Department of Surgical Science, Dentistry, Gynecology and Paediatrics, University of Verona, Paediatric Dentistry and Oral Hygiene Unit, IRCCS Sacro Cuore-Don Calabria Hospital, Negrar di Valpollicella, Verona, Italy.
Eur J Paediatr Dent. 2024 Sep 3;25(3):244-249. doi: 10.23804/ejpd.2024.25.03.02. Epub 2024 Jul 1.
Dental avulsion, the complete displacement of a tooth from its socket, is a severe dental trauma with a prevalence of 0.5% to 16% of all dental injuries. Replantation of avulsed teeth is common, yet recent studies show high failure rates and unpredictable long-term outcomes. This review examines clinical variables influencing intentional dental replantation decisions and proposes a treatment flow chart. A comprehensive literature search was conducted in PubMed-Medline, Scopus, WoS, and Cochrane databases using the keywords "tooth avulsion," "tooth replantation," and "tooth ankylosis." Inclusion criteria encompassed studies from January 2018 to February 2024. From 752 identified articles, 9 systematic reviews including 3 meta-analyses were selected for this scoping review. Immediate replantation is the gold standard for avulsed teeth, yet delayed replantation is more common in practice, impacting survival rates. Adherence to guidelines from the International Association on Dental Traumatology improves outcomes, especially in paediatric patients. Factors such as multiple caries, severe periodontal disease, advanced age, psychological conditions, immunodeficiency, and lack of cooperation are contraindications for replantation. Despite the high failure rate, replantation remains recommended in literature due to its potential advantages over prosthetic implants. This review highlights the complexities in decision-making for dental replantation, emphasising the need for a comprehensive approach considering individual clinical cases. A proposed treatment flow chart aims to support clinicians in predicting prognosis and making informed decisions. The review also underscores the link between dental trauma, poor oral health, and potential neglect in children, highlighting the importance of preventive measures and parental awareness.
牙齿脱位，即牙齿从牙槽窝中完全脱出，是一种严重的牙科创伤，其发生率为所有牙科损伤的 0.5%至 16%。离体牙再植较为常见，但最近的研究显示其失败率较高，且长期预后不可预测。本综述检查了影响意向性牙再植决策的临床变量，并提出了治疗流程图。在 PubMed-Medline、Scopus、WoS 和 Cochrane 数据库中使用关键词“牙脱位”、“牙再植”和“牙粘连”进行了全面的文献检索。纳入标准包括 2018 年 1 月至 2024 年 2 月的研究。从 752 篇已识别的文章中，选择了 9 篇系统综述，其中包括 3 项荟萃分析，用于本次范围综述。即刻再植是离体牙的金标准，但在实践中更常见延迟再植，这会影响存活率。遵循国际牙科创伤协会的指南可改善预后，尤其是在儿科患者中。存在多个龋齿、严重牙周病、年龄较大、心理状况、免疫缺陷和缺乏合作等因素时，是再植的禁忌症。尽管再植失败率较高，但由于其在某些情况下优于种植体修复，文献中仍推荐进行再植。本综述强调了在决定牙再植时的复杂性，强调需要综合考虑个体临床情况。提出的治疗流程图旨在帮助临床医生预测预后并做出明智的决策。该综述还强调了牙科创伤、口腔健康不良和儿童潜在忽视之间的联系，突出了预防措施和家长意识的重要性。
