Recently, one of my young adult patients arrived at my office promptly at 8am with his permanent tooth in hand that had been completely knocked out in a hockey game the night before. This was a neighborhood "pick up" game and the usual protective equipment was not worn. His tooth had been out of its natural environment for more than twelve hours and re-implantation of his tooth was not an option. It was hard to tell him that it was too late to re-implant the tooth, if only he would have called me immediately after the accident. Of course this young man will have a false tooth placed and most likely an implant at a later date, but there is nothing better than saving that natural tooth.
A permanent tooth that has been completely avulsed (knocked out), in most cases can be re-implanted if it is done so during the first 2-4 hours. Handle the tooth gently, place the tooth back into the socket if possible by handling the crown portion of the tooth or have the patient hold the tooth in his or her mouth (the natural environment) until seeking care. If this treatment is not an option then, gently rinse the tooth and place it in milk, or water. Avoid cleaning or rubbing the tooth as this could destroy the connective fibers that help anchor the tooth in the socket.
Seek treatment as soon as possible to increase your chances of a successful re-implantation.
My procedure for re-implantation is a dental splint with arch wire and composite for 7-10days. The splint is then removed after tooth is stable and then I refer to an Endodontist for further evaluation.
