Delayed Replantation of Avulsed Tooth: a 4-Year Follow-Up

Objectives: The aim of this case report is to address a delayed replantation and apexification of an avulsed immature permanent incisor with calcium hydroxide.
Methods: A 9-year-old boy was referred to our pediatric dental clinic after dental trauma 2 hours ago while the child was playing in the water park. Intraoral examination revealed that maxillary right central incisor was avulsed and buccal alveolar plate was fractured. Parents were advised to find avulsed tooth immediately. After another 2 hours, tooth was brought to our clinic stored in buttermilk and standard treatment guidelines for avulsed immature permanent teeth were followed. Endodontic treatment was started placing calcium hydroxide extraorally. Tooth was replanted, buccal bone fragment was replaced, sutured and stabilized using a flexible splint for 4 weeks. After apical closure, root canal treatment was completed and the tooth was restored with composite resin 22 months after trauma.
Results: The radiographic and clinical evaluations a period of 4 years demonstrated periodontal bone healed without root resorption and mobility. Endodontic treatment was performed on the patient's maxillary right central incisor using calcium hydroxide as an intracanal medicament in apexification procedure. Although tooth was left with calcium hydroxide dressing during pandemic period over 12 months, apex was closed successfully. After obturation, tooth was permanently restored with composite resin. Endodontic success with a closed apex was demonstrated by clinical and radiographic imaging 4-year follow-up. However, ankylosis caused significant infraposition of the maxillary right central incisor. Ankylosed tooth was esthetically restored with composite resin using mock-up technique.
Conclusions: Although delayed replantation with prolonged extra-alveolar dry time, tooth remained stable and functional after four years. Using replanted tooth to maintain the surrounding bone until the patient is a viable implant candidate can be considered as an option for pediatric patients.