To the Editor:--A 53-yr-old, 152-cm, 41-kg woman was scheduled for removal of a pheochromocytoma. The patient had no obvious dental caries or periodontal disease. After induction of anesthesia with 250 mg intravenous thiamylal and 10 mg vecuronium, the anesthetic resident ventilated the lungs with 5% sevoflurane for 3 min and attempted tracheal intubation. However, more than 30 s passed before the vocal cords were seen, and arterial blood pressure increased to 243/96 mmHg. The resident rushed the intubation, which led to complete avulsion of the maxillary incisors. We immediately consulted a dentist, who strongly recommended early stabilization of the teeth. The teeth were replaced into the socket in their original position, and a cross-suture splint was applied within 10 min. The patient was instructed to report to the dental clinic for subsequent observation and treatment.
On replantation, the durability of the teeth depends on which of three courses is followed:(1) Nearly normal function of the periodontal ligament is restored, in which the durability is almost the same as untraumatized teeth. (2) The root of the replanted tooth undergoes osseous replacement and eventually may cause loss of the tooth. (3) Root resorption occurs with a necrosed tooth pulp and early loss of the tooth. The outcome depends largely on the first-aid treatment. Teeth are held to the alveolar bone by collagenous tissue that forms the periodontal ligament. It is imperative not to damage or dry the ligament if avulsed teeth are to be replanted successfully. The less time the tooth is out of its socket, the more successful the replantation will be. A 90% success rate occurs if the extraoral period of the teeth avulsed does not exceed 30 min. [1,2]Early dental consultation even before surgery is crucial to achieve satisfactory replantation.
Motoshi Kainuma, M.D., Associate Professor of Anesthesiology.
Morimasa Yamada, D.D.S., Associate Professor of Anesthesiology.
Toshiyuki Miyake, M.D., Professor of Anesthesiology Department of Anesthesiology, Fujita Health University, 1–98 Dengakugakubo, Kutsukake-cho Toyoake, Aichi, Japan.