dental disorders
How To Replace and Splint an Avulsed Tooth
Step by Step Description of Procedure
Initial assessment and preparation Wear nonsterile gloves and mask/safety glasses, or face shield. Handle the tooth only by the crown and do not disturb any of the root's tissues. If the tooth has been out of the socket<20 minutes, immediately reimplant it. Gently rinse the tooth with saline. To prepare a space for the root, remove the bulk of the clot from the socket using gentle irrigation and suction (small-tipped). Do not waste time trying to remove the entire clot. Be sure the tooth is oriented correctly. Use the contralateral tooth as a guide for orientation if needed. If the tooth has been out of the socket>20 minutes but<2 hours, soak the tooth in Hanks'balanced salt solution(HBSS; the preferred treatment) for 30 minutes to revitalize the cells of the periodontal fibers, then reimplant the tooth. If HBSS is not available, milk can be used, but is less desirable. Saline is an even less desirable alternative. Remove the clot as described above. If anesthesia is needed For most lower teeth, do an How To Do an Inferior Alveolar Nerve Block . For most upper teeth, do How To Do a Supraperiosteal Infiltration . For the frequent anterior permanent tooth avulsions that occur in school-aged children without other significant trauma, local infiltration over the socket usually provides adequate anesthesia and is faster than a nerve block. Reinsert an avulsed tooth Holding the tooth by the crown, gently insert it into its socket in correct anatomic orientation (use contralateral side as a guide if needed). Gently push the tooth into the socket (pressing on the crown) to seat the tooth but without compressing any tissues at the root. Use digital pressure only. Check bite: Have patient gently and slowly bite down to be sure opposing teeth do not move the reimplanted tooth. Readjust position of tooth if needed so that the patient can bring the teeth together normally. Splint the tooth (see below). If the tooth cannot be seated securely or oriented with certainty, send the patient directly to a dentist. Stabilize a subluxed (mobile but not displaced) tooth Gently move the crown to reposition the tooth to its correct location, but do not compress any tissues at the root. Splint the tooth (see below). Reduce a luxated tooth(displaced to the side, or partially extruded from the socket; intruded teeth should be managed by a dentist) Use digital pressure as needed to reposition the displaced tooth into its correct anatomic position. Use adjacent and opposing teeth as guides. Gentle forceps traction in a forward direction is sometimes needed for palatally displaced teeth. Significantly displaced teeth are best referred directly to a dentist or oral surgeon. Check bite: Have the patient gently and slowly bite down to be sure opposing teeth do not move the repositioned tooth. Splint the tooth (see below). Splint the reduced tooth Prepare the flexible splint material as directed by the manufacturer, particularly the recommended ratio of base and catalyst and degree of mixing, and roll the resultant putty into a cylindrical (sausage) shape using your moistened, gloved fingers. Maintain the tooth in position within the socket. Make 2 small strips of paste. Lay one strip over the buccal surface and one over the lingual/palatal surface of the reimplanted tooth, extending the strips across 1 or 2 teeth on either side. Do not cover the occlusal surfaces of the teeth. Gently smooth the surface of the putty while working it into the spaces between the teeth. If both sides of the teeth cannot be covered, place the splint only on the buccal side. If the temporary splint is not effective, send the patient directly to a dentist for more advanced splinting options. After reimplantation, obtain dental x-rays to identify associated damage. 