Why the first minutes decide
A knocked-out permanent tooth (in dental medicine: avulsion) is the emergency situation in dentistry in which time works most immediately against you. The key to successful replantation is the vitality of the desmodontal cells, the microscopically fine connective tissue cells that cover the root surface. These cells need a moist, isotonic environment to survive.
In a dry environment, desmodontal cells die within 15 to 30 minutes. In a tooth rescue box they survive up to 48 hours. In milk at least six to eight hours. These numbers are not theory, they directly determine whether the tooth heals in without irritation after replantation, or whether it resorbs as a root after months.
What happens at the treatment chair
When you arrive with us, treatment runs in a fixed sequence. First, focused inspection of the tooth socket and the tooth itself. Fractures at the root end or at the alveolar bone can prevent replantation and then require a different strategy.
Second, cleaning of the tooth socket and if necessary of the tooth with sterile saline solution, without mechanical friction. Third, the replantation itself, usually without major local anesthesia, because pain perception in the empty alveolus is reduced.
Fourth, splinting of the replanted tooth to the neighboring teeth with a flexible wire-composite splint for seven to fourteen days. This splint allows physiological micro-movement that is important for healing.
Fifth, in the same session or after a few days, the decision about root canal treatment. With completed root growth (adults), the root canal treatment is almost always indicated, because the pulp usually becomes necrotic after avulsion. In children with still open root tip, we wait and observe because the pulp sometimes still revascularizes.
Milk tooth knocked out
For children and milk teeth a different rule applies. Knocked-out milk teeth are usually not replanted because there is a risk that replantation damages the underlying permanent tooth germ. Still bring your child to the practice. We check findings, inform you, and observe the subsequent development of the permanent tooth over the next months.
Insurance note
Dental injuries from falls, sports, impact or traffic accidents are in Switzerland always accident events and fall under accident insurance, not under health insurance. Note date, time, place and course immediately. For school children, the school insurance is the first point of contact. For employees, Suva or private insurance. We help you with registration and provide the treatment plan. More on the insurance situation for dental accidents.