Multidisciplinary Management Of Avulsed Teeth With Prolonged Extra-Oral Time

The prognosis of completely avulsed teeth worsens significantly when extra-oral dry time exceeds 10 hours. This case demonstrates the efficacy of a multidisciplinary protocol for salvaging avulsed teeth under suboptimal conditions. An 18-year-old male presented with complete avulsion of teeth #11 and #21 and a fractured #22 after trauma, with 10 hours of dry extra-oral time. Treatment Protocol: Immediate reimplantation: Avulsed teeth were cleansed with saline-soaked gauze, followed by socket debridement and splinting (flexible wire-composite splint, 4 weeks). Periodontal intervention: Subgingival scaling and minocycline gel application at 72 hours post-op; splint removal at 4 weeks. Endodontic therapy: Initiated at 2 weeks using calcium hydroxide intracanal medication, root canal therapy was initiated two weeks postoperatively to prevent root resorption. Prosthetic rehabilitation: Lithium disilicate crowns placed at 3 months post-op. Despite the 10-hour dry time (far exceeding IADT guidelines), favorable outcomes were achieved through staged interventions: Early splinting minimized mobility-induced trauma, critical for periodontal ligament cell survival. Delayed endodontic treatment (2 weeks post-replantation) balanced pulp necrosis management and periodontal healing. CBCT at 6 months confirmed osseous healing (ankylosis area <10% root surface), contrasting typical replacement resorption in prolonged dry-time cases. This challenges the traditional 60-minute "golden period" dogma, suggesting salvage potential through protocol-driven care. A multidisciplinary sequence enabled functional preservation of severely compromised avulsed teeth. This underscores the importance of structured collaboration between endodontists, periodontists, and prosthodontists, even in cases defying conventional prognostic thresholds.