Evaluation of Long-Term Clinical and Radiographic Prognosis of Avulsed Teeth: A Retrospective Study.

Background/aim: Avulsion injuries have an uncertain prognosis. This study aims to evaluate periodontal ligament healing patterns and factors affecting the survival of replanted avulsed teeth.

Materials and methods: In this retrospective study, data from 204 avulsed teeth in 143 children (mean age: 9.6 ± 2 years) who sustained avulsion injuries were reviewed. Primary teeth, non-replanted permanent teeth, and cases with follow-up shorter than 60 days were excluded. Data analysis included 60 replanted permanent teeth from 41 patients (18 girls and 23 boys), with a follow-up period ranging from 2 to 147 months. Collected data covered age, gender, extra-alveolar storage time, root development stage, and periodontal ligament healing patterns. Statistical analysis was performed on the data.

Results: Avulsion injuries predominantly occurred during outdoor activities (n = 22, 59.5%), followed by school (n = 10, 27%) and home (n = 5, 13.5%). The main causes were falls (n = 20, 50%), bicycle accidents (n = 6, 15%), sports injuries (n = 5, 12.5%), traffic accidents (n = 2, 5%), and violence (n = 1, 2.5%). Among replanted teeth, 51.7% were immature. Treatments included root canal therapy (n = 30, 50%), apexification (n = 12, 20%), and regeneration (n = 2, 3.3%), while 16 teeth received no treatment. Inflammatory resorption was not observed in teeth replanted within 1 h of injury (8.4%). Functional healing/ankylosis was observed in 14 (23.3%) of the replanted teeth, replacement resorption in 40 (66.7%), and inflammatory resorption in 6 (10%). Replacement resorption affected 66.7% of the replanted teeth, with 62.5% lost over time. Functional healing/ankylosis was more common in mature teeth, while inflammatory resorption was higher in immature teeth. According to Kaplan-Meier estimated survival curves, the survival rate during the 5-year observation period was 47.5%. Survival times were longer in boys and in mature teeth (p < 0.05).

Conclusions: Gender and root development stages were observed to significantly impact the prognosis of replanted avulsed teeth.