Factors Related To Treatment And Outcomes Of Avulsed Teeth With Prolonged Extra-alveolar Duration And In Dry Conditions

BackgroundDuration of extraoral storage and storage media are identified as themajor impact on the success rate of replantation for the avulsed teeth.Under the circumstances, most of the avulsed teeth could not bereplanted in short duration and storaged in the ideal medium. Ourresearch will try to find out the factors related to treatment andoutcomes of these avulsed teeth. We will focus on the temporary rootcanal filling material and apical maturity of the root. So we designedtwo-part experiment to do a primary exploration.Part one: Clinical study on prevention root absorption after teethreplantation with Vitapex paste.PURPOSE: To evaluate the result of using Vitapex paste for preventingroot absorption after replanting the avulsed teeth. METHODS:36avulsedanterior teeth with fully developed apex were enrolled in this study.Each tooth was avulsed over an hour and storage in unsatisfactory medium.For each case, the tooth was put into its original site and fixed withresin plate. One week later, the involved teeth underwent pulpectomy andwere randomly divided into two groups. Calcium hydroxide was used fortemporary root canal filling in group A, and Vitapex paste in group B.The patients were asked to recall every three months. The permanent rootcanal filling was performed about one year after replantation when rootabsorption stopped. Statistical analysis was carried out using SPSS13.0software package. RESULT: The success rate of two groups was notsignificantly different, though which was a little higher in group A than group B(88.9%vs83.3%).Part two: Clinical study on the result of immature avulsed teeth afterreplantationPURPOSE: To evaluate the result of immature avulsed teeth afterreplanted by reservation of pulp. METHODS:13avulsed anterior teethwith no fully developed apices which were reserved in dry conditionbetween an hour to two hours were enrolled in this study. For each case,the tooth and its alveolar site were irrigated with0.9%NaCl, then thetooth was put into its original site and fixed with resin splint,selective grinding to avoid premature contact. Another13avulsedpermanent teeth were also enrolled as control group. The inclusioncriteria and emergency treatment were the same as study group. One weeklater, the teeth in control group underwent root canal treatment. Butroot canal would be filled by Vitapex paste in stead of gutta-perchapoint. All the patients were asked to recall every three months, X-rayfilm was taken to evaluate root absorption. Vitapax paste as thetemporary root canal filling material was replaced every six months.Whether the treatment was successful or not was depend on the rootabsorption. Statistical analysis was carried out using SPSS13.0software package. RESULT: The success rate of two groups was significantlydifferent， which was higher18months after treatment in Control groupthan Study group(84.6%vs.46.2%).CONCLUSIONS:1. Calcium hydroxide and Vitapex are both effective to prevent rootabsorption of the avulsed teeth which were not replanted in shortduration and storaged in the ideal medium. The injection style ofVitapex paste makes it easily being manipulated and is an ideal materialfor preventing root absorption of replanted teeth.2. If the immature avulsed teeth which were reserved in dry conditionover an hour were treated in an conservative way, the success rate ofreplantation would much lower than average. The new therapy should betaken into account to improve the success rate of replantation of theseteeth.