Delayed replantation of an avulsed permanent incisor with 10 h of extraoral dry time: A case report with 1-year follow-up

Abstract Avulsion is the complete displacement of the tooth from its alveolar socket and comprises of 11% of traumatic dental injuries. The duration of extra-alveolar storage and the type of media used determine the prognosis of replanted avulsed teeth. This case details the successful management of an avulsed maxillary right central incisor (#11) stored dry for approximately 10 h. A 25-year-old male reported with a “knocked-out” tooth after an accidental fall. The avulsed tooth showed an uncomplicated crown fracture involving enamel. The preoperative radiograph revealed no signs of concomitant dentoalveolar trauma. Clinical examination revealed a dry socket of tooth #11, with a blood clot. The adjacent tooth left central incisor (#21) showed an Ellis Class II fracture. A diagnosis of avulsion was made for the tooth #11. The patient was presented with the option of either replanting the natural tooth or prosthetic rehabilitation. The consequences and complications associated were explained. As the patient wished to retain the natural tooth, delayed replantation was planned and performed. The tooth was cleaned with sterile saline and placed in fluoride gel. Extraoral root canal treatment was completed followed by 3 mm apicoectomy and retrograde mineral trioxide aggregate filling. Bleeding was induced in the socket and the tooth was replanted with a splint for 2 weeks. Despite extended dry storage, no symptoms or resorption was seen at the 12-month follow-up, and the lamina dura along with the periodontal ligament space were intact. The present case demonstrates a favorable outcome of delayed replantation despite prolonged nonphysiologic extra-alveolar storage by employing a unique approach to achieve positive endodontic outcomes by minimally invasive procedures.