Comparative Evaluation of Replantation Outcomes of Avulsed Teeth-Influence of Extraoral Time and Storage Medium: A CBCT-based Study.

BACKGROUND: Tooth avulsion is a severe dental trauma predominantly affecting children and adolescents. Prognosis depends largely on extraoral time and storage medium before replantation. Cone-beam computed tomography (CBCT) provides superior evaluation of healing outcomes compared to traditional radiography. AIM: To evaluate the influence of extraoral time and storage medium on clinical and radiographic outcomes of replanted permanent maxillary central incisors in children aged 9-14 years. MATERIALS AND METHODS: This randomized, controlled, parallel-arm trial was conducted at a private dental college in India over 12 months, from July 2024 to July 2025. A total of 48 avulsed permanent maxillary central incisors from children aged 9 to 14 years were included based on standardized inclusion criteria and grouped according to extraoral dry time and storage medium. Clinical parameters (pain, pocket depth) and radiographic outcomes [lesion diameter (LD), apical diameter (AD), root wall thickness, and tooth-bone resorption] were evaluated at baseline, 6, and 12 months using CBCT and clinical examination. Data were analyzed with repeated measures ANOVA, correlation, and multiple linear regression, with p < 0.05 considered statistically significant. RESULTS: Significant improvements were observed in pain (p < 0.001), pocket depth (p < 0.001), lesion diameter (p < 0.001), and tooth-bone resorption (p < 0.001) over time. Tooth-bone resorption was the most protocol-sensitive parameter, with better protocols showing lower resorption scores. Larger lesion diameter and thinner root walls were significantly associated with increased resorption. CONCLUSION: Rapid replantation with biologically compatible storage media and adjunctive root-surface treatments optimizes healing outcomes for avulsed teeth. CBCT is an indispensable tool for monitoring healing and guiding prognosis.