272 - Effectiveness of Endodontic Management of Avulsed Immature Permanent Teeth

Purpose: We investigated the most appropriate time of follow up and initiation of endodontic treatment for avulsed immature permanent teeth by critically reviewing the literature and presenting two cases completed at the University of Pennsylvania School of Dental Medicine.

Methods: Data were collected searching for keywords “endodontics”, “tooth avulsion”, “intrusion” in PubMed, Ovid Medline, Embase and Cochrane. The results were screened for publishing time, language, subject age, injury type and intervention technique. Variations in time to initial treatment, initial treatment type, time between initial treatment to endodontic intervention and types of endodontic intervention were recorded and studied in relation to healing outcome.

Results: Clinical and radiographic examinations in Case #2 show that delay in endodontic management of avulsed immature permanent teeth may affect the treatment outcome. 25 teeth included in the study, 17 teeth had < 60 minutes and 8 had > 60 min of extra-oral dry time. There was a trend towards increased (but not statistically significant) ERR occurrence in the over 60 minutes group, (Fisher’s exact test, p = 0.23). To determine the impact of the time to endodontic intervention to ERR, and survival of the teeth, the data was stratified into four time segments and the extra-oral dry time; trends were not observed. A total of 4 teeth were eventually extracted due to vertical fracture following re-traumatization.

Conclusion: Our study did not have the statistical power to identify predictors of endodontic treatment success due to limited data points. To date, many published studies on avulsed teeth do not include time to initial treatment, follow up frequency and time between initial treatment to endodontic intervention on the basis of these factors. Future publications should include these time points to allow further investigation of timing of endodontic intervention following trauma to immature permanent teeth.