Late re-implantation (48 hours) of an avulsed upper central incisor to preserve function, esthetics and alveolar bone for eleven years

Aim: To describe the clinical management of a tooth re-implanted late to maintain functionality, esthetics and alveolar bone preservation.

Summary: A healthy 11-year-old female patient presented 48 hours after avulsion of the left upper central incisor, which was carried in a paper napkin. The tooth was rinsed with physiological solution, conditioned with sodium fluoride and root canal treatment was performed extra-orally. The tooth was immersed in distilled water mixed with MTA, the blood clot was removed from the socket and the tooth was re-implanted and splinted. The patient was prescribed antibiotics, analgesics and a tetanus vaccination. After 8 days, the patient was asymptomatic with no mobility and mild gingival inflammation. The splint was removed 2 months later. At 8 months, resorption by substitution began and was followed for 1 to 7 years, at which time resorption by substitution occupied approximately 95% of the root, but without mobility. After 11 years of re-implantation, the remains of the crown and the gutta-percha were removed from the alveolus. The re-implanted tooth served to preserve the bone without the need for bone grafting, as alveolar bone was formed as the tooth resorbed.

Key Learning points:

-The avulsed and re-implanted tooth, even late, maintains masticatory function and prevents psychological distress for the patient.

-Late re-implantation of the avulsed tooth allows alveolar preservation with functional bone and provides better support for the placement of an osseointegrated implant.