Accidental tooth bud extraction

What to do for an accidental tooth bud extraction during primary tooth removal?

Accidental tooth bud extraction during removal of a primary tooth can occur. When it does it is important to replace the tooth bud into socket quickly.

How do you replace the accidental tooth bud extraction into the socket?

Step one of replacing a tooth bud or immature tooth is the separation of it from the primary tooth. Do this gently and try to avoid touching the tooth bud and immature tooth as much as possible, especially avoid touching the apical portion. Once you have only the tooth bud remaining place it back into the socket. The position is not critical as it will likely develop and erupt just as one does in an auto-transplantation case or surgical extrusion technique case. However, there is definitely a “right” position for the tooth bud.  You should try to put it back exactly where it came from. The piece should fit together like a piece of a puzzle.

How should you monitor a re-implantation of an accidental tooth bud removal during primary tooth extraction?

Follow up with patient at 1 week and 1 month. After that routine follow up at their 6 month recall is fine.

What does an accidental tooth bud removal during primary tooth extraction look like?

The tooth bud may be very small and look similar to an enamel pearl. However, the position of it should be a giveaway.

You can see an immature premolar tooth bud that came out with the primary molar.

The tooth bud may also really be more mature and we can consider it an immature tooth. Efrat 2001 shows a case of accidental immature tooth removal during extraction. Tooth #28 was the accidental tooth that was removed. The 2 year follow up looks good other than some coronal pulp calcification.

What determines if the replacement of an immature tooth re-implantation will be successful?

Basically stage of development and time out of socket are the critical factors, with earlier in the development and shorter time being better for survival.

• Short distance from pulp horn to apical foramen
• An open apical foramen
• Short extraoral time, which may be less than 45 min or less than 2 hours depending on source of information
• What was tooth storage medium for the tooth while it is out? Preferably saliva, saline, milk or HBSS4).

List of some accidental immature tooth removal during primary tooth extraction literature.

The is not much literature on this exact topic but auto-transplantation has a lot of literature and since the procedure is so similar one can consider them a good source of information.

Efrat 2001 describes a case of immature premolar tooth removal during extraction of primary tooth roots in the Dental Trauma journal. Kemp 1977 also describes a case of immature premolar tooth removal during extraction of a primary molar in JOE.

Andreson has a lot of literature on tooth avulsion and auto-transplantation. The recommendation is non-rigid splint for 2 weeks if tooth is erupted.

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