Smiles For Tomorrow

Course Author(s): American Academy of Pediatric Dentistry


Avulsion is complete displacement of the tooth from the socket.  Avulsed primary teeth should not be replanted.  In the primary dentition, the maxillary anterior region is at low risk for space loss unless the avulsion occurs prior to the eruption of the canines or the dentition is crowded.  Fixed or removable appliances, while not always necessary, can be fabricated to satisfy parental concerns for esthetics or to return a loss of oral or phonetic function.

An avulsed permanent tooth should be replanted except when replanting is contraindicated by the child’s stage of dental development (risk for ankylosis where considerable alveolar growth has to take place) or compromising medical condition or by compromised integrity of the avulsed tooth or supporting tissues.  Examples of compromised medical conditions are severe congenital cardiac anomalies, severe uncontrolled seizure disorder, severe mental disability, severe uncontrolled diabetes, and immunocompromised status.

An avulsed permanent tooth should be replanted as soon as possible.  Do not handle the root surface, but do rinse the tooth quickly under running water to remove foreign material.  The reimplanted tooth should be stabilized in its anatomically correct location by a flexible splint for 2 weeks.


If it is not possible to reimplant the tooth within 5 minutes, it should be stored in a medium that will help maintain the vitality of the periodontal ligament fibers on the root’s surface.  Transportation media for avulsed teeth include (in order of preference): Viaspan®, Hank’s Balanced Salt Solution, cold milk, saliva, or physiologic saline.  Water is preferable only to dry storage.  The risk of ankylosis increases significantly with an extraoral dry time of 20 minutes.  An extraoral dry time of 60 minutes is considered the point where survival of the root periodontal cells is unlikely.  Tetanus prophylaxis and antibiotic coverage should be considered.  In permanent avulsed teeth, there is considerable risk for pulp necrosis, root resorption, and ankylosis following reimplantation.  Close monitoring is required following reimplantation and if the avulsed tooth had a closed apex, pulpectomy/debridement should be performed within 7 to 10 days.