Title	Treatment Outcome For Avulsed And Replanted Permanent Teeth
Clinical Question	In a child with an avulsed permanent incisor, what is the survival rate after replantation?
Clinical Bottom Line	A wide range of survival rates was reported. Werdner and colleagues found an 83.3% survival rate after replantation, reporting 7 out of 42 permanent incisors being extracted over a median observation period of 2.8 years. Furthermore, Petrovic and colleagues showed 10 teeth out 32 permanent incisors being extracted over a median observation period of two years. In addition, both studies indicated a more favorable treatment outcome in incisors with closed apices.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 19919541 Petrovic/2010 62 avulsed permanent incisors, in 51 children (mean age 10.7 years old, a range of 7-19 years old). Prospective Cohort Study Key results This study reported that out of the 62 avulsed teeth only 32 teeth could be replanted. Over two-year median observation period, 10 of those replanted teeth had to be extracted. The study also indicated that incisors with open apices had a relative risk of failure that was 6.4 times greater than that of incisors with closed apices (p=0.04). 21557097 Werder/ 2011 42 avulsed permanent incisors, in 37 patients (mean age of 16.3 years, 81% of patients under 20 years of age). Retrospective Cohort Study Key results Over a 2.8 year median observation period, 7 of the incisors were extracted indicating a survival rate of 35/42 teeth (83.3%).
Evidence Search	("Tooth Avulsion"[Majr] OR "Tooth Replantation"[Majr]) AND "Child"[Mesh] AND (("therapy"[Subheading] OR "therapy"[All Fields] OR "treatment"[All Fields] OR "therapeutics"[MeSH Terms] OR "therapeutics"[All Fields]) AND Outcome[All Fields]) AND ("humans"[MeSH Terms] AND English[lang])
Comments on The Evidence	Petrovic and colleagues had a follow-up period ranged from one to six years, with a median of two years. For the initial 8 weeks patient follow-up was 100%, however that number decreased to 50% in the first year. Werdner and colleagues had a follow-up period ranged of 1 to 5 years, with a median of 2.8 years. Both of these articles show a low-level of evidence.
Applicability	This is applicable to health care providers treating these children as well as parents whose children have avulsed and replanted teeth.
Specialty	(General Dentistry) (Orthodontics) (Pediatric Dentistry) (Dental Hygiene)
Keywords	Tooth Avulsion, Tooth Replantation
ID#	2420
Date of submission	02/28/2013
E-mail	huttoa@livemail.uthscsa.edu
Author	Ashley Hutto
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Maria Cervantes Mendez, DDS
Faculty mentor e-mail	CervantesMen@uthscsa.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available