Review on storage and transportation process of avulsed permanent tooth before re-plantation

Avulsion of permanent tooth can be successfully re-plantation if it properly handle and transported in easily available media at the accidental site. After reviewing the whole literature it can be concluded that avulsed tooth should be hold from the crown and gentally wash in a running tap water to preserve the periondal ligament cells. Put the washed avulsed tooth in the mouth to protect the cells of periodontal ligament because saliva is a natural preservative media. The running tap water and saliva is easily available at the trauma site. The preservation of avulsed tooth for longer duration can be done in various preservatives in the hospital before planned re-plantation. Immediate re-plantation of avulsed permanent tooth is generally accepted as treatment of choice, which may successfully restore the aesthetics and functional value of the tooth (Venkataramana et al., 2015). The prognosis of an avulsed tooth is essentially dependent on its extra-alveolar time, transfer media and the procedures performed at the time of re-implantation. In cases where these factors are unfavorable, pulp necrosis and degeneration of periodontal ligament (PDL) cells may ensue, resulting in inflammatory/replacement root resorption or ankylosis of the tooth, eventually leading to tooth loss (Andersson and Andreasen, 2012; Soares et al., 2008). Immediate replantation is the treatment of choice for an avulsed permanent tooth, although it is not always possible to perform this treatment. Replantation success depends on the maintenance of PDL cell vitality (Pileggi et al., 2002). Re-plantation of the avulsed tooth may be a promising treatment modality and can be achieved at a lower cost with higher success rate, if the people involved in the process have a sound knowledge about the various aspects of avulsed tooth re-implantation. If a tooth is maintained in a dry environment prior to re-implantation, irreversible damage to PDL cells can cause an inflammatory response on the root surface, which leads to ankylosis and eventual tooth loss. Hank’s Balanced Salt Solution (HBSS), a tissue culture medium is recommended as the best storage medium for avulsed permanent tooth in order to maintain the viability and enabling in multiplication of the periodontal ligament cells. If HBSS is not available then cold milk, the patient’s saliva and water can be used as a storage medium (American Association of Endodontics, 1995; Krasner and Person, 1992). Sigalas et al. (2004) reported that HBSS ( tissue culture medium) was found to be superior among other storage media such as eye contact lens solution, water, milk and ice in maintaining the viability of PDL cells up to one hour. It is also observed that water had a most detrimental effect on PDL cells. Two percent milk preserved more viable cells than contact lens solution.