Cochrane · intervention · CD006542
Interventions for treating traumatised permanent front teeth: avulsed (knocked out) and replanted
Day, PF, Duggal, M, Nazzal, H · Cochrane Database of Systematic Reviews · 2019 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
18
current version
GRADE rated
10
No studies
3
Included studies
4
as reported
No studies 3 · 16.7%Ungraded 5 · 27.8%Very low 10 · 55.6%Low 0 · 0%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Patients attending a dental clinic with tooth avulsion involving one or more permanent front teeth (permanent dentition); excludes avulsed primary teeth and patients whose medical history contraindicates replantation | People with avulsed and replanted permanent front teeth; children and young adults (n=4 studies; 183 participants, 257 teeth) |
| Intervention | Treatment with antibiotics; Timing of pulp extirpation; Type of root canal medicament; Replantation procedures (handling prior to replantation); Storage of the tooth prior to replantation; Fixation and stabilisation (splinting); Care following replantation (mouthwashes/mouthcare) | Extra-oral pulp extirpation at day 0 (n=1); Ledermix root canal medicament day 0 to 10 (n=1); Thymosin alpha 1 10-minute soak (n=1); Hyperbaric oxygen (n=1) |
| Comparison | No antibiotics/placebo/different antibiotics; Immediate/delayed/no extirpation; No medicament/placebo/different medicaments; Different replantation techniques; Different storage mediums/dry storage; Different splints/no splint/different splinting duration; No mouthwash/placebo/different care | Intra-oral pulp extirpation at day 7 (n=1); Ultracal root canal medicament day 7 to 10 (n=1); Saline control (n=1); Control (n=1) |
| Outcomes | Primary: Periodontal ligament healing (may include proxy outcomes such as extent of radiographic root resorption). Secondary: Tooth survival; Pulpal healing; Pain; Aesthetics (discolouration); Oral health-related quality of life; Trauma-related dental anxiety; Infraocclusion; Cost; Other complications or adverse effects | Periodontal healing (n=3); Tooth survival (n=3); Pulpal healing (n=1); Radiographic resorption proxy (n=1); Discolouration (n=1); Pain (n=1); Adverse effects (n=4, none identified) |
| Study designs | Randomised and quasi-randomised controlled trials with minimum 12 months follow-up | RCT/quasi-RCT (n=4; alternation or quasi-random sequence in 2) |
| Timing | Minimum 12 months follow-up | 12 months (n=3); 48 months (n=1) |
Search date: 2018-03. Databases: Cochrane Oral Health's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE Ovid; Embase Ovid; ClinicalTrials.gov; WHO International Clinical Trials Registry Platform (ICTRP)
Questions and results
Current version onlyTreatment with antibiotics vs No antibiotics, placebo, or different types of antibiotics
Population: People with avulsed and replanted permanent (front) teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | no estimate extracted | 0 studies | No studies |
Extra-oral pulp extirpation at day 0 vs Intra-oral pulp extirpation at day 7
Population: People with avulsed and replanted permanent (front) teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse effects | Giannetti 2006 did not report this outcome; following email correspondence, authors reported no adverse effects were seen (uncertain whether formally assessed). | 1 study | Ungraded |
Radiographic resorption (proxy measure for periodontal healing) at 12 months 12 months | RR 1.35 [0.81, 2.24] 333 per 1000 vs 450 per 1000 | 1 study · 19 participants | Very low Downgraded: risk of bias, imprecision |
Ledermix root canal medicament (day 0 to 10) vs Ultracal root canal medicament (day 7 to 10)
Population: People with avulsed and replanted permanent (front) teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Tooth survival at 12 months 12 months | Tooth survival at 12 months: Not estimable (due to no events in either arm); 27 teeth in 22 patients (1 RCT). At 12 months, no teeth were lost. 1 tooth was lost at 16 months in the Ultracal group. | 1 study · 22 participants | Very low Downgraded: risk of bias, imprecision |
Adverse effects | Day 2012 used a formal methodology to identify and report adverse effects, with none identified. | 1 study · 22 participants | Ungraded |
Aesthetics (discolouration) at 12 months (patient level) 12 months | RR 7.20 [1.03, 50.28] 83 per 1000 vs 600 per 1000 | 1 study · 22 participants | Very low Downgraded: risk of bias, imprecision |
Periodontal healing at 12 months (tooth level) 12 months | RR 1.67 [0.80, 3.49] 400 per 1000 vs 668 per 1000 | 1 study · 22 participants | Very low Downgraded: risk of bias, imprecision |
Thymosin alpha 1 (10-minute soak prior to replantation) vs Control (saline)
Population: People with avulsed and replanted permanent (front) teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Tooth survival at 12 months 12 months | RR 1.46 [1.11, 1.91] 655 per 1000 vs 957 per 1000 | 1 study · 73 participants | Very low Downgraded: risk of bias, imprecision |
Pain day 1 | A benefit in pain scores was reported on day 1 in favour of the thymosin alpha 1 group; no difference found on days 2 and 5. | 1 study · 73 participants | Ungraded |
Adverse effects | Loo 2008 did not report this outcome; following email correspondence, authors reported no adverse effects were seen (uncertain whether formally assessed). | 1 study | Ungraded |
Periodontal healing at 48 months 48 months | RR 5.60 [2.22, 14.11] 138 per 1000 vs 772 per 1000 | 1 study · 73 participants | Very low Downgraded: risk of bias, imprecision |
Tooth survival at 48 months 48 months | RR 3.58 [1.86, 6.89] 241 per 1000 vs 864 per 1000 | 1 study · 73 participants | Very low Downgraded: risk of bias, imprecision |
Storage of the tooth prior to replantation (storage medium) vs Different storage medium or dry storage
Population: People with avulsed and replanted permanent (front) teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | no estimate extracted | 0 studies | No studies |
Fixation and stabilisation (splint type/duration) vs Different splint, no splint, or different splinting duration
Population: People with avulsed and replanted permanent (front) teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | no estimate extracted | 0 studies | No studies |
Hyperbaric oxygen (following replantation) vs Control
Population: People with avulsed and replanted permanent (front) teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse effects | Chen 2000 did not report this outcome; following email correspondence, authors reported no adverse effects were seen (uncertain whether formally assessed). | 1 study | Ungraded |
Tooth survival at 12 months 12 months | RR 1.21 [1.07, 1.36] 815 per 1000 vs 987 per 1000 | 1 study · 69 participants | Very low Downgraded: risk of bias, imprecision |
Periodontal healing at 12 months 12 months | RR 2.04 [1.52, 2.73] 431 per 1000 vs 879 per 1000 | 1 study · 69 participants | Very low Downgraded: risk of bias, imprecision |
Pulpal healing at 12 months 12 months | RR 1.25 [1.06, 1.48] 723 per 1000 vs 904 per 1000 | 1 study · 69 participants | Very low Downgraded: risk of bias, imprecision |
Treatment with antibiotics vs No antibiotics, placebo, or different types of antibiotics
Population: Children and young adults with avulsed and replanted permanent teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | no estimate extracted | 0 studies | No studies |
Extra-oral pulp extirpation at day 0 vs Intra-oral pulp extirpation at week 1
Population: Children and young adults with avulsed and replanted permanent teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Radiographic resorption at 12 months (tooth survival measure) 12 months | RR 0.30 [0.04, 2.39] | 1 study · 19 participants | Ungraded |
Adverse effects | None of the three studies formally reported adverse effects; on questioning, authors reported no adverse effects were seen (uncertain whether formally assessed). | 1 study | Ungraded |
Root canal medicament vs No medicament, placebo, or different medicaments
Population: Children and young adults with avulsed and replanted permanent teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | no estimate extracted | 0 studies | No studies |
Thymosin alpha 1 (10-minute soak prior to replantation) vs Saline (control)
Population: Children and young adults with avulsed and replanted permanent teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain day 1 | The thymosin group demonstrated a statistically significant decrease in pain score on day 1 compared with control (Spearman's correlation, P = 0.009). | 1 study · 73 participants | Ungraded |
Tooth survival at 48 months (as reported) 48 months | RR 3.58 [1.86, 6.89] | 1 study · 73 participants | Ungraded |
Adverse effects | None of the three studies formally reported adverse effects; on questioning, authors reported no adverse effects were seen (uncertain whether formally assessed). | 1 study | Ungraded |
Periodontal healing at 48 months (as reported) 48 months | RR 5.60 [2.22, 14.11] | 1 study · 73 participants | Ungraded |
Storage of the tooth prior to replantation (storage medium) vs Different storage medium or dry storage
Population: Children and young adults with avulsed and replanted permanent teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | no estimate extracted | 0 studies | No studies |
Fixation and stabilisation (splint type/duration) vs Different splint, no splint, or different splinting duration
Population: Children and young adults with avulsed and replanted permanent teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | no estimate extracted | 0 studies | No studies |
Hyperbaric oxygen (following replantation) vs Control
Population: Children and young adults with avulsed and replanted permanent teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse effects | None of the three studies formally reported adverse effects; on questioning, authors reported no adverse effects were seen (uncertain whether formally assessed). | 1 study | Ungraded |
Periodontal healing at 12 months (as reported) 12 months | RR 2.04 [1.52, 2.73] | 1 study · 69 participants | Ungraded |
Pulp survival at 12 months (as reported) 12 months | RR 1.25 [1.06, 1.48] | 1 study · 69 participants | Ungraded |
Tooth survival at 12 months (as reported) 12 months | RR 1.21 [1.07, 1.36] | 1 study · 69 participants | Ungraded |
Treatment with antibiotics vs No antibiotics, placebo, or different types of antibiotics
Population: Patients attending a dental clinic with tooth avulsion involving one or more permanent front teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | no estimate extracted | 0 studies | No studies |
Immediate pulp extirpation (extra-oral or intra-oral) vs Delayed or no pulp extirpation
Population: Patients attending a dental clinic with tooth avulsion involving one or more permanent front teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | no estimate extracted | 0 studies | No studies |
Root canal medicament vs No medicament, placebo, or different medicaments
Population: Patients attending a dental clinic with tooth avulsion involving one or more permanent front teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | no estimate extracted | 0 studies | No studies |
Replantation procedure (technique/handling prior to replantation) vs Different replantation technique or protocol
Population: Patients attending a dental clinic with tooth avulsion involving one or more permanent front teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | no estimate extracted | 0 studies | No studies |
Storage of the tooth prior to replantation (storage medium) vs Different storage medium or dry storage
Population: Patients attending a dental clinic with tooth avulsion involving one or more permanent front teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | no estimate extracted | 0 studies | No studies |
Fixation and stabilisation (splint type/duration) vs Different splint, no splint, or different splinting duration
Population: Patients attending a dental clinic with tooth avulsion involving one or more permanent front teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | no estimate extracted | 0 studies | No studies |
Care following replantation (chlorhexidine mouthwash / mouthcare protocol) vs No mouthwash, placebo, or different care protocol
Population: Patients attending a dental clinic with tooth avulsion involving one or more permanent front teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | no estimate extracted | 0 studies | No studies |