Occasionally a tooth will be pulled out of its socket without fracturing the root. This is typically seen in canine teeth due to dogfights or other trauma. This can be partially (luxation or subluxation) or completely (avulsed) removed from the socket. This is an emergency situation, the faster the treatment is begun the better the prognosis. If the tooth is completely avulsed from the socket, keep the tooth moist, milk is the best liquid to use. Get the patient to the veterinarian as quickly as possible.

Treatment is initiated by anesthetizing the patient and obtaining a dental radiograph. This will determine whether there are complicating factors such as periodontal disease or a fractured root. If the radiograph is otherwise normal then reinplantation can be attempted. The first step is to flush the alveolus with sterile saline or an antiseptic solution. Next, replace the tooth back in position and suture the gum tissue closed. Occlusion should be checked at this time to ensure the tooth is in the right position. After the tooth is in the right position, fixation can take place.

Fixation can be accomplished in many ways. My favorite is via an acrylic splint +/- wire stabilization technique. The teeth are acid etched to increase retention area of the teeth to be involved in the splint. The acrylic or composite is then placed on all the teeth to be included in the splint. Depending on the material used you can coat the opposite arcade with petroleum jelly and close the mouth before the material hardens. This will give you an accurate mold of the opposite arcade. This step will eliminate a lot of the shaping of the splint. Next, the occlusion is checked to ensure that the splint is not causing any problems. Finally, the splint is shaped and smoothed to ensure that the splint fits well and is not irritating.

If the tooth is completely avulsed or moderately to severely luxated then in all likelihood the blood supply to the tooth will be severed. In this case root canal therapy will be necessary. This can be performed at the time of original surgery or 2 weeks later. If the tooth is not moved very much, this step may not be necessary. In these cases I recommend recheck radiographs six months after the injury to assess tooth vitality.

The splint is usually left in place for about 2-3 months. During this time the owner has to be very careful with the patients mouth. No playing or mouth work is to be done. In addition, the owner needs to perform fastidious home care to keep the area clean. The patient is the resedated and a dental radiograph is exposed to ensure adequate healing. The splint is then removed and a complete prophylaxis (cleaning) is then performed on the teeth.

Recheck radiographs are recommended in 12 months to determine the status of the root