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A tooth is knocked out (tooth avulsion)

Tooth rescue boxes SOS Zahnbox or  Dentosafe

What happens following tooth replantation?




A tooth is knocked out (tooth avulsion)

This is the worst tooth injury. Basically knocked out teeth can be replanted and heal in. But a tooth may not dry off for more than 20 to 30 minutes.

Knocked out teeth must be searched immediately and be put into a cell compatible medium (tooth rescue box)
Visit dentist!

The dentist will replant the tooth and then splint it.

The root surface may not dry off.
Keep the tooth moist immediately.
The root surface may not be touched.
The root surface may never be disinfected.

Search for the tooth!
Put tooth immediately into a special cell culture medium
(tooth rescue boxes: SOS Zahnbox or Dentosafe).

When tooth rescue box is not available:

sterilized milk

for limited time a knocked-out tooth may be stored in sterilized milk

plastic foil

Wrap in plastic foil to keep the tooth moist

isotonic saline

from a physician/pharmacy - do not try to mix it

totally inappropriate:

water, dry storage, saliva

When a tooth rescue box is not available on the spot
and the tooth was rescued with one of the above-mentioned methods:

As soon as possible - within 30 minutes -
place tooth in the tissue culture medium of the tooth rescue box!
Before replantation
store tooth at least 30 minutes
in the tissue culture medium of the tooth rescue box!




Scientific research at the University of Giessen has shown that the cells in the periodontium of teeth which were stored in the medium of the tooth rescue box survive for at least 24 to 48 hours in this medium at room temperature. Nevertheless when a tooth is knocked out visit your dentist immediately.

The tooth rescue box is also suitable for transportation of fractured tooth fragments. The dentist can attach the fragments to the tooth with special adhesives. It is important to keep the fragments moist.

The tooth rescue box contains a special cell culture medium, not only salt solutions. It is similar to cell culture media which are used for transportation of organs that are to be transplanted. Due to an added preservative and a protect medium the unopened tooth rescue box has a shelf life of 3 years at room temperature. There are two tooth rescue boxes  available in  Germany, Austria and Switzerland, the SOS Zahnbox and Dentosafe.






What happens following tooth replantation?

Periodontium – physiologic rescue

When the tooth has been rescued correctly (=physiologically) the specialised cells in the periodontium survive. These cells are responsible for the reattachment of the periodontal fibers. The tooth heals in with normal periodontium and functions as before the trauma.

In the medium of the tooth rescue box these important cells survive for 1 to 2 days at room temperature.

Periodontium – unphysiologic rescue

When the tooth has been recued in an unphysiologic way the specialised cells die. This already happens about 15 to 30 minutes after trauma. Storage in milk, saline or plastic foil extends this time inessentially - despite moist storage the cells die. Then there are to less cells left for a correct and normal healing of the periodontium. The surrounding bone reaches contact to the root surface (ankylosis), then the tooth is resorbed. It will be lost within some months or years

When the patients are still growing (children, adolescents) in the region of an ankylosed tooth there is no more growth of bone. The ankylosed tooth gets in a infraposition while the neighboured teeth grow together with the bone. Eventually the ankylosed tooth must be removed.





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