Avulsie van bovenfrontelementen in het definitieve gebit en schade na reïmplantatie: een paradigmashift

Abstract

Total luxation (avulsion) of a tooth is treated with immediate replantation of the tooth in the socket. During the extra-oral time the tooth has to be stored in milk. The shorter the extra-oral storage time, the better. When allowed to dry out, cells rapidly become necrotic with a negative bearing on the outcome. Statistically only 5% of the replanted teeth result in a succesful healing with normal periodontal ligament and normal restitution of pulp vitality. Possible medico-legal implications warrant a clinical photograph of the traumatized tissues. In the child and in the growing teenager, if the tooth cannot be replanted straight away, late replantation is followed by ankylosis and root resorption. Orthodontic treatment is severely impeded and normal development of the alveolus will be impaired. The golden standard in these cases is the replacement of the avulsed tooth with a dental implant, placed after most of the alveolar growth has taken place. Contra-indications, possible complications and some medico-legal aspects will be discussed.