What is the treatment for avulsion injuries?

Treatment of Avulsion Injuries

For avulsion injuries, immediate reimplantation of the avulsed tissue or tooth is the most critical intervention to maximize survival and minimize complications. 1, 2

Dental Avulsion Treatment

Immediate Actions

• When a permanent tooth is avulsed, remove visible debris by brief rinsing (<10 seconds), taking care not to damage the tooth or attached tissue, and attempt to replant the tooth in its socket immediately 1
• If immediate reimplantation is not possible, proper storage of the tooth is crucial to preserve periodontal ligament cell viability 1, 2
• The patient should seek dental or medical care immediately, bringing the tooth if not successfully replanted 1

Storage Media for Avulsed Teeth (in order of preference)

1. First choice: Hanks Balanced Salt Solution, oral rehydration salt solutions, propolis, rice water, or wrap in cling film 1
2. Second choice: Cow's milk or patient's saliva 1, 2
3. Third choice: Probiotic, egg white, or almond milk 1
4. Never use: Tap water (damages periodontal ligament cells) 1, 2

Professional Dental Treatment

• Stabilization with flexible splint for 2 weeks 2
• Root canal treatment within 7-10 days after reimplantation 2
• Systemic antibiotics (doxycycline, penicillin, or clindamicina) 2
• Regular monitoring for complications such as necrosis pulpar, root resorption, or ankylosis 2

Special Considerations

• Primary (baby) teeth should NOT be reimplanted to avoid damage to the permanent tooth bud 2
• In children under 5 years with severe dental trauma, consider child abuse as a possible cause 2

Soft Tissue Avulsion Injuries

Standard Avulsion Injuries

• Remove avulsed tissue and replace it as a full-thickness skin graft 3
• Additional meshed split-thickness skin grafts may be needed for complete soft-tissue coverage 3
• Treat accompanying fractures appropriately 3

Plantar Avulsions

• Revascularization of the plantar surface should be performed when possible 3
• Similar to digital amputations and major scalp avulsion injuries, replantation is worthwhile 3
• Free tissue transfer may be necessary for complete soft-tissue coverage around the ankle 3

Atypical Avulsion Injuries

• These injuries occur from shearing forces (commonly from heavy vehicles) and cause extensive undermining of tissues despite normal-appearing external surface 3
• Quantitative dermofluorometry can assess viability of undermined skin and subcutaneous tissue 3
• Viable undermined areas require early limited debridement of the undersurface to remove necrotic fascia and fat 3

Ring Avulsion Injuries

• Treatment depends on injury severity (commonly classified using Urbaniak system) 4
• Class I (circulation intact) and Class II (arterial flow compromised) injuries have better outcomes with microsurgical revascularization 4
• Select Class III injuries (complete amputation) can be treated with replantation in appropriate cases 4
• Shared decision-making with patients is essential when considering replantation for severe injuries 4

Monitoring and Complications

• Regular follow-up is essential to detect potential complications early 2, 5
• Possible complications include necrosis, resorption, ankylosis, tooth loss, gingival abscess, infection, and functional deficits 2, 5
• Children with avulsion injuries have increased risk of developing functional deficits as scars and reconstructed tissues may not adapt sufficiently during growth 5