Surgical replantation and immobilization of teeth

Replantation and temporary splinting are common post-traumatic procedures in oral surgery and form part of an emergency protocol aimed at preserving natural tissues and minimizing the need for extraction and immediate prosthetic restorations.

Indications

• • Acute trauma with complete avulsion of a permanent tooth in a patient where rapid restoration of the tooth to the socket is possible; the shorter the time spent outside the oral cavity and the better the storage medium (e.g., milk, saline), the higher the chance of success.
  • Absence of extensive root fractures or cracks that prevent stable immobilization, and no general contraindications for an emergency procedure.

Procedure stages

• • Immediate injury assessment and radiological diagnostics, gentle cleaning of the tooth and socket without damaging the periodontal ligament, atraumatic replantation, and positioning the tooth in the correct alignment.
  • Temporary immobilization with a flexible splint to adjacent teeth (usually 1–2 weeks, longer in the case of concurrent alveolar process fractures), healing monitoring, and implementation of anti-infective prophylaxis as indicated.

Tooth immobilization (splinting)

• • Flexible composite-wire splints or fibers are used to stabilize the tooth while allowing for physiological micro-movements that promote periodontal ligament remodeling.
  • The splinting period depends on the type of injury: shortest for avulsion without fractures, longer for root or alveolar bone fractures; regular follow-up visits are essential.

Endodontic treatment after replantation

• • Teeth with mature apices usually require root canal treatment shortly after replantation to prevent inflammatory resorption; in teeth with immature apices, monitoring for recanalization and revascularization is possible.
  • Radiological monitoring evaluates resorption and periapical tissue healing, while potential retrograde treatment is considered if signs of chronic inflammation are present.

Factors affecting prognosis

• • The time from avulsion to replantation, the tooth storage method, periodontal integrity, and stable yet flexible immobilization are critical for the success rate and for limiting external resorption.
  • Hygiene, a soft diet in the first few days, and adherence to post-treatment recommendations reduce the risk of infection and complications.