Pediatric Dentistry Evolution. Avulsion of tooth: research, treatment and clinical recommendations

- Principles of treatment of tooth avulsion 
- Research enhancing predictability of treatment protocols
- Immediate and long-term complications of avulsion
- Splinting recommendations, treatment of pulp necrosis especially in teeth with immature roots, periapical pathologies, future orthodontic treatment, and prosthodontic rehabilitation

Traumatic dental injuries in children, adolescents and adulthood have been established to cause several immediate and long-term complications. They have a prevalence of 11-30% in different parts of the world, with a high predilection for adolescents (teen ages). Tooth Avulsion or exarticulation is one of the most severe forms of traumatic dental injuries leading to complete disjunction of tooth from its supporting structures. Avulsion is itself an emergency and is often accompanied by pan-facial trauma or injuries to other parts of the body.

Tooth avulsion in primary and permanent teeth warrants adequate emergency management which must be done by caregivers, parents, sports coaches, teachers and even the healthcare workers at the site of trauma. A low level of awareness in public often leads to a delayed reporting of these cases; affecting the prognosis adversely. Avulsion of young permanent teeth is complex and require a practical and evidence based protocol for management. The attending pediatric dentist needs to have a clear understanding regarding follow up assessments, splinting recommendations, treatment of pulp necrosis especially in teeth with immature roots, periapical pathologies, future orthodontic treatment, and prosthodontic rehabilitation. Additionally, the avulsion of primary teeth must be followed up for long duration due to chances of developmental deformities in succedaneous teeth.

With increase in understanding of regenerative medicine, efforts are underway to develop methods for improving the prognosis of avulsed teeth reporting after a delay and inadequate storage. This lecture aims to provide an insight of recent evidence based guidelines for immediate and long term management of avulsed teeth and to highlight the futuristic researches which can improve the predictability of management protocols.