An evidence-based assessment of the clinical guidelines for replanted avulsed teeth. Part I: timing of pulp extirpation


Professor Louise Brearley Messer, Emeritus Professor, School of Dental Science, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, 720 Swanston Street, Victoria, 3010, Australia
Tel.: +61 3 9341 1473
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Abstract –  Background:  Clinical guidelines for the management of avulsed teeth recommend pulp extirpation (PE) within 10 to 14 days of replantation. The principles of evidence-based dentistry can be used to assess whether this is the best approach based on currently-available evidence. The objective of this study was to use the principles of evidence-based dentistry to answer the PICO Question: (P) For a replanted avulsed permanent tooth, (I) is early PE within 10 to 14 days of replantation, (C) compared with delayed pulp extirpation, (O) associated with an increased likelihood of successful periodontal healing after tooth replantation?

Materials and methods:  A literature search was performed across four internet databases for relevant citations (n = 38 400). Limiting citations to those in English and removing duplicates produced a set of titles (n = 14 729) which were sieved. Relevant titles were selected for abstract assessment (n = 628), and then papers were selected for examination (n = 84). Inclusion criteria were applied and six papers (total 236 teeth) met the final criteria for meta-analysis.

Results:  Meta-analyses found a statistically significant association between PE performed after 14 days and the development of inflammatory resorption [common odds ratio (COR) = 0.37, standard error (se) = 0.50, 95% confidence interval (CI): 0.14–0.98]. Pulp extirpation within 10 days of replantation was not significantly associated with a decreased likelihood of developing inflammatory resorption. There were no statistically significant differences in PE times for functional healing, acceptable healing without progressive resorption, or the development of replacement resorption.

Conclusion:  There is clinical evidence for an association between PE performed after 14 days following replantation and the development of inflammatory resorption. This investigation supports the current clinical guidelines for PE within 10 to 14 days of replantation.