Management of tooth avulsion: a systematic review

Abstract

Tooth avulsion is one of the most serious traumatic dental injuries (TDIs), and it occurs mainly in pediatric and adolescent patients. Early, evidence-based management is essential to optimize prognosis and preserve dental and periodontal health. This systematic review integrates existing literature that deals with clinical protocols and outcomes related to the treatment of avulsed permanent teeth. It focus specifically on the timing of replantation, use of various storage media, splinting methods, timing and technique of endodontic treatment, and use of regenerative materials. Interventional trials, case reports, and retrospective cohort studies are included, all aimed at elucidating the variables determining prognosis. The review demonstrates superior outcomes through early replantation and illustrates how technological advancements in materials such as platelet-rich fibrin (PRF) and mineral trioxide aggregate (MTA) have expanded the window for delayed replantation therapy. The methodological quality of the included studies was evaluated using standardized critical appraisal instruments. The evidence supports a protocol-based, multidisciplinary approach that incorporates current bioactive materials and early emergency treatment to achieve optimal long-term results. The aim of this review is to help clinicians and stakeholders in the management of dental trauma and guide future research identifying optimized treatment for avulsed permanent teeth.