatol. 2012 Feb;28(1):33-41. [PubMed]
11. Andreasen JO, Andreasen FM, Bakland LK, Flores MT, Andersson L. Traumatic dental injuries, a manual. 3rd edition. Wiley-Blackwell. 2011; p. 48–53.
12.  Trope M. Avulsion of permanent teeth: theory to practice. Dent Traumatol. 2011 Aug;27(4):281–94. [PubMed]
13. Petrovic B, Markovic D, Peric T, Blagojevic D. Factors related to treatment and outcomes of avulsed teeth. Dent Traumatol. 2010 Feb;26(1):52–9. [PubMed]
14. Andersson L, Bodin I. Avulsed human teeth replanted within 15 minutes – a long-term clinical follow-up study. Endod Dent Traumatol. 1990 Feb;6(1):37–42. [PubMed]
15. Andersson L, Malmgren B. The problem of dentoalveolar ankylosis and subsequent replacement resorption in the growing patient. Aust Endod J. 1999 Aug;25(2):57–61. [PubMed]
16. Kling M, Cvek M, Mejare I. Rate and predictability of pulp revascularization in therapeutically reimplanted permanent incisors. Endod Dent Traumatol. 1986 Jun;2(3):83–9. [PubMed]
17. Andersson L, Bodin I, Sorensen S. Progression of root resorption following replantation of human teeth after extended extraoral storage. Endod Dent Traumatol. 1989 Feb;5(1):38–47. [PubMed]
18. Barrett EJ, Kenny DJ. Survival of avulsed permanent maxillary incisors in children following delayed replantation. Endod Dent Traumatol. 1997 Dec;13(6):269–75. [PubMed]
19. Pohl Y, Wahl G, Filippi A, Kirschner H. Results after replantation of avulsed permanent teeth. III. Tooth loss and survival analysis. Dental Traumatol. 2005 Apr;21(2):102–10. [PubMed]
20. Kinirons MJ, Gregg TA, Welbury RR, Cole BO. Variations in the presenting and treatment features in reimplanted permanent incisors in children and their effect on the prevalence of root resorption. Br Dent J. 2000 Sep;189(5):263–6. [PubMed]
21. Filippi A, Pohl Y, von Arx T. Decoronation of an ankylosed tooth for preservation of alveolar bone prior to implant placement. Dent Traumatol. 2001 Apr;17(2):93–5. [PubMed]
22. Cohenca N, Stabholz A. Decoronation – a conservative method to treat ankylosed teeth for preservation of alveolar ridge prior to permanent prosthetic reconstruction: literature review and case presentation. Dent Traumatol. 2007;23:87–94. [PubMed]
23. Malmgren B, Malmgren O, Andreasen JO. Alveolar bone development after decoronation of ankylosed teeth. Endod Top. 2006 Jul;14(1):35-40. [CrossRef]
24. Al-Asfour A, Andersson L. The effect of a leaflet given to parents for first aid measures after tooth avulsion. Dent Traumatol. 2008 Oct;24(5):515-21. [PubMed]
25. Al-Asfour A, Andersson L, Al-Jame Q. School teachers' knowledge of tooth avulsion and dental first aid before and after receiving information about avulsed teeth and replantation. Dent Traumatol. 2008 Feb;24(1):43-9. [PubMed]
26. Al-Sane M, Bourisly N, Almulla T, Andersson L. Laypeoples' preferred sources of health information on the emergency management of tooth avulsion. Dent Traumatol. 2011 Dec;27(6):432-7. [PubMed]
27. Feldens EG, Feldens CA, Kramer PF, da Silva KG, Munari CC, Brei VA. Understanding school teacher’s knowledge regarding dental trauma: a basis for future interventions. Dent Traumatol. 2010 Apr;26(2):158–63. [PubMed]
28. Committee on Pediatric Emergency Medicine and Committee on Bioethics. Consent for emergency medical services for children and adolescents. Pediatrics. 2011 Aug;128(2):427-33. [PubMed]
29. Santos ME, Habecost AP, Gomes FV, Weber JB, de Oliveira MG. Parent and caretaker knowledge about avulsion of permanent teeth. Dent Traumatol. 2009 Apr;25(2):203-8. [PubMed]
30. Oliviera TM, Sakai VT, Moretti AB, Silva TC, Santos CF, Machado MA. Knowledge and attitude of mothers with regards to emergency management of dental avulsion. J Dent Child (Chic). 2007 Sep-Dec;74(3):200-2. [PubMed]
31. Day P, Duggal M. Interventions for treating traumatised permanent front teeth: avulsed (knocked out) and replanted. Cochrane Database Syst Rev. 2010 Jan 20;(1):CD006542. [PubMed]
32. Andreasen JO, Storgaard Jensen S, Sae-Lim V. The role of antibiotics in presenting healing complications after traumatic dental injuries: a literature review. Endod Top 2006; 14:80-92. [CrossRef]
33. Berthold C, Thaler A, Petschelt A. Rigidity of commonly used dental trauma splints. Dent Traumatol. 2009 Jun;25(3):248–55. [PubMed]
34. Hinckfuss S, Messer LB. Splinting duration and periodontal outcomes for replanted avulsed teeth, a systematic review. Dent Traumatol. 2009 Apr;25(2):150-7. [PubMed]
35. Pohl Y, Filippi A, Kirschner H. Results after replantation of avulsed permanent teeth. I. Endodontic considerations. Dental Traumatol. 2005 Apr;21(2):80-92. [PubMed]
36. Pohl Y, Filippi A, Kirschner H. Results after replantation of avulsed permanent teeth. II. Periodontal healing and the role of physiologic storage and antiresorptive-regenerative therapy. Dent Traumatol. 2005 Apr;21(2):93-101. [PubMed]
37. Day PF, Gregg TA, Ashley P, Welbury RR, Cole BO, High AS, et al. Periodontal healing following avulsion and replantation of teeth: a multi-centre randomized controlled trial to compare two root canal medicaments. Dent Traumatol. 2012 Feb;28(1):55-64. [PubMed]
38. Johns DA, Shivashankar VY, Maroli RK, Vidyanath S. Novel management of avulsed tooth by pulpal and periodontal regeneration. J Endod. 2013 Dec;39(12):1658-62. [PubMed]
39. Priya HM, Tambakad PB, Naidu J, Pulp and Periodontal Regeneration of an Avulsed Permanent Mature Incisor Using Platelet-rich Plasma after DelayedReplantation: A 12-month Clinical Case Study. J Endod. 2016 Jan;42(1):66-71. [PubMed]
40. Qazi SR, Nasir KS. First-aid knowledge about tooth avulsionamong dentists, doctors and lay people. Dent Traumatol. 2009 Jun;25(3):295-9. [PubMed].

Received: 03 September 2016
Published online: 20 December 2016

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