Treatment

• Leave the tooth in place.
• Clean the area with water spray, saline, or chlorhexidine.
• Suture gingival lacerations if present.
• Verify normal position of the replanted tooth both clinically and radiographically.
• Apply a flexible splint for up to 2 weeks.
• Administer systemic antibiotics. Tetracycline is the first choice (Doxycycline 2x per day for 7 days at appropriate dose for patient age and weight). The risk of discoloration of permanent teeth must be considered before systemic administration of tetracycline in young patients (In many countries tetracycline is not recommended for patients under 12 years of age). In young patients Phenoxymethyl Penicillin (Pen V), at an appropriate dose for age and weight, is an alternative to tetracycline.
• If the avulsed tooth has been in contact with soil, and if tetanus coverage is uncertain, refer to physician for a tetanus booster.
• Initiate root canal treatment 7-10 days after replantation and before splint removal.

Patient instructions

• Soft food for up to 2 weeks.
• Brush teeth with a soft toothbrush after each meal.
• Use a chlorhexidine (0.1 %) mouth rinse twice a day for 1 week.

Follow-up

• Clinical control once a week during the first month.
• Root canal treatment 7-10 days after replantation. Place calcium hydroxide as an intra-canal medicament for up to 1 month followed by root canal filling with an acceptable material.
• Splint removal and clinical and radiographic control after 2 weeks.
• Clinical and radiographic control after 4 weeks, 3 months, 6 months, 1 year and then yearly thereafter.

Treatment

• Clean the tooth with saline.
• Irrigate the socket with saline.
• Examine the alveolar socket. If there is a fracture of the socket wall, reposition it with a suitable instrument.
• Replant the tooth with gentle pressure.
• Suture gingival lacerations if present.
• Verify normal position of the replanted tooth both, clinically and radiographically.
• Apply a flexible splint for up to 2 weeks.
• Administer systemic antibiotics. Tetracycline is the first choice (Doxycycline 2x per day for 7 days at appropriate dose for patient age and weight). The risk of discoloration of permanent teeth must be considered before systemic administration of tetracycline in young patients (In many countries tetracycline is not recommended for patients under 12 years of age). In young patients Phenoxymethyl Penicillin (Pen V), at appropriate dose for age and weight, is an alternative to tetracycline.
• If the avulsed tooth has been in contact with soil, and if tetanus coverage is uncertain, refer to physician for a tetanus booster.
• Initiate root canal treatment 7-10 days after replantation and before splint removal.

Patient instructions

• Soft food for up tp 2 weeks.
• Brush teeth with a soft toothbrush after each meal.
• Use a chlorhexidine (0.1 %) mouth rinse twice a day for 1 week.

Follow-up

• Clinical control once a week during the first month.
• Root canal treatment 7-10 days after replantation. Place calcium hydroxide as an intra-canal medicament for up to 1 month followed by root canal filling with an acceptable material.
• Splint removal and clinical and radiographic control after 2 weeks.
• Clinical and radiographic control after 4 weeks, 3 months, 6 months, 1 year and then yearly thereafter.

Treatment

Delayed replantation has a poor long-term prognosis. The periodontal ligament will be necrotic and can not be expected to heal. The goal in doing delayed replantation is to promote alveolar bone growth to encapsulate the replanted tooth. The expected eventual outcome is ankylosis and resorption of the root. In children below the age of 15, when ankylosis occurs, and when the infraposition of the tooth crown is more than 1 mm, it is recommended to perform decoronation to preserve the contour of the alveolar ridge.

• Remove attached necrotic soft tissue with gauze.
• Root canal treatment can be performed prior to replantation, or it can be done 7-10 days later.
• Immerse the tooth in a 2% sodium fluoride solution for 20 min.
• Irrigate the socket with saline.
• Examine the alveolar socket. If there is a fracture of the socket wall, reposition it with a suitable instrument.
• Replant the tooth with gentle pressure.
• Suture gingival lacerations if present.
• Verify normal position of the replanted tooth clinically and radiographically.
• Stabilize the tooth for 4 weeks using a flexible splint.
• Administer systemic antibiotics. Tetracycline is the first choice (Doxycycline 2x per day for 7 days at appropriate dose for patient age and weight). The risk of discoloration of permanent teeth must be considered before systemic administration of tetracycline in young patients (In many countries tetracycline is not recommended for patients under 12 years of age). In young patients Phenoxymethyl Penicillin (Pen V), at an appropriate dose for age and weight, is an alternative to tetracycline.
• If the avulsed tooth has been in contact with soil, and if tetanus coverage is uncertain, refer to physician for a tetanus booster.

Patient instructions

• Soft food for up to 2 weeks.
• Brush teeth with a soft toothbrush after each meal.
• Use a chlorhexidine (0.1%) mouth rinse twice a day for 1 week.

Follow-up

• Clinical control once a week during the first month.
• If root canal treatment was not performed at the initial treatment session then root canal treatment should be performed 7-10 days after replantation.
• Splint removal and radiographic control after 4 weeks.
• Clinical and radiographic control after 4 weeks, 3 months, 6 months, 1 year and yearly thereafter.

Treatment

• Leave the tooth in place.
• Clean the area with water spray, saline, or chlorhexidine.
• Suture gingival laceration if present.
• Verify normal position of the replanted tooth both clinically and radiographically.
• Apply a flexible splint for up to 1-2 weeks.
• Administer systemic antibiotics. For children 12 years and younger: Penicillin V at an appropriate dose for patient age and weight.
• If the avulsed tooth has been in contact with soil and if tetanus coverage is uncertain, refer to physician for a tetanus booster.
• The goal for replanting still-developing (immature) teeth in children is to allow for possible revascularization of the tooth pulp. If that does not occur, root canal treatment is recommended.

Patient instructions

• Soft food for up to 2 weeks.
• Brush teeth with a soft toothbrush after each meal.
• Use a chlorhexidine (0.1%) mouth rinse twice a day for 1 week.

Follow-up

• Clinical control once a week during the first month.
• Splint removal and clinical and radiographic control after 2 weeks.
• Root canal treatment should be avoided unless there is clinical and radiograpic evidence of pulp necrosis.
• Clinical and radiographic control after 4 weeks, 3 months, 6 months, 1 year and yearly thereafter.

Treatment

• Clean the tooth with saline.
• Evacuate the socket with saline.
• If available, cover the root surface with minocycline hydrochloride microspheres before replanting the tooth.
• Examine the alveolar socket. If there is a fracture of the socket wall, reposition it with a suitable instrument.
• Replant the tooth with gentle pressure.
• Suture gingival lacerations, especially in the cervical area.
• Verify normal position of the replanted tooth clinically and radiographically.
• Apply a flexible splint for up to 2 weeks.
• Administer systemic antibiotics. For children 12 years and younger: Penicillin V at an appropriate dose for patient age and weight.
• If the avulsed tooth has been in contact with soil and if tetanus coverage is uncertain, refer to physician for a tetanus booster.
• The goal for replanting still-developing (immature) teeth in children is to allow for possible revascularization of the tooth pulp. If that does not occur, root canal treatment may be recommended.

Patient instructions

• Soft food for up to 2 weeks.
• Brush teeth with a soft toothbrush after each meal.
• Use a chlorhexidine (0.1%) mouth rinse twice a day for 1 week.

Follow-up

• Clinical control once a week during the first month.
• Splint removal and clinical and radiographic control after 2 weeks.
• Root canal treatment should be avoided unless there is clinical and radiographic evidence of pulp necrosis.
• Clinical and radiographic control after 4 weeks, 3 months, 6 months, 1 year and then yearly thereafter.

Treatment

Delayed replantation has a poor long-term prognosis. The periodontal ligament will be necrotic and not expected to heal. The goal in doing delayed replantation of immature teeth in children is to maintain alveolar ridge contour. The eventual outcome is expected to be ankylosis and resorption of the root. It is important to recognize that if delayed replantation is done in a child, future treatment planning must be done to take into account the occurrence of tooth ankylosis and the effect of ankylosis on the alveolar ridge development. When ankylosis occurs, and when the infraposition of the tooth crown is more than 1 mm, it is recommended to perform decoronation to preserve the contour of the alveolar ridge.

• Remove attached necrotic soft tissue with gauze.
• Root canal treatment can be performed prior to replantation through the open apex.
• Immerse the tooth in a 2% sodium fluoride solution for 20 min.
• Irrigate the socket with saline.
• Examine the alveolar socket. if there is a fracture of the socket wall, reposition it with a suitable instrument.
• Replant the tooth with gentle pressure.
• Suture gingival lacerations if present.
• Verify normal position of the replanted tooth clinically and radiographically.
• Stabilize the tooth for 4 weeks using a flexible splint.
• Administer systemic antibiotics. For children 12 years and younger: Penicillin V at an appropriate dose for patient age and weight.
• If the avulsed tooth has been in contact with soil or if tetanus coverage is uncertain, refer to physician for evaluation of the need for a tetanus booster.

Patient instructions

• Soft food for up to 2 weeks.
• Brush teeth with a soft toothbrush after each meal.
• Use a chlorhexidine (0.1%) mouth rinse twice a day for 1 week.

Follow-up

• If root canal treatment was not performed at the initial treatment session then root canal treatment should be performed 7-10 days after replantation.
• Radiographic control after 2 weeks.
• Splint removal and radiographic control after 4 weeks.
• Clinical and radiographic control after 3 months, 6 months, 1 year and then yearly thereafter.