Dislodged (Luxated) Teeth
During an injury, a tooth may be pushed sideways, out of or into its socket. We will reposition and stabilize your tooth. Root canal treatment is usually needed for permanent teeth that have been dislodged and should be started a few days following the injury. Medication such as calcium hydroxide may be put inside the tooth as part of the root canal treatment. A permanent root canal filling will be placed at a later date.
Children between seven and 12 years old may not need root canal treatment since their teeth are still developing. For those patients, we will monitor the healing carefully and intervene immediately if any unfavorable changes appear. Therefore, multiple follow-up appointments are likely to be needed. New research indicates that stem cells present in the pulps of young people can be stimulated to complete root growth and heal the pulp following injuries or infection.
Knocked-Out (Avulsed) Teeth
If a tooth is completely knocked out of your mouth, time is of the essence. See an endodontist or dentist immediately! Handled the knocked-out tooth very gently, avoiding touching the root surface and follow the below steps.
Your endodontist or dentist will carefully evaluate the tooth, place it back in its socket and examine you for any other dental and facial injuries. A stabilizing splint will be placed for a few weeks. Depending on the stage of root development, your dentist or endodontist may start root canal treatment a week or two later. A medication may be placed inside the tooth followed by a permanent root canal filling at a later date.
The length of time the tooth was out of the mouth and the way the tooth was stored before reaching the dentist influence the chances of saving the tooth. Again, immediate treatment is essential. Taking all these factors into account, your dentist or endodontist may discuss other treatment options with you.
Injuries in children
An injured immature tooth may need one of the following procedures to improve the chances of saving the tooth:
This procedure encourages the root to continue development as the pulp is healed. Soft tissue is covered with medication to encourage growth. The tip of the root (apex) will continue to close as the child gets older. In turn, the walls of the root canal will thicken. If the pulp heals, no additional treatment will be necessary. The more mature the root becomes, the better the chance to save the tooth.
In this case, the unhealthy pulp is removed. The doctors place medication into the root to help a hard tissue form near the root tip. This hardened tissue provides a barrier for the root canal filling. At this point, the root canal walls will not continue to develop, making the tooth susceptible to fractures. So it is important to have the tooth properly restored by your dentist.
Traditionally, when an immature tooth suffers root damage, we perform an apexification to harden the root end and close the canal. While effective, apexification also means that the tooth’s root will not continue to develop. A new procedure, regenerative endodontics, might be available as an alternative. With regenerative endodontics, we instead revive or regenerate the tooth’s natural tissue so the root can continue growing.
Regenerative endodontics uses the concept of tissue engineering to restore the canals to a healthy state. The benefits of this method include continued root development and strengthened hard tissues to prevent potential fractures. Though tissue regeneration procedures are still in their infancy, studies suggest that “dead,” immature teeth are capable of regenerating pulp-like tissues that foster root development.