Podcast 810: Tooth Replantation

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

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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