Timing of pulp extirpation for replanted avulsed teeth.

DATA SOURCES: A search was performed (April 2004) across four databases, namely Ovid Medline, Cochrane Library, PubMed and Web of Science, relevant to the proposed PICO ( Patient or problem, Intervention, Comparison, Outcome) question: (P) for a replanted avulsed permanent tooth, (I) is early pulp extirpation within 10-14 days of replantation, (C) compared with delayed pulp extirpation, (O) associated an increased likelihood of successful periodontal healing after tooth replantation. Only articles published in the English language were considered.

STUDY SELECTION: Relevant titles were selected for abstract assessment (N = 628), and then 84 papers were selected for examination.

DATA EXTRACTION AND SYNTHESIS: A quality assessment was made of relevant publications: only six papers met the inclusion criteria (making a total of 236 teeth).

RESULTS

Meta-analyses found a statistically significant association between pulp extirpation performed after 14 days and the development of inflammatory resorption. Pulp extirpation within 10 days of replantation was not significantly associated with a decreased likelihood of developing inflammatory resorption. There is no significant difference in pulp extirpation times for functional healing, acceptable healing without progressive resorption, or the development of replacement resorption.

CONCLUSIONS

There is clinical evidence for an association between pulp extirpation performed after 14 days following replantation and the development of inflammatory resorption. This investigation supports the current clinical guidelines for pulp extirpation within 10-14 days of replantation.