It has been previously recommended that in mature
teeth, endodontic therapy should be commenced seven
to 10 days following replantation.
However, it would now seem that pulp extirpation should be
carried out as soon as possible to prevent the initiation
of inflammatory root resorption.
The canal should be
debrided, dressed with a corticosteroid/antibiotic or
calcium hydroxide paste preparation for one to three
months, after which time the canal can be obturated
and the access cavity sealed. Follow-up radiographs
should be taken at regular intervals of one, three, six
and 12 months.
Longer-term follow-up radiographs
are desirable, as a number of authors have reported
that resorption may occur up to 10 years after
avulsion.
In immature teeth, when the time out of the mouth is
short and the apex is open, revascularization of the
pulp may occur. Endodontic therapy can be delayed to
establish whether revascularization will occur but only
if patient compliance for follow-up treatment is
assured. Regular follow-up is essential and apexification
procedures should be carried out at the first sign of
resorption, discolouration, the presence of a draining
sinus or periapical bone loss. The root canal should be
accessed so the infected tissue and debris can be
removed and the canal can then be filled with calcium
hydroxide. Root filling procedures involving gutta-percha and/
or MTA can be carried out at a later date.