Volume No:

8, Issue No:

ISSN No: 2582-0559

REIMPLANTATION: BOON TO DENTISTRY - A CASE REPORT

Dr. V. Balakumar, Dr. R. Haribabu, Dr. K. Vidya BDS, Dr. R. Bhavani*

Department of Prosthodontics, Sathyabama Dental College and Hospital, Jeppiar Nagar, Chennai, Tamilnadu, India

*Consultant, V.B.K Dental Foundations, Chennai, Tamilnadu, India

Address for Correspondence:

Dr. V. Balakumar., MDS.,

Professor, Department of Prosthodontics,

Sathyabama Dental College, Jeppiar Nagar,

Chennai-600119, Tamilnadu, India

Email id: venkatbala_123@yahoo.com

ABSTRACT

Avulsion of permanent teeth is the most common dental injuries

in a road traffic accident. It’s a boon that the patient’s original teeth can
be replanted provided the fracture of the tooth and socket are within
limits. Educating the community plays a major role in reimplantation. In
this case report, the patient’s avulsed maxillary central incisors (11,21)
were replanted by simple composite splinting technique.

KEY WORDS:

Avulsed tooth, Composite splinting, Reimplantation,

Golden hour.

Received:

4.11.2020 First Published

27.02.2021

Accepted:

14.02.2021

Published:

27.03.2021

CASE REPORT

DOI:1.37841/jidam_2021_V8_I1_07

Balakumar et al: Reimplantation- A case report

Volume No:

8, Issue No: 1

ISSN No: 2582-0559

INTRODUCTION

Teeth  are  an  integral  part  of  stomatognathic  system
with their functions – smiling, phonetics and mastication. An
attractive  smile  is  the  important  social  asset  and  makes
someone more appealing. Smile can convey confidence and
an  appearance,  which  simply  reflects  our  emotional
expression.

   Loosing teeth at young age could be of various reasons
ranging  from  trauma  to  gum  diseases,  which  has
physiological  traits  including  self-esteem,  optimism,
depression, stress about appearance. When there is an option
of replanting our own teeth, it will boost self-confidence and
satisfaction.

The procedure is known as reimplantation

which is a boon to dentistry.

Reimplantation refers to the insertion and fixation of

completely or partly avulsed teeth that have been resulted
from traumatic injury.

The most conservative approach for

managing the avulsed incisors is to replant them as soon as
possible.

Dental avulsion is a type of dental trauma and its

prevalence is estimated as 17.5%. Males are affected 3 times
more than females. Prevalence is more among school
children and sports person.

CASE REPORT

A 17 year old male patient reported to the hospital

with bleeding per mouth. The history revealed that the
patient had met with an road traffic accident 10 minutes ago.
On examination, found that the upper central incisors (11,21)
were missing.

The patient elaborated that accident took place 10

minutes ago and both his upper anterior teeth were avulsed
as a whole, but was dropped at the accident site. Patient’s
kin

was advised to bring back the avulsed teeth from the

accident site by holding the crown part

of the teeth

and

transporting them in a bowl of milk (Figure 3).

2,7

IOPA X

ray  (Figure  1)  was  taken  to  confirm  that  the  teeth  were
avulsed  as  a  whole  and  also  to  evaluate  the    socket  .
Debridement  of  the  avulsed  socket  was  done  in  an  aseptic
way  with  hank’s  balanced  salt  solution

(Figure 2) and

povidone iodine

, to remove blood clot and thereby creating

fresh bleeding of the socket.

Figure 1: IOPA reveals completely avulsed 11 21 and no
fracture of bone

Figure 2: Avulsed 11 ,21

Figure 3: Bowl of milk as medium of transport

Balakumar et al: Reimplantation- A case report

Volume No:

8, Issue No:

ISSN No: 2582-0559

The avulsed teeth were brought back within minutes

and thorough debridement was done(Figure 4) by holding the
crown part of the tooth with running saline.

After which the

tooth was inserted in their respective socket to check for
initial stability. The teeth was held in position by asking the
patient to bite on a sterile gauze

(Figure 5) and digital

palpitation was conducted on both labial and palatal surface
to check the cortical plates were intact. Patient was asked to
occlude in centric occlusion to check any pre matured
contacts, selective grinding to be done if required.

Figure 4: Debridement of the avulsed socket along with
acid etching

Figure 5: Avulsed 11,21 placed in their respective sockets
to check snug fit

Stabilization splinting was done using a stainless steel

wire with Ivoclar composite resin extending from canine to
canine

1,12

(Figure 6) Centric, eccentric premature contacts

are checked with articulating paper and interferences
relieved. Oral hygiene instructions were given and the patient
was periodically reviewed.

Figure 6: Composite splitting done and stabilized

DISCUSSION

Reimplantation is a unique treatment of choice for

avulsion  of  tooth.  Prognosis  is  always  positive  for
completely  avulsed  tooth.  Hence  in  this  case  the  teeth  was
avulsed as a whole thereby reimplantation was attempted.

Success of an avulsed tooth is higher if replanted

within 15-20 minutes. This time period is known as golden
hour.

Reimplantation was planned for this particular case

because the dry time was within the golden hour. The
advantages of replanting the tooth within this golden hour are
preservation

periodontal

ligament

vitality

and

reattachment, minimal inflammatory responses, repair with
replacement of cementum. Disadvantages would be
ankylosis, replacement resorption and external inflammatory
root resorption.

The available medium of transportation for avulsed

tooth are water, hank’s balanced salt solution, milk

2,7

coconut water

and patient saliva.

Milk is a better choice of

medium

, since high percentage of vital cells maintained for

six hours and easy availability reason

2,7

. Therefore the

avulsed teeth were transported in a bowl of milk from the
accident site.

Holding the tooth in the root portion would lead to

disembarkment of the periodontal ligaments. Hence it is
always important to handle the avulsed tooth by handling the
crown portion of the tooth.

Same was instructed to the

patient’s kin.

5,10

A through debridement of socket is a must with water

and  saline  to  remove  blood  clot  and  thereby  creating  fresh
bleeding of the socket for better prognosis. It is mandatory to
check  the  anatomical  position  of  the  teeth  in  the  socket  to
establish  initial  stabilization.  Splinting  is  a  method  of
stabilization of avulsed tooth by using composite resin

1. 10

, as

it is the material of choice for esthetics.

Balakumar et al: Reimplantation- A case report

Volume No:

8, Issue No:

ISSN No: 2582-0559

CONCLUSION

Reimplantation of avulsed permanent tooth is a boon

to dentistry.  The prognosis of reimplantation depends upon
the  extent  of  trauma,  minimizing  the  extra  oral  dry  time,
material of choice of splinting, duration of stabilization and
occlusal  factors.  Composite  splitting  is  the  traditional
method of stabilization from past to present. Reimplantation
of  one’s  natural  tooth  with  utmost  care  will  build  up  self-
confidence and psychological wellbeing.

FINANCIAL SUPPORT AND SPONSORSHIP

Nil

CONFLICTS OF INTEREST

There are no conflicts of interest.

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