What is the Best Root Surface Treatment for Avulsed Teeth?

Elif B Tuna 1, *, Duygu Yaman 2, Seiko Yamamato 3
1 DDS, PhD, Department of Pediatric Dentistry, Faculty of Dentistry, Istanbul University, Capa, Istanbul, Turkey
2 DDS, PhD, Department of Periodontology, Faculty of Dentistry, Istanbul University, Capa, Istanbul, Turkey
3 DDS, PhD, Department of Pediatric Dentistry, School of Dentistry, Nihon University at Matsudo, Chiba, Japan

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© Tuna et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Istanbul University Faculty of Dentistry, Department of Pediatric Dentistry, 34093, Capa, Istanbul, Turkey; Tel: +90 212 414 2020 / 30283; Fax: +90 212 531 0515; E-mail:


Dental avulsion is the most severe type of traumatic tooth injuries since it causes damage to several structures and results in avulsion of the tooth from its socket. Management protocols for avulsed teeth should include management of the pulp and periodontal ligament (PDL) cells in order to improve the long-term prognosis and survival of these teeth. The prognosis of the treatment as well as the survival of an avulsed tooth depends on intrinsic and extrinsic factors, such as the duration of the tooth’s extra-alveolar period, replantation time, the type of storage medium, PDL status and duration of splinting.

Recent research has led to the development of storage media. However, there is not yet a single solution that fulfills all requirements to be considered as the ideal medium for temporary storage of avulsed teeth, and research on this field should carry on. On the other hand in case of delayed replantation, due to the great risk of tooth loss after avulsion, different root surface treatments have been proposed to prevent and delay root resorption before replantation. For this purpose, researchers have applied some different root surface treatment modalities in delayed replantation of avulsed teeth. Several protocols have been used to maintain PDL viability; some involve fluorides, steroids, sodium alendronate, enamel matrix derivatives (EMD) and basic fibroblast growth factor (bFGF, FGF-2). Among these applications, bFGF shows promising results in the regeneration of natural tooth structures and tissues. Better understanding of mechanism of bFGF may help to improve new technologies of regeneration of tooth structures.

Keywords: Avulsion, dental trauma, replantation, root surface treatment, storage media, survival rate.