TITLE OF THE STUDY

SUCCESS RATE OF REIMPLANTATION OF AVULSE

PRIMARY ANTERIOR TEETH IN CHILDREN–
A SYSTEMATIC REVIEW
 INTRODUCTION

Progress
Behavior Unsightly
Psychologic well Problems appearance
being

(Slack and Jones,1955)

 TRAUMATIC INJURIES

Traumatic injuries must be tackled with a lion’s heart and a surgeon’s brain
- Dr. A Ajmeri 3
 “ Avulsed primary
teeth should be given
to tooth fairy!”

- Johnson et al
Should an avulsed primary anterior tooth be reimplanted
back into the socket?
 PICO

P Population Children aged between 1-6 years

I Intervention Reimplantation of avulsed primary tooth..

C Comparison No reimplantation of avulsed tooth.

O Outcome To evaluate the success rate of reimplanted primary teeth.

 OBJECTIVES

1. To evaluate the clinical outcome of reimplanted primary teeth

2. To evaluate radiographic outcome of reimplanted primary teeth

 REGISTRATION
The review has been registered in PROSPERO; International prospective register of systematic reviews funded by
National Institute of Health Research and produced by CRD. The registration number of this review is
CRD42020212131 .
PREFERRED REPORTING ITEMS FOR SYSTEMATIC REVIEWS AND META ANALYSES (PRISMA)
 INCLUSION CRITERIA
1. Study setting should be clinical.

2. Study design should be randomized control trials, quasi-randomized, control clinical trial, retrospective

or a cohort study, case series and case reports.

3. Study population should be children between 1-6 years of age with primary teeth.

4. Study assessing the efficiency of reimplantation of avulsed primary teeth.

5. Study published between 1st January 2010 and 31th December 2020.

6. Studies written in English language and studies written in any other language but are possible to get

translated into English.

EXCLUSION CRITERIA

1. Studies conducted on animal.

2. Article reported as a review and systematic review.

3. Participants aged above 6 years of age.

4. Studies on reimplanted avulsed permanent teeth.

 EVALUATION CRITERIA
CRITERIA FOR CLINICAL SUCCESS:

 Absence of pain ,Vitality of pulp of reimplanted tooth, Absence of tenderness on percussion, No gingival

swelling/inflammation/redness, Occlusal balance, speech and psychological effects on child, No evidence of

discoloration of the tooth, No sinus opening in the oral mucosa or purulent exudate expressed from the gingival

margin.

CRITERIA FOR RADIOGRAPHIC SUCCESS:

 Any damage caused to permanent successor, No evidence of extensive pathologic root resorption.
 INFORMATION SOURCES

• Literature search strategy was developed using keywords related to avulsion, children, deciduous,
primary, reimplantation

• Data was searched through the database, PubMed, Google scholar, Scopus and Cochrane from 1 st
January 2011 and 31st December 2020.
TABLE SHOWING SEARCH STRATEGIES USED, THE ARTICLES THAT GOT
SEARCHED AND SELECTED
ARTICLES ARTICLES
SEARCH STRATERGIES
IN SEARCH SELECTED

Avulsion AND Reimplantation AND Primary teeth 28 2

Avulsion AND Reimplantation AND Deciduous teeth 12 1

Avulsion AND Reimplantation AND Primary central

1 1
incisor

Avulsion AND Replantation AND Deciduous central

1 1
incisor

TOTAL 42 5
 SELECTION PROCESS

5
 TABLE SHOWING QUALITATIVE ANALYSIS OF THE STUDIES SELECTED FOR THE SYSTEMATIC REVIEW

Year of Number Number of

Sl. Study Follow Clinical Radiographic Damage to
Author Name public- of teeth teeth
No setting up outcome outcome permanent successor
ation avulsed reimplanted

Case 12 No
1 Acharya S. et. al 2017 2 2 No Sequelae No Sequelae
Report Months Sequelae

No Developmental
Case No
2 Kang M. et al 2014 1 1 follow No Sequelae Disturbance- Root
Report Sequelae
up duplication with 11
External Root
Case 32 No
3. Kapur A. et. al 2014 1 1 resorption after 8 No Sequelae
Report Months Sequelae
months
Case 72 No
4 Friedlander et. al 2012 1 1 No Sequelae No Sequelae
Report Months Sequelae

Developmental
No Disturbance- Root
Case No
5 Tewari N. et al 2011 4 4 follow No Sequelae duplication with 12,
Report Sequelae
up Root hypoplasia with
11, 21. Missing 22.
 ASSESMENT OF RISK OF BIAS (Newcastle-Ottawa scale)

Selection Comparability Outcome

Case Reports Total
Representa Selection of Ascertainment of Assessment Adequacy
tiveness of non- exposure (⋆) of outcome of follow-
(⋆⋆)
exposed exposed (⋆ ) up (⋆)
cohort (⋆) cohort (⋆)

Tewari N. et al - ⋆ ⋆ - ⋆ - 3

Friedlander et.
- ⋆ ⋆ - ⋆ ⋆ 4
al

Kapur A. et. al - ⋆ ⋆ - ⋆ ⋆ 4

Kang M. et al - ⋆ ⋆ - ⋆ - 3

Acharya S. et. al - ⋆ ⋆ - ⋆ ⋆ 4
DISCUSSION
 Avulsion (Exarticulation)
• Total displacement of tooth out of its socket.
• Incidence
• 0.5-16% in permanent dentition
• 7-13% in primary dentition
• Male: female ratio - 3:1
• Age group -2-5 yrs (due to loosely structured
PDL)
• Maxillary central incisors are commonly
avulsed

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 Emergency treatment of avulsed tooth
IADT
Keep in mouth Avoid storage in
inside lip / cheek / water (but, better
Keep patient calm saliva container. than keeping it dry)

In case not possible,

Find tooth- pick it place it in milk, Seek emergency
up by crown, avoid suitable storage dental management
touching root media- present to
emergency clinic

Dirty tooth- wash

briefly (10s) in milk Once in position,
saline, patients bite on
saliva and handkerchief
reposition
22
 Modification is needed due to several differences and
factors to be considered:

The proximity of
avulsed primary
The temporary teeth to the
nature of the developing
Parents primary dentition permanent
compliance successors
Cooperation and
follow
instructions

If replaced - Should be replaced within 15 min

 Year
Yearof of Number
NumberNumberNumberof of
Sl.
Sl. Study
Study Follow
FollowClinical
Clinical Radiographic
Radiographic Damage
Damageto to
Author
AuthorName
Name public-
public- of teeth
of teeth teeth
teeth
No
No setting
setting upup outcome
outcome outcome
outcome permanent
permanent
successor
successor
ation
ation avulsed
avulsedreimplanted
reimplanted

Case
Case 12 12 NoNo
11 Acharya
AcharyaS. S.
et.et.
al al 2017
2017 2 2 2 2 NoNo
Sequelae
Sequelae NoNo
Sequelae
Sequelae
Report
Report Months
MonthsSequelae
Sequelae
NoNo Developmental
Developmental
Case
Case NoNo
22 Kang
KangM.M.
et et
al al 2014
2014 1 1 1 1 follow
follow NoNoSequelae
Sequelae Disturbance-
Disturbance-
RootRoot
Report
Report Sequelae
Sequelae
up up duplication
duplication
with
with
11 11
External
External
Root
Root
Case
Case 32 32 NoNo
3.3. Kapur
KapurA.A.
et.et.
al al 2014
2014 1 1 1 1 resorption
resorption
after
after
8 8 NoNoSequelae
Sequelae
Report
Report Months
Months Sequelae
Sequelae
months
months
Case
Case 72 72 NoNo
44 Friedlander
Friedlander
et.et.
al al 2012
2012 1 1 1 1 NoNo
Sequelae
Sequelae NoNo
Sequelae
Sequelae
Report
Report Months
MonthsSequelae
Sequelae
Developmental
Developmental
NoNo Disturbance-
Disturbance-
Root
Root
Case
Case NoNo
55 Tewari
Tewari
N.N.
et et
al al 2011
2011 4 4 4 4 follow
follow NoNo
Sequelae
Sequelae duplication
duplication
with
with
12,12,
Report
Report Sequelae
Sequelae
up up Root
Roothypoplasia
hypoplasia
with
with
11,11,
21.21.
Missing
Missing
22.22.

25
 Time elapsed
Stage of root Storage Degree of
between trauma
development medium contamination
and dental care

Execution of
Endodontic
tooth Splint Follow-up
treatment
replantation
 CONCLUSION
 Reimplantation can be carried out in primary dentition too by following proper and immediate treatment
protocols.
• The data offered in this review demonstrate a lack of high-quality studies with an adequate sample size
and long follow-up periods. Therefore, more clinical studies are needed with longer follow-up for the
establishment of reliable scientific evidence that can help guide clinicians regarding the best approach in
cases of primary tooth avulsion
 LIMITATIONS
 During the literature search of our systematic review, we encountered a few lacunae, one of which
was found to be that very few studies were conducted in between the span of 2010- 2020.
 One of the major drawback was that some articles did not have a proper follow up regime.
 Thus, more meticulous research is needed to be carried out in this direction with long term follow
up periods involving larger sample size where avulsed primary tooth has been reimplanted, so that a
better conclusion and a proper protocol can be laid down.
 FUTURE IMPLICATIONS

The reimplantation of avulsed primary incisor is not an evidence-based care and so cannot be

formally recommended. However, a gentle attitude to look for evidence should be adopted rather

than negation based on anecdotal evidence from statements made in published work.
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PUBLICATION
Thank you…

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