Title Root Canal Therapy Within 14 Days of Replantating an Avulsed Tooth Reduces Likelihood of Root Resorption
Clinical Question For a replanted avulsed permanent tooth with fully formed roots, is root canal therapy (RCT) within 14 days of replantation associated with a decreased likelihood of root resorption compared to RCT after 14 days?
Clinical Bottom Line The endodontic treatment of replanted teeth with closed apices within 14 days reduces the likelihood and severity of root resorption.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
19208008Hinckfuss/20096 included studies; 236 total teethMeta-Analysis
Key resultsThis article searched the existing literature for articles that addressed this PICO question: For a replanted avulsed permanent tooth, is early pulp extirpation within 10 to 14 days of replantation, compared with delayed pulp extirpation, associated with an increased likelihood of successful periodontal healing after tooth replantation? A search of 4 databases located over 14,000 English articles, of which 6 articles (236 teeth) were retained for meta-analysis. The data was separated into many categories to analyze periodontal healing, one of which is likelihood of resorption. A significant common odds ratio (COR) of 0.37 showed that "the likelihood of developing inflammatory resorption as a healing complication is approximately one-third when PE is within 14 days of replantation." The overall estimate of effect showed an association between endodontic treatment within 14 days of replantation and periodontal healing without inflammatory resorption that was statistically significant for(Z=2.0, P=0>05) This article concluded that the evidence supported the current clinical guideline by the American Association of Endodontists, which supports RCT within 14 days of replantation of fully formed permanent teeth.
24565654Bastos/2014165 patients with replanted tooth with closed apicesCase Control Study
Key resultsThis study looked retrospectively at cases of replanted teeth. Timing of root canal therapy after replantation affected both the presence and severity of root resorption seen on radiographs on the avulsed tooth. There is an increase in risk of severe external root resorption development of 1.2% per day between replantation and pulpectomy. The findings continue to support the guidelines concerning timing of RCT issued by the American Association of Endodontists.
Evidence Search ("Tooth Avulsion"[Mesh]) AND "Root Resorption"[Mesh]
Comments on
The Evidence
Validity: These studies looked into many aspects of replanting avulsed teeth to try to assure the most successful treatment. They did a comprehensive search of clinical trials to get the most data. They only included human cases, and restricted the data to those that fit the question best and had highest evidence. Studies are limited in methods due to treatment based on trauma; thus, retrospective studies must be used. The extensive analysis of data in Hinckfuss/2009 supported the guidelines American Association of Endodontists. Five years later, the second study continues to support this treatment timeline. Perspective: It is very important to understand how to give patient the best likelihood for long-term success after a traumatic accident. Treatment has to be initiated quickly if replantation is desired. Waiting for tooth stability in the bone before doing an RCT may be desirable, but it is important to realize that waiting too long may cost the patient in the long run. RCT should be initiated as quickly as reasonably possible to avoid more serious problems. If the root is not fully formed and the dentist is anticipating regeneration of the nerve, that creates a more difficult decision concerning timing of RCT.
Applicability Timing of RCT on avulsed teeth should be initiated quickly for teeth with fully formed roots because the nerve and vessels will not regenerate. Traumatic incidents in children resulting in avulsed teeth often will not have closed apices. Thus, RCT is often delayed to allow healing. The 14-day timeline is mostly restricted to adults whose teeth have closed apices. The American Association of Endodontists issued guidelines stating that RCT should be performed within 14 days of replantation. This is supported by the evidence found in the meta-analysis and then again in a more recent study. This treatment is a risk; if unsuccessful, it could result in additional cost to the patient for an FPD or implant treatment. Thus, before taking risk the doctor should understand how to give the best chance for success. This clinical question does not apply to patients with risk factors that suggest poor healing or stability of tooth regeneration.
Specialty (Endodontics) (General Dentistry)
Keywords Tooth avulsion, replantation, root resorption, root canal therapy
ID# 2860
Date of submission 03/30/2015
E-mail fulbrightd@livemail.uthscsa.edu
Author Devon Fulbright
Co-author(s) e-mail
Faculty mentor Birgit J. Glass, DDS, MS
Faculty mentor e-mail glass@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
None available