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AVULSION OF DECIDUOUS TEETH: CONTRAINDICATIONS AND
IMPACT ON THE DEVELOPMENT OF PERMANENT TEETH
Mariana Meira Soares1
Anne Caroline Ribeiro Lacerda2
Amanda de Almeida Rodrigues3
Ana Jessica Dos Santos Nascimento4
Isabela Luzia Coelho Bezerra de Carvalho5
Letícia Gama de Oliveira Muniz6
Lívia Jordania Lino Figueredo7
Jamilly Carvalho Rodrigues8
Júlio Cesár Ferreira Gomes9
Malvina de Souza Pereira10
1 Undergraduate in dentistry at the Sovereign Faculty of Health of Petrolina, 56308-000, Petro-
lina – PE, Brazil.
2 Undergraduate in dentistry at the Sovereign Faculty of Health of Petrolina, 56308-000, Petro-
lina – PE, Brazil.
3 Undergraduate in dentistry at the Sovereign Faculty of Health of Petrolina, 56308-000, Petro-
lina – PE, Brazil.
4 Undergraduate in dentistry at the Sovereign Faculty of Health of Petrolina, 56308-000, Petro-
lina – PE, Brazil.
5 Undergraduate in dentistry at the Sovereign Faculty of Health of Petrolina, 56308-000, Petro-
lina – PE, Brazil.
6 Undergraduate in dentistry at the Sovereign Faculty of Health of Petrolina, 56308-000, Petro-
lina – PE, Brazil.
7 Undergraduate in dentistry at the Sovereign Faculty of Health of Petrolina, 56308-000, Petro-
lina – PE, Brazil.
8 Undergraduate in dentistry at the Sovereign Faculty of Health of Petrolina, 56308-000, Petro-
lina – PE, Brazil.
9 Undergraduate in dentistry at the Sovereign Faculty of Health of Petrolina, 56308-000, Petro-
lina – PE, Brazil.
10 Master in Pediatric Dentistry from São Leopoldo Mandic– 13045-755, Campinas – SP, Brazil.
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Abstract: Introduction: Dental avulsion is dened as the complete displacement of the tooth out of the
alveolus, resulting in rupture of the periodontal ligament and, in some cases, fractures of the alveolar
bone. Reimplantation of avulsed deciduous teeth is widely contraindicated. This is because this process
can generate additional trauma to the permanent successor, especially due to the possibility of intrusion
or direct injury to the germ. Objective: To analyze the clinical implications and contraindications of
the reinsertion of avulsed deciduous teeth, highlighting the risks of complications for the permanent
successor teeth and the impact on child dental development. Methodology: To develop this integrative
literature review, the Pubmed, Scielo and BVS databases were used. Articles published between 2014
and 2024, covering the Portuguese, Spanish and English languages, were selected. Results: After a
thorough review, the nal set of studies included a total of 16 articles, indicating that the replacement of
deciduous teeth is directly associated with several complications in those that will erupt later. Among the
main consequences, damage to the permanent tooth germ stands out, resulting in changes in its growth,
color and root curvature. Although there are few studies on the subject, it is clear that these factors can
cause misalignment and delay in the eruption of permanent teeth, emphasizing the contraindication of
reinsertion of the element. Conclusion: Tooth avulsion aects not only oral health, but also the aesthetics
and quality of life of these patients. In these cases, the role of the dentist is essential, both to safely replant
the tooth and to guide parents and guardians on the necessary care. Trauma to deciduous teeth can have
a direct impact on the growth of permanent teeth, and specialized care, combined with prevention, helps
to reduce the risk of sequelae that can aect the child throughout life.
Keywords: Tooth Replantation, Clinical Protocols and Tooth Injuries.
INTRODUCTION
Dental avulsion corresponds to approximately 13% of the traumas that aect the deciduous
dentition, and is characterized by the complete displacement of the tooth out of the alveolus, resulting in
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the rupture of the periodontal ligament and, often, in the fracture of the alveolar bone. (Christophersen;
Freund; Harild, 2005; Mctigue, 2013)
This type of injury can have serious consequences, especially for the development of permanent
teeth, with enamel hypoplasia and ankylosis being some of the most common irreversible sequelae.
(Sakai et al., 2008) Sequelae in permanent teeth resulting from trauma to deciduous teeth can occur in
two ways: by the direct impact of the root of the deciduous tooth on the germ of the permanent tooth
or as a result of a periapical infection originated after pulp necrosis of the avulsed tooth. (Da Silva
Assunção et al., 2009)
Children in the primary dentition phase, especially between 0 and 6 years old, are more
susceptible to dental trauma due to a lack of motor coordination, often resulting from falls and collisions.
Between 7 and 15 years of age, traumatic injuries tend to occur in sports and recreational activities.
(Goswami; Rahman; Singh, 2020)
Tooth replantation, a technique that consists of reinserting the avulsed tooth into its socket, is
widely discussed in the scientic literature. Although it is a common practice for permanent teeth, its
applicability in primary teeth is not recommended.
This study aims to analyze the clinical implications and contraindications of the reinsertion
of avulsed deciduous teeth, emphasizing the importance of an in-depth debate on the feasibility of this
approach in pediatric dentistry.
METHODOLOGY
Regarding the systematization of this integrative literature review, the most relevant scientic
articles on the subject were initially selected from the following databases: National Center for
Biotechnology Information, U.S. National Library of Medicine (Pubmed), Virtual Health Library
(VHL) and Scientic Electronic Library Online (Scielo), in English, Spanish and Portuguese. For the
inclusion criteria, studies from the period between 2014 and 2024 were used, with some other studies
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established in the literature that were related to the theme guided. The descriptors in Health Sciences
(DeSC): “Dental Replantation”, “Deciduous Teeth” and “Dental Trauma”. Monographs, articles not
accessible online, articles outside the period presupposed by the inclusion criterion, and indexed in other
databases were excluded.
A total of 1270 articles were obtained from the databases. Of which 432 articles, being excluded
where they did not meet the inclusion criteria, as they were Theses, Monographs, articles that did not
meet the theme, full text not available. They resulted in 838 articles, after a complete reading, 16 articles
were selected, thus composing the owchart presented below:
Source: Prepared by the authors.
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DISCUSSION
Although the literature presents several studies on dental trauma in several countries and
Brazilian states, there is still a lack of specic studies that address detailed data on dental trauma in the
deciduous dentition and how they impact successors. In view of this gap, the present study aims to ll
this deciency of knowledge about the problem. Some professionals may question the fact that avulsion
is a trauma with the potential to damage the germ of the permanent tooth. This is because, unlike an
extraction, the tooth does not come directly out of the socket, as it is not removed in a similar way to
extraction, since the root can be forced into the socket, changing its position before coming out, which
can lead to sequelae in the teeth that will succeed it. (Martioli et al., 2024; Wanderley et al., 2014)
At the stage when all deciduous teeth are present, the permanent teeth are already partially or
completely developing, with an intimate relationship between their anatomical structures. The younger
the child, the greater the chance of sequelae, which tend to be more severe. (Guedes-Pinto; Mello-
Moura, 2016; Goswami; Rahman; Singh, 2020)
In this scenario, a minimally interventional approach and adequate training of health
professionals are essential, especially with regard to the management of traumatic injuries and the
guidance of caregivers, who may be emotionally aected by the situation. Lesions in deciduous teeth
are often underestimated by parents, who ignore the current situation because they believe that they
will soon be resolved with the birth of the permanent tooth, however the impacts on the development
of these successor dental elements should not be ignored, as they can result in dysfunctions, aesthetic
compromise, as well as emotional and social eects for both the child and his family. (Day et al., 2020;
Richards, 2018; Aldrigui et al., 2011)
Among the therapeutic strategies for tooth avulsion is replantation, a procedure that replaces the
tooth in the cavity from which it was expelled. Poluha et al argue that one of the advantages of replacing
the tooth in the socket would be the resumption of the function of maintaining the space in the dental
arch, preventing the delay in the eruption of the successor permanent tooth and possible misalignments
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after its eruption. However, Flores et al report that this technique, preferable to permanent teeth, is
no longer recommended for primary teeth, since there are few reports on its ecacy and many risks
involved, such as damage to the permanent germ. (Sakai et al., 2008; Goswami; Rahman; Singh, 2020)
One of the main acts harmful to the permanent tooth is the act of repositioning the deciduous
in the socket, this happens because the movement performed in this maneuver ends up compelling
the clot that is in the socket, pressing in some way on the underlying germ, causing some injury and
promoting necrosis of the pulp associated with inammation that will also cause a new risk to the
permanent element. Therefore, due to the anatomical proximity between the root apex of the deciduous
element and the germ of the permanent successor, at the time of replantation, it may end up negatively
aecting the development of the permanent successor tooth, thus interfering with the mineralization of
the enamel, resulting in the appearance of white spots due to the loss of mineral or brown-yellow spots
due to the diusion of substances that are present in the blood where the enamel is formed. (Lenzi et
al., 2011)
Many of the reimplanted primary teeth end up being extracted in a short period due to
complications such as abscesses, mobility, and extensive root resorption. Deciduous teeth are important
to maintain the space necessary for the correct development of occlusion in both dentitions. Thus, it is
essential that they remain in the mouth until the transition to permanent teeth occurs properly. If there is
tooth loss, maintenance of the edentulous space should be carried out immediately to avoid damage to
the permanent dentition, such as reducing the length of the arch and tilting adjacent teeth. (Friedlander;
Chandler; Drummond, 2012; Santos et al., 2013; Silva; Saroza, 2008)
FINAL CONSIDERATIONS
Deciduous teeth avulsion not only aects oral health but also impacts the aesthetics and
quality of life of patients. This study reinforces that the replantation of avulsed deciduous teeth is
contraindicated, mainly due to the risks of injury to the germ of the permanent tooth, such as changes
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in enamel formation, delay in eruption, and deviations in the root anatomy.
In these cases, the role of the dental surgeon is essential, not only to reimplant the tooth safely,
but also to guide parents and guardians on the necessary care. The presence of trauma to the primary
teeth can directly interfere with the development of permanent teeth. Therefore, specialized care,
combined with preventive actions, is essential to reduce the risk of sequelae that can aect the child
throughout his or her life. Although studies on the subject are still scarce, the available data conrm the
need to avoid replantation and prioritize preventive strategies that help preserve children’s oral health
and avoid future complications.
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