Dental avulsion is the complete removal of a tooth from its socket on the alveolar bone due to trauma. Permanent dental treatment consists of replantation, if possible. The oldest teeth should not be replanted because of the risk of damaging the permanent tooth. Immediate replanting ensures the best prognosis but not always possible because more serious injuries may exist. Studies have shown that protected teeth in ideal physiological media can be replanted within 15 minutes to an hour after an accident with a good prognosis. The success of postponed replantation depends on the vitality of the remaining cells on the root surface. Under normal conditions, the tooth is connected to the socket through a periodontal ligament. When the tooth is knocked out, the ligament stretches and splits in half. Maintaining the vitality of cells that remain attached to the root surface is the key to success after replantation. Years ago, it was thought that the key to maintaining the vitality of root cells is keeping the wet teeth wet, increasing the recommendation of storage media such as water, mouth, and milk. Recent research shows that one of the key elements to maintaining vitality is to store teeth in an environment that closely resembles the original socket environment. This environment is an environment that has osmolality (cell pressure), pH, nutrient metabolites, and proper glucose. There is a scientifically designed storage medium that provides this environment. This storage medium is now available in retail products. The use of devices that combine ideal storage media and protective equipment has increased the success rate of tooth dropped by more than 90% when used within sixty minutes of accidents.
Video Dental avulsion
Prevention
The best method for preventing collapsed teeth is the use of helmets and mouth protectors. Mouthguards can be very cheap, however, compliance rates for their use are poor. Research has shown that, even when mandated, athletes and other high-risk individuals will often not use them. In addition, even with its use, the mouth protector can be destroyed, leaving the user unprotected.
Maps Dental avulsion
Management
Dental avulsion is a real tooth emergency where rapid management (within 20-40 minutes of injury) affects dental prognosis. Avulsion permanent teeth should be gently dried but rinsed with salt, be careful not to damage the root surfaces that may have fibers and living periodontal cells. After cleansing teeth and mouth, efforts can be made to be replanted in the original socket inside the alveolar bone and then healed by the dentist for several weeks. Failure to reinstall avulsion teeth within the first 40 minutes after injury may lead to a poor prognosis for teeth. If the tooth can not be replaced immediately in the socket, follow the instructions to Treat torn teeth (avulsion) and cold milk or saliva and take it to the emergency room or dentist. If the mouth is sick or injured, wound cleaning may be required, along with sutures, local anesthesia, and tetanus immunization updates if the mouth is contaminated with soil. Management of injured primary teeth is different from permanent dental management; Avulsion firstborn should not be replanted (to avoid damage to permanent dental crypt).
Although some doctors suggest that the best treatment for avulsion teeth is immediate replantation, for various reasons this can make it difficult for unprofessional people. Teeth are often covered with debris. These debris should be cleaned with physiological solution and not rubbed. Often many teeth are torn and the person will not know which individual teeth are. The injured victim may have other more serious injuries that require more immediate attention or injuries such as bloody lips or severe torn blisters that prevent easy visualization of the socket. Pain can be severe and people may resist dental replantation. People may, given infectious diseases (eg HIV), fear of handling teeth or touching the blood associated with it. If immediate replantation is not possible, the tooth should be placed in a suitable storage solution and taken to the dentist who can then replant it. The dentist will clean the socket, wash the teeth if necessary, and plant them back into the socket. He will put it on a tooth that is not torn for a maximum of two weeks for the tooth with normal alveolar process and bone support. Handled correctly, even permanent computed permanent dental replantation in older patients under good care has been reported, with splinting extending for more than 4 weeks due to reduced support structures for periodontal disease roots. One week to ten days after replantation, the dental pulp of the replanted tooth should be removed and root canal treatment completed within two months.
In addition, as recommended in all dental traumas, good oral hygiene with 0.12% chlorhexidine gluconate mouthwash, soft and cold diet, and avoiding smoking for several days may provide favorable conditions for regeneration of periodontal ligaments.
Biological basis for successful replantation following avulsion
Each tooth is connected to the surrounding bone by a periodontal ligament. Teeth receive their food through this ligament. When the tooth is knocked out, this ligament extends and splits into two; half fixed at the root of the tooth and half fixed on the socket wall. If these two parts can survive, the teeth can be replanted and the beak of the ligaments will be reattached and the teeth will remain vital. The half that remains in the socket wall, as it remains connected to the bone blood supply, naturally continues to live. However, the remaining ligament cells in the tooth root lose their blood supply and nutrients and should be artificially maintained. They must be protected from two potentially damaging processes: destroying cells and loss of normal cell metabolism. All treatments between accident time and primary replantation should be focused on preventing these two possibilities.
Prevent cell destruction
When the teeth faint, they end up on an artificial surface: floor, soil or material like a carpet. If the surface is hard, the root cells of the tooth will be traumatized. Because the remaining cells in the tooth root are very fragile, additional trauma to the root cells of the tooth should be avoided thus preventing more destruction of root cells of the tooth. This damage can occur when lifting the tooth up and/or during transport to the dentist.
When the tooth is taken, it should always be grasped by the enamel on the crown. Finger pressure on tooth root cells will cause cell destruction. Any attempt to clear the debris should be avoided. Debris should always be washed clean with, at least, physiological salts. Even with the use of physiological saline, "scrubbing" of the tooth root to remove debris should be avoided. When placed in a physiological solution, the tooth should be gently restless to allow root cleaning of the tooth. At the same time that this agitation occurs, tooth root collisions with hard surfaces such as glass, plastic or even cardboard should also be avoided. For the same reason, the method in which the toothed teeth are transported must be chosen carefully. Placing collapsed teeth in transporting vehicles such as tissue and handkerchiefs can damage and move them into glass or cardboard containers can also potentially damage cells. In addition to the potential damage that can lead to hard surfaces, glass containers have the possibility of additional damage or leakage of physiological storage fluids. If the glass container does not have the right top, then during transportation, physiological storage solutions may spill and teeth may fall, again, on the floor and, at the same time, out of the physiological environment.
Maintenance of normal cell metabolism
Usually the tooth root cell metabolism has internal cell pressure (osmolality) of 280-300 mOs and pH of 7.2. When there is an uninterrupted supply of blood, all the metabolites (calcium, phosphate, potassium) and glucose needed by the cells are provided. When the tooth collapses, the normal blood supply is interrupted and within 15 minutes most of the stored metabolites are depleted and the cells begin to die. In one to two hours, enough cells will die so that the rejection of the tooth by the body in the future is the usual result. The method by which the body rejects the replanted tooth is a process called "root resorption replacement". During this process, the tooth root cells become necrotic (dead) and will activate the body's immunological mechanisms to try to remove this necrotic layer and literally gnaw the roots of the tooth. This is called "root resorption" This is a slow, but painless process, which is sometimes not observed by x-rays over many years. Once this process begins, it can not be changed and the tooth will eventually fall out. In growing children, this can cause bone development problems because replacement resorption (also called ankylosis) attaches teeth firmly to the jawbone and stops normal tooth eruption and inhibits normal jaw growth.
Studies have shown that an important factor for reducing tooth root cell death and subsequent root replacement resorption after reimplantation of collapsed teeth is the maintenance of normal cell physiology and the metabolism of cells remaining in the tooth root while the tooth is out of the socket. To maintain this normal state, the environment in which the tooth is stored must provide optimal internal cell pressure, cell nutrition and pH.
Media storage
There are many storage media available for the storage of damaged tooth. The most frequently recommended are: saliva, physiological salt, milk and pH of a balanced cell preservation fluid. Water and ice have been shown to damage tooth root cells, and thus, avulsion teeth should not be stored in them. Osmolality and pH of water and ice are very low (7-17mOs) compared with normal cell pressure (280 mOs). When the collapsed teeth are placed in water, the cells try to equate with the surrounding environment, the cell fluid tries to move into the external pressure environment and explodes. Water with table salt in it damages a collapsed tooth.
Saliva, ie placing a tooth under the tongue of an accident victim or on the cheek, has been recommended. Saliva, as a storage medium, causes twice as much damage as water. Its osmolality is very low, causing the bursting of tooth root cells, but also, since saliva is filled with normal flora of microorganisms, it infects the tooth root cells. When the teeth are rejuvenated, not only the cells become necrotic but will also infect the bone socket. Physiological saline has a fairly compatible osmolality and will not cause cell swelling but lacks the metabolites and glucose required for the maintenance of normal cell metabolism.
Milk is also recommended as a storage medium for avulsion teeth. The advantage is the availability of high fresh milk. Only whole milk can be used for preserving teeth. Skim milk and thick cream do not have proper fluid pressure and will cause damage to the root cells. Milk does not have the observed regenerative properties for cells in collapsed teeth.
Found 30 years ago that milk is less damaging to teeth that are torn than water or saliva. This is recommended because it has compatible osmolality (fluid pressure) to the tooth root cells and is considered available. However, like physiological salts, milk lacks the metabolites and glucose needed to keep the metabolism of normal tooth root cells. The cells in the tooth roots that collapse in the milk do not die immediately but can not replicate (mitosis) and are less able to reform new cells when replanted.
The most optimal available storage media has been proven as a pH balance preservation solution. The most known and most extensively tested is called Hank's Balanced Salt Solution (HBSS). It has all the metabolites such as Ca, phosphate ions, K and glucose needed to maintain normal cell metabolism for long periods of time. HBSS has been extensively tested in dental and medical research over the past twenty years. This study has shown that 90% of cells stored in HBSS for 24 hours maintain normal viability and after four days, still have a decent 70%. In the study, extracted dog teeth that have been placed in HBSS for four days can still be replanted with few signs of resorption. Hank's Balanced Salt Solution is found in Save-A-Tooth, a storage device for storage, preservation, and regeneration of tooth root cells.
HBSS has also been shown to be able to replace lost cell metabolites. Because cells that have been disconnected from their blood supply spend metabolites stored after fifteen minutes, extra-oral teeth for an hour have fewer vital cells to reconnect with bone ligament cells. Several studies in dental studies have shown that teeth that have been dried for an hour will have less resorption if soaked in HBSS for 30 minutes before replantation. In this study, the dog's teeth were extracted and allowed to dry for 30, 45 and 60 minutes and then immersed in HBSS for 30 minutes and then replanted. This tooth indicates a replacement resorption of 50% less after reimplantation. It has also been shown that keeping teeth cool when in HBSS does not affect success.
Many other types of storage fluids have been tested such as milk powder, Enfamil, Gatorade, and contact lens solutions. All of them have been shown to be ineffective or to damage the avulsion teeth.
Prognosis
The long-term prognosis of rejuvenated dentures varies greatly. Treatment for paralyzed teeth has grown from a 10% success rate to over 90%. However, this success rate can only be achieved with optimal care institutions within fifteen minutes to an hour from accidents. In the case of a collapsed tooth, being prepared and knowing what to do can mean the difference between a person who maintains or loses a tooth that is plopped for life. Teeth that have fainted when they are fully mature, that is, when the roots are fully formed, have a much better prognosis than immature teeth and are not yet fully formed. This is because of the fragility of the roots. When the teeth are not fully formed, the root wall is thinner and more fragile. Another complication for prognosis is the length of time the tooth has come out of its socket. Replanted teeth within fifteen minutes of accidents have a very good prognosis. Teeth that have been stored extra-orally and dry for more than an hour have a poor prognosis. Teeth that have been placed in optimum storage media within an hour of the accident also have an excellent prognosis. All teeth that have been beaten should be replanted but carefully monitored for root resorption development. Teeth that do not have root canal treatment within two weeks of replantation also have a poor prognosis.
Epidemiology
Research has shown that there are five million teeth that are eliminated each year in the United States.
Up to 25% of school-aged children and military trainees and fighters experience some type of dental trauma each year. The incidence of dental avulsion in school-aged children ranges from 0.5 to 16% of all dental traumas. Many of these teeth are destroyed during school activities or sporting events such as contact sports, soccer, basketball, and hockey. It is important for anyone who is related, working, or watching the sport they are educating on this issue. Being educated can help in minimizing injuries that can endanger the victim. Being informed and spreading awareness of dental avulsion in knowledge, treatment, and prevention can have an impact.
History
The first reproductive denture cases were reproduced by Pare in 1593. In 1706, Pierre Fauchard also reported replanting of tooth that was beaten. Wigoper in 1933 used a cast of gold splint to hold the planted teeth in place. In 1959, Lenstrup and Skieller stated that the success rate of dentures removed should be considered a temporary procedure because the success rate of less than 10% is very bad. In 1966 in a retrospective study, Andresen theorized that 90% of avulsion teeth can be successfully maintained if they are replanted within the first 30 minutes of an accident. In 1974, Cvek showed that removal of dental pulp after reimplantation was necessary to prevent resorption of tooth roots. In 1974, Cvek demonstrated that the storage of damaged tooth in saline can improve the success of the replanted tooth. In 1977, Lindskog et al. shows that the key to maintaining a collapsed tooth is to maintain the vitality of the periodontal ligament. In 1980, Blomlof showed storage of periodontal ligamentous cells in biocompatible media could extend extra oral time to four hours or more. He found that the best storage media is a medical research fluid called Hank's Balanced Solution. In this study, it was discovered incidentally that milk can also maintain cell survival for two hours. In 1981, Andreasen pointed out that destroying cells in the tooth root can cause cell death and cause resorption and decreased prognosis. In 1983, Matsson et al. showed that immersion in Hank's Balanced Solution for thirty minutes before reimplantation can revitalize the extracted tooth of dry dog ​​for 60 minutes. In 1989, systematic storage devices were developed to store and preserve optimally cured teeth. In 1992, Trope et al. shows that extracted dog teeth can be stored in Hank's Balanced Solution for up to 96 hours and retain significant vitality. In this study, milk is only able to maintain vitality for two hours.
See also
- Dental emergency
- Tooth trauma
References
Source of the article : Wikipedia
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