Department of Oral and Maxillofacial Surgery and Medicine, Faculty of Odontology, Malmö University, Malmö, Sweden.
Department of Oral and Maxillofacial Surgery, University Hospital, Copenhagen, Denmark.
Dent Traumatol. 2021 Aug;37(4):537-545. doi: 10.1111/edt.12659. Epub 2021 Feb 1.
BACKGROUND/AIM: The survival of an avulsed tooth highly depends on the emergency management. The aim of this study was to evaluate the risk of ankylosis for avulsed human teeth stored in saliva preceded by various dry storage conditions prior to replantation.
Data include 74 patients (54 male and 20 female) with 89 avulsed and replanted teeth (16 immature teeth, 73 mature teeth). Patient ages ranged from 6 to 36 years (median: 13.0 years). All teeth were stored in saliva before replantation. Treatment and follow-up were performed according to a standardized procedure. Follow-up periods ranged from 7 months to 20 years (mean 5.3 years). The risk of ankylosis over time was estimated by the Aalen-Johansen method in relation to the length of dry storage and the stage of root development. The effect of risk factors (root development and length of dry time) on the risk of ankylosis was analysed by Cox regression analysis.
For mature teeth, dry storage for 5 min or less before saliva storage resulted in a 47.4% (95% confidence interval (CI): 32.8-60.7) ankylosis rate. When dry storage was >5 min and <20 min, the risk of ankylosis was 76.8% (95% CI: 45.7-91.5). When dry storage exceeded 20 min prior to saliva storage, ankylosis increased to 89.3% (95% CI: 68.0-96.7). Ankylosis also increased with increasing saliva storage time. Specifically, one additional minute of wet time increased the ankylosis hazard rate (HR) by approximately 1% (CI = [0%, 2%], p = .052). Teeth with mature root development were significantly more frequently affected by ankylosis than teeth with immature root development (HR: 2.4 (95% CI: 1.0-5.5), p = .04).
Temporary storage in saliva should be encouraged if an avulsed permanent tooth cannot be immediately replanted or a suitable storage medium such as milk or saline is not immediately available at the place of the accident.
背景/目的：外伤性脱位牙的存活高度依赖于紧急处理。本研究的目的是评估在重新植入之前，经过各种干燥储存条件处理并保存在唾液中的脱位人牙发生骨性粘连的风险。
数据包括 74 名患者（54 名男性和 20 名女性）的 89 颗脱位和再植牙（16 颗未成熟牙，73 颗成熟牙）。患者年龄 6-36 岁（中位数：13.0 岁）。所有牙齿在重新植入前均保存在唾液中。治疗和随访按照标准化程序进行。随访时间 7-20 年（平均 5.3 年）。通过 Aalen-Johansen 法，根据干燥储存时间和牙根发育阶段来估计随时间推移发生骨性粘连的风险。通过 Cox 回归分析，分析危险因素（牙根发育和干燥时间长度）对骨性粘连风险的影响。
对于成熟牙，在保存唾液之前干燥 5 分钟或更短时间会导致 47.4%（95%置信区间（CI）：32.8-60.7）的骨性粘连率。当干燥储存时间>5 分钟且<20 分钟时，粘连风险为 76.8%（95%CI：45.7-91.5）。当干燥储存时间超过 20 分钟后再保存在唾液中时，粘连增加到 89.3%（95%CI：68.0-96.7）。随着唾液保存时间的延长，粘连也会增加。具体来说，湿存时间增加 1 分钟会使粘连的危险率（HR）增加约 1%（CI=[0%，2%]，p=0.052）。牙根发育成熟的牙齿比牙根发育不成熟的牙齿更容易发生骨性粘连（HR：2.4（95%CI：1.0-5.5），p=0.04）。
如果外伤性脱位的恒牙不能立即重新植入，或者在事故发生地点无法立即获得合适的储存介质（如牛奶或生理盐水），应鼓励将牙齿暂时储存在唾液中。
