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Medical Forum / General / Dentistry / June 2007

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Reset avulsed teeth - Need root canals?

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raffo - 13 Jun 2007 09:48 GMT
I got in an accident where by top two front teeth (central incisors)
got avulsed. They were not knocked out of my mouth, but they were in
pretty bad shape, crooked, and almost out of their sockets...

I went to the emergency room within an hour of the incident and they
were set back in my sockets, although one of them was not completely
set back, and I could not bite down normally.

The next morning I went to my dentist, and he splinted them, and set
them in better... Now, a month later, my dentist is urging me to have
root canals on both teeth, despite the fact that they look fine.

My dentist says that resorption will occur if I do not get root canals
done, and that the roots of my teeth will rot away, and my teeth will
subsequently become loose and fall out.

I was hoping that perhaps my nerves and blood vessels would reattach
themselves to the teeth.... I didn't exactly understand the concept of
resorption. I asked my dentist but he seemed to become impatient with
my questions.

If my nerves and blood vessels in the roots of my teeth disolve away,
what's the big deal? Then my teeth would presumably become discolored,
and then I would know for sure that I need a root canal.

What exactly is resorption, why is it bad, and how would a root canal
stop it from happening?

Thank you,
Amatus Cremona - 13 Jun 2007 12:29 GMT
I think resorption is a risk whether or not RCT is done.  However, if the
vitality of the teeth has been compromised, you NEED the RCT's to get rid of
the dead tissue.  Remember that a tooth is filled with soft connective
tissue in its pulp chamber.  If the blood supply to that pulp tissue is
interrupted, that soft tissue dies and undergoes a gangrene process.  It
must be removed.

A simple pulp vitality test will let the dentist know if your pulp tissue
has survived this incident (based on your description, I would be very
surprised if the pulp tissue is still vital--unless you are a teenager).

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Amatus

/

>I got in an accident where by top two front teeth (central incisors)
> got avulsed. They were not knocked out of my mouth, but they were in
[quoted text clipped - 25 lines]
>
> Thank you,
Dartos - 13 Jun 2007 14:23 GMT
Thinking back over the last 29 years of dental practice, I can't
remember any teeth that were displaced in the socket healing up
fine on anyone.  Often a single sharp blow (without displacement)
is enough to cause pulpal death.

Root resorption simply means that the tooth root itself starts to
dissolve.  If enough root is lost, the tooth loosens and cannot
be saved.

AC is correct in his response.  There are no guarantees about
keeping these teeth the rest of your life, but the endo is
necessary 99% of the time.

D

> What exactly is resorption, why is it bad, and how would a root canal
> stop it from happening?
>
> Thank you,
Newbie - 13 Jun 2007 21:20 GMT
>Thinking back over the last 29 years of dental practice, I can't
>remember any teeth that were displaced in the socket healing up
>fine on anyone.  Often a single sharp blow (without displacement)
>is enough to cause pulpal death.

Had one young girl ~12 who was hit in #10 with a putter by her
little brother by accident. Partial avultion. Splinted immediately and
did endo at 6 weeks. Direct bonded til pt was old enough for
a perm crown.
Still functional over a decade later.

>Root resorption simply means that the tooth root itself starts to
>dissolve.  If enough root is lost, the tooth loosens and cannot
>be saved.

External resorption can *almost never* be sucessfully treated.

Internal resorption can *sometimes* be sucessfully treated.
6 mos to 2 yrs CaOH may stop internal resorption.

On time endo can prevent resorption.

>AC is correct in his response.  There are no guarantees about
>keeping these teeth the rest of your life, but the endo is
>necessary 99% of the time.

Amen.

>D
>
>> What exactly is resorption, why is it bad, and how would a root canal
>> stop it from happening?
>>
>> Thank you,
raffo - 13 Jun 2007 22:18 GMT
> >Thinking back over the last 29 years of dental practice, I can't
> >remember any teeth that were displaced in the socket healing up
[quoted text clipped - 30 lines]
>
> >> Thank you,

Is it not possible for the artery and nerve endings to reattach after
being severed? I thought that nerves can grow back when treated with
stimuling. I'm always eating food and using my front teeth to bite
into soft foods. This gives the nerves stimuli, or at least I hope it
does. Also, when I touch my teeth with a pen, I do feel some
sensation. But perhaps this is just the other end of the nerve that
got severed reacting to the tapping of my tooth.... I suppose I do
need root canals after all... But I'm Glad to hear somebody say it
usually should happen after 6 weeks. My dentist told me I should have
gone to see him 2 weeks after the splinting for the root canals. But
it has now been a month. Well, if 6 weeks is okay, then I'm in good
shape. Thanks everybody for your replys, you've made everything
clearer for me, and now I can go and get root canals and be sure that
that's what I really need.

Thanks
Steven Fawks - 14 Jun 2007 02:02 GMT
About as much as me becoming president.

;-)
Steve

> Is it not possible for the artery and nerve endings to reattach after
> being severed?
> Thanks
Amatus Cremona - 17 Jun 2007 12:17 GMT
I cannot even run for President :(

> About as much as me becoming president.
>
[quoted text clipped - 3 lines]
>> Is it not possible for the artery and nerve endings to reattach after
>> being severed? Thanks
Steven Fawks - 17 Jun 2007 13:45 GMT
Neither can Arnold.  Don't feel too bad.

;-)
Steve

> I cannot even run for President :(
>
[quoted text clipped - 5 lines]
>>>Is it not possible for the artery and nerve endings to reattach after
>>>being severed? Thanks
George - 14 Jun 2007 18:27 GMT
A tooth that hasn't fully developed and has an open apex has a chance
to get a new blood supply. A fully developed tooth like yours has
virtually no chance of that happening.

Regards,
George
John Keiser - 13 Jun 2007 19:02 GMT
Just curious, being that RCT is needed 99% of the time, would it not be much
more convenient to do the RCT before the tooth is replaced?  Or is time to
critical?

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Newbie - 13 Jun 2007 19:46 GMT
>Just curious, being that RCT is needed 99% of the time, would it not be much
>more convenient to do the RCT before the tooth is replaced?  Or is time to
>critical?

Huh ?

Do you mean before the avulsed tooth is re-planted ?

If so the answer is a resounding NO !

The bone and periodontal ligament must first heal to stabilize
the tooth. Then RCT is done at about 6 weeks.

Resorption is a very real concern, lost one of my teeth (#9)
due to resorption even after endodontic retreatment and surgery.
Dartos - 13 Jun 2007 19:48 GMT
Time is critical to having the bone, periodontal tissues, and tooth
reattach to each other.  The less handling/contamination of the root
surface, the better.

Replace/splint/recovery and then endo is the usual progression.

JME,
D

> Just curious, being that RCT is needed 99% of the time, would it not be much
> more convenient to do the RCT before the tooth is replaced?  Or is time to
> critical?
 
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