CASE REPORT: Delayed reimplantation of an avulsed central incisor - A 12-year follow-up

The present case highlights the 12-year follow-up of delayed replantation of a maxillary central incisor which was avulsed due to trauma.

The complications seen in the present case were ankylosis and replacement resorption. Clinically, the tooth was asymptomatic and in infraocclusion; however, esthetics was maintained. 

Information on the long-term outcome and prognosis of surface treatment by the application of tetracycline HCl is lacking and this case report highlights the result of root surface treatment with tetracycline HCl.

Tooth avulsion is defined as complete displacement of the tooth from its alveolar socket after traumatic injury and requires more attention and follow-up care. 

Although dentoalveolar injuries are most commonly observed in children and adolescents, particularly boys, they may affect individuals of any age. The deal procedure in the case of avulsion is the immediate reimplantation of the tooth into its socket, which warrants the vitality of the structures adhered to the root surface. 

Periodontal ligament (PDL) healing by reattachment of its fibers to the root surface occurs only when cell viability is maintained. In most situations, the conditions are not so favorable and the avulsed teeth are exposed to a dry medium for long periods, PDL necrosis may ensue which may start an external root resorption process. 

The contamination of delayed reimplanted teeth can be controlled by the treatment of root surface and administration of systemic antibiotics. Recently, the use of chemotherapeutic agents has been advocated to manipulate external root resorption pharmacologically. 

In experimental animal studies, tetracycline has been shown to be effective in preventing or attenuating external root resorption when applied systemically and/or topically. 

This case report presents the clinical and radiographic conditions of a reimplanted incisor after 12 years. The root surface was immersed in tetracycline HCl although the tooth was stored under dry conditions for 1 day after the avulsion injury. 

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