Severe Case of Delayed Replantation of Avulsed Permanent Central Incisor: A Case Report with Four-Year Follow-Up

Efficacy of Simvastatin in Inhibiting Bone Resorption and Promoting Healing in Delayed Tooth Avulsion: A Case Series

An avulsion is a severe dental injury characterized by the complete displacement of a tooth from its socket, often resulting in a compromised prognosis. One of the key factors influencing the success of reimplantation is the extraoral dry time, which refers to the duration the tooth remains outside of the socket. Prolonged dry time significantly impairs the viability of the periodontal ligament cells, crucial for successful healing and reattachment. Despite various protocols and treatment strategies developed to manage avulsed teeth, no single approach addresses all treatment needs effectively, particularly in cases of delayed reimplantation. Simvastatin, an anti-lipidemic drug, has demonstrated pleiotropic effects that extend beyond cholesterol lowering. These effects include anti-inflammatory properties, promotion of bone regeneration, and enhancement of periodontal ligament cell survival. Such actions suggest that simvastatin may have a beneficial role in improving outcomes following the delayed reimplantation of avulsed teeth. This case series proposes the use of simvastatin as an adjunctive treatment for avulsed teeth along with platelet-rich fibrin and hydroxyapatite, particularly in situations where reimplantation is delayed. By mitigating inflammation and stimulating tissue regeneration, simvastatin may help counteract the damage caused by prolonged extraoral dry time. Its potential to promote periodontal ligament cell survival and enhance healing processes could improve the prognosis of reimplantation, even in cases where traditional treatment alone would be less effective. Given these promising properties, simvastatin may represent a valuable addition to the treatment protocol for avulsed teeth with extended dry times. However, further clinical studies and trials are necessary to validate its efficacy and establish a clear role in the management of delayed reimplantation.

Appropriate Terminology for the Time Elapsed From Avulsion of a Permanent Tooth to Replantation: A Scoping Review and Delphi Consensus

BACKGROUND

The prognosis of an avulsed permanent tooth depends on the time elapsed from injury to replantation in the injured socket. Wide variability exists in the terminologies used to describe this period. Hence, the aim of this study was to identify and categorize the terminologies related to this aspect of tooth avulsion, grade the explanations provided by the authors, and develop a consensus about the most appropriate terminology through a Delphi approach.

METHODS

This study involved a scoping review to identify and analyze the terminologies. It was performed according to PRISMA-ScR with a systematic search performed in PubMed, Scopus, EMBASE, LILACS, and Web of Science. The terminologies were extracted, categorized, and evaluated for correctness. On the basis of the results of the review and expert group discussion, an ideal terminology was proposed. A Delphi study with 20 global experts in dental traumatology was conducted to develop a consensus for the proposed terminology and its description.

RESULTS

A total of 92 studies were included. They were distributed into five categories according to the terminology used: (a) dry period alone, (b) total period with dry and/or wet times, (c) extra-alveolar period, (d) extraoral period, and (e) miscellaneous. The explanations provided were correct in 37.5% of the studies that used an extraoral period. In the Delphi study, the lowest scores were given to the term dry period. There was an agreement of 95% for the proposed terminology.

CONCLUSION

A wide variation in terminologies was observed that could be distributed into five categories. The correctness of explanations was highest in the studies that described total periods with dry and wet times. The Delphi study revealed excellent agreement for the proposed term "total extra-alveolar period," with precise and clear recordings of both nonphysiologic (dry) periods and physiologic (wet) periods.

Retrospective analysis of survival of avulsed and replanted permanent teeth according to 2012 or 2020 IADT Guidelines

This study aimed to compare the survival of replanted teeth that followed the 2012 or the 2020 International Association of Dental Traumatology (IADT) guidelines. Sixty-two permanent replanted teeth were retrospectively assessed (IADT 2012, n = 45; IADT 2020, n = 17). Five years after replantation (from January 2017 to December 2021), clinical and radiographic examinations were performed. A significance level of 95% was considered to evaluate the outcomes. Thirty-one teeth (50.0%) remained in their sockets and 31 (50.0%) were lost due to external root resorption. Of the 25 (40.3%) teeth replanted within one hour, 16 (64.0%) remained in their sockets, and 9 (36.0%) were lost. Twenty-two (71.0%) of all 31 lost teeth had an extra-alveolar time of more than one hour. Twelve teeth remained in their sockets without resorption: 8 (66.7%) were replanted within one hour, 2 (16.7%) followed the 2012 IADT, and 2 (16.7%) the 2020 IADT guidelines for late replantation. There was a significant difference (p <0.05) in the extra-alveolar time (< one hour), but without difference between the guidelines in late replantation (p > 0.05). Replanted teeth following both, 2012 or 2020 IADT guidelines, have similar clinical outcomes. The extra-alveolar time of less than one hour was demonstrated to be important to keep the permanent tooth in its socket.