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Treatments for managing knocked out and replanted front teeth

Day P, Duggal M
Published Online: 
20 January 2010

Injuring your front teeth during childhood is common. One of the most severe injuries occurs when the tooth is knocked totally out of the mouth (avulsed). Often the best option is to replant the tooth as quickly as possible. This is true only for permanent teeth. Once replanted the tooth can heal in two ways if managed correctly. Ideally the ligament around the root reforms and the tooth can be expected to last as long as any other tooth, this is known as 'periodontal healing'. When there is too much damage to the ligament, healing occurs by bony replacement and the tooth is replaced by bone and lost over a few years. This is called 'bony healing'.

Bony healing causes significant problems in the medium term for children and treatments for this are the subject of a different Cochrane review. A missing front upper tooth or teeth, as a result of not replanting an avulsed tooth or as a treatment for bony healing, can have a major effect on dental and facial 'good looks'. This can affect the individual's self esteem and general social interaction, as well as how others think and see them.

This Cochrane review investigated what treatments encourage the tooth to repair by periodontal healing. Three studies were found. The benefits of these treatments require further investigation before specific medicaments can be advised. This is because the studies had weakness in their design which may have influenced the benefits they found. The following general treatment principle can be concluded which reinforces current treatment guidelines: For teeth with little chance of periodontal healing, a root canal treatment can be carried out before the tooth is replanted without further detrimental effects.

This record should be cited as: 
Day P, Duggal M. Interventions for treating traumatised permanent front teeth: avulsed (knocked out) and replanted. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD006542. DOI: 10.1002/14651858.CD006542.pub2
Assessed as up to date: 
28 October 2009