Published: 2021-09-27

Causes of primary tooth avulsion and replantation treatment

Ameera Ibrahim Amer, Balges Mohammad Alrowili, Raghad Naif Aljohani, Mona Dabshi Alanazi, Basmah Mustafa Ageel, Rawan Hussein Alhasawi, Iradah Abas Alsbban, Haifa Saeed Alanazi, Sultan Ali Alrashdi, Reem Ibrahim Alkhateeb, Rand Baher Aldamanhori


During primary dentition, the etiology changes by age group. For instance, traumas secondary to collisions and falls are attributable to early movement within the first six years, while accidents secondary to frequent playing are the main reason within the following nine years, and violence is the most common etiology until the age of 25 years old. Previous studies have estimated that traumas from falls, sporting activities, bicycling, traffic accidents, and violence were the most common causes of dental injuries in children. Iatrogenic causes also contribute to 0.04-12% of dental injuries, including avulsions. According to the current evidence, whether to use reimplantation or not is still controversial and further investigations are needed. Among the various case reports, damage to the permanent successors, root resorption, clot formation, and pulp necrosis were documented as potential complications and adverse events with intended reimplantation. However, many techniques were reported to overcome these problems. Besides, favorable outcomes following reimplantation could be hypothetically obtained as sound articulation, proper mastication, and proper dentition. Therefore, this encourages reimplantation, however, further evidence is still needed to validate the proposed advantages and disadvantages of the approach.


Dentistry, Avulsions, Dental trauma, Etiology, Reimplantation

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Borum MK, Andreasen JO. Sequelae of trauma to primary maxillary incisors. I. Complications in the primary dentition. Endodontics & dental traumatology. 1998;14(1):31-44.

Kenwood M, Seow WK. Sequelae of trauma to the primary dentition. The Journal of pedodontics. 1989;13(3):230-8.

Ravn JJ. Sequelae of acute mechanical traumata in the primary dentition. A clinical study. ASDC journal of dentistry for children. 1968;35(4):281-9.

Soporowski NJ, Allred EN, Needleman HL. Luxation injuries of primary anterior teeth--prognosis and related correlates. Pediatric dentistry. 1994;16(2):96-101.

Guideline on management of acute dental trauma. Pediatric dentistry. 2008;30(7):175-83.

de Carvalho Rocha MJ, Cardoso M. Reimplantation of primary tooth--case report. Dental traumatology : official publication of International Association for Dental Traumatology. 2008;24(4):e4-10.

Onetto JE, Flores MT, Garbarino ML. Dental trauma in children and adolescents in Valparaiso, Chile. Endodontics & dental traumatology. 1994;10(5):223-7.

Kinoshita S, Mitomi T, Taguchi Y, Noda T. Prognosis of replanted primary incisors after injuries. Endodontics & dental traumatology. 2000;16(4):175-83.

Hashan MR, Ghozy S, El-Qushayri AE, Pial RH, Hossain MA, Al Kibria GM. Association of dengue disease severity and blood group: A systematic review and meta-analysis. Rev Med Virol. 2021;31(1):1-9.

El-Qushayri AE, Ghozy S, Abbas AS. Hyperimmunoglobulin therapy for the prevention and treatment of congenital cytomegalovirus: a systematic review and meta-analysis. Expert Rev Anti Infect Ther. 2020:1-9.

Lam R, Abbott P, Lloyd C, Lloyd C, Kruger E, Tennant M. Dental trauma in an Australian rural centre. Dental traumatology: official publication of International Association for Dental Traumatology. 2008;24(6):663-70.

Díaz JA, Bustos L, Brandt AC, Fernández BE. Dental injuries among children and adolescents aged 1-15 years attending to public hospital in Temuco, Chile. Dental traumatol. 2010;26(3):254-61.

Faus-Damiá M, Alegre-Domingo T, Faus-Matoses I, Faus-Matoses V, Faus-Llácer VJ. Traumatic dental injuries among schoolchildren in Valencia, Spain. Medicina oral, patologia oral y cirugia bucal. 2011;16(2):e292-5.

Taiwo OO, Jalo HP. Dental injuries in 12-year old Nigerian students. Dental traumatology: official publication of International Association for Dental Traumatology. 2011;27(3):230-4.

Chapman HR, Curran AL. Bicycle helmets--does the dental profession have a role in promoting their use? British dental journal. 2004;196(9):555-60.

Chadwick RG, Lindsay SM. Dental injuries during general anaesthesia. British dental journal. 1996;180(7):255-8.

Chadwick RG, Lindsay SM. Dental injuries during general anaesthesia: can the dentist help the anaesthetist? Dental update. 1998;25(2):76-8.

Malikaew P, Watt RG, Sheiham A. Prevalence and factors associated with traumatic dental injuries (TDI) to anterior teeth of 11-13 year old Thai children. Community dental health. 2006;23(4):222-7.

Piovesan C, Guedes RS, Casagrande L, Ardenghi TM. Socioeconomic and clinical factors associated with traumatic dental injuries in Brazilian preschool children. Brazilian oral research. 2012;26(5):464-70.

Sgan-Cohen HD, Yassin H, Livny A. Dental trauma among 5th and 6th grade Arab schoolchildren in Eastern Jerusalem. Dental traumatol. 2008;24(4):458-61.

Zaleckiene V, Peciuliene V, Brukiene V, Drukteinis S. Traumatic dental injuries: etiology, prevalence and possible outcomes. Stomatologija. 2014;16(1):7-14.

Steelman R, Holmes D, Byron M, Cupp D. Traumatic avulsion of the mandibular right primary lateral incisor and cuspid. The Journal of clinical pediatric dentistry. 1991;15(4):249-50.

Crabb JJ, Crabb VP. Reimplantation of a primary central incisor: a case report. The Dental practitioner and dental record. 1971;21(10):353-4.

Malmgren B, Andreasen JO, Flores MT. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 3. Injuries in the primary dentition. Dental traumatol. 2012;28(3):174-82.

Huber CT. Resin-bonded retainer for replacement of an avulsed primary incisor: a case report. Quintessence international. 1997;28(5):337-9.

Bassiouny MA, Giannini P, Deem L. Permanent incisors traumatized through predecessors: sequelae and possible management. The Journal of clinical pediatric dentistry. 2003;27(3):223-8.

Christophersen P, Freund M, Harild L. Avulsion of primary teeth and sequelae on the permanent successors. Dental traumatol. 2005;21(6):320-3.

Gatewood JC, Thornton JB. Successful replantation and splinting of a maxillary segment fracture in the primary dentition. Pediatric dentistry. 1995;17(2):124-6.

Andreasen J, Andreasen F, Andersson L. Textbook and Color Atlas of Traumatic Injuries to the Teeth. 1994.

Cardoso M, Rocha MJ. Federal University of Santa Catarina follow-up management routine for traumatized primary teeth -- part 1. Dental traumatology: official publication of International Association for Dental Traumatology. 2004;20(6):307-13.

Rocha MJ, Cardoso M. Federal University of Santa Catarina endodontic treatment of traumatized primary teeth - part 2. Dental traumatology : official publication of International Association for Dental Traumatology. 2004;20(6):314-26.

Filippi A, Pohl Y, Kirschner H. Replantation of avulsed primary anterior teeth: treatment and limitations. ASDC journal of dentistry for children. 1997;64(4):272-5.

Eisenberg MD. Reimplantation of a deciduous tooth. Oral surgery, oral medicine, and oral pathology. 1965;19:588-90.

Weiger R, Heuchert T. Management of an avulsed primary incisor. Endodontics & dental traumatology. 1999;15(3):138-43.

Acharya S. Avulsion and replantation of primary teeth-a viable option. 2017.

Friedlander LT, Chandler NP, Drummond BK. Avulsion and replantation of a primary incisor tooth. Dental traumatol. 2013;29(6):494-7.

Kalia G, Tandon S, Bhupali NR, Rathore A, Mathur R, Rathore K. Speech evaluation in children with missing anterior teeth and after prosthetic rehabilitation with fixed functional space maintainer. Journal of the Indian Society of Pedodontics and Preventive Dentistry. 2018;36(4):391-5.

Holan G, Needleman HL. Premature loss of primary anterior teeth due to trauma--potential short- and long-term sequelae. Dental traumatol. 2014;30(2):100-6.

Moss SJ, Maccaro H. Examination, evaluation and behavior management following injury to primary incisors. The New York state dental journal. 1985;51(2):87-92.

Fried I, Erickson P. Anterior tooth trauma in the primary dentition: incidence, classification, treatment methods, and sequelae: a review of the literature. ASDC journal of dentistry for children. 1995;62(4):256-61.

Zamon EL, Kenny DJ. Replantation of avulsed primary incisors: a risk benefit assessment. Journal Canadian Dental Association. 2001;67(7):386.

Andreasen JO. Relationship between surface and inflammatory resorption and changes in the pulp after replantation of permanent incisors in monkeys. Journal of endodontics. 1981;7(7):294-301.

Cully JL, Zeeb K, Sahay RD, Gosnell E, Morris H, Thikkurissy S. Prevalence of Primary Teeth Injuries Presenting to a Pediatric Emergency Department. Pediatric dentistry. 2019;41(2):136-9.

Levine N. Injury to the primary dentition. Dental clinics of North America. 1982;26(3):461-80.

Jones J, Spolnik K, Yassen G. Management of Trauma to the Teeth and Supporting Tissues. 2015:563-602.

Kawashima Z, Pineda FR. Replanting avulsed primary teeth. Journal of the American Dental Association. 1992;123(10):90-1.

Mopagar VP, Phadnis MV, Joshi SR, Shetty V, Pendyala GS. Avulsion and Replantation in Primary Dentition--A Review. Journal of Evolution of Medical and Dental Sciences. 2021;10(9):619-24.

Tucker L, Adewumi AO. Dental Avulsion Management. In: Atlas of Emergency Medicine Procedures. Ganti L, ed. Springer New York. 2016;381-5.