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


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.


CONCLUSIONS
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.
Hinckfuss
Susan Elisabeth
SE
Paediatric Dentistry, School of Dental Science, University of Melbourne, Melbourne, Australia.
Messer
Louise Brearley
LB
D055094:Evidence-Based Dentistry; D006801:Humans; D010513:Periodontal Ligament / Q000502:physiology; D017410:Practice Guidelines as Topic / Q000592:standards*; D011670:Pulpectomy; D012038:Regeneration; D012391:Root Resorption / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D014084:Tooth Avulsion / Q000150:complications / Q000601:surgery*; D014090:Tooth Replantation / Q000592:standards*