Storage of an avulsed tooth prior to replantation: a systematic review and meta-analysis.

BACKGROUND/AIM: It is crucial to store an avulsed tooth appropriately to preserve the viability of the periodontal ligament cells prior to replantation. The aim of this systematic review was to identify the best available evidence for the effectiveness of any technique available to laypeople for storing an avulsed tooth compared with storage in milk or saliva. METHODS: The following databases were searched (September 2019): Cochrane Library, MEDLINE and Embase. Two reviewers independently considered trial eligibility, then extracted and analyzed data and assessed the risk of bias. The certainty of the body of evidence was appraised according to the GRADE methodology. RESULTS: Out of 4118 references, 33 studies were included and reported on 23 comparisons of which 10 were synthesized in a meta-analysis. The limited evidence available favors storing an avulsed tooth in Hank's Balanced Salt Solution (pooled SMD 2.47, 95%CI [1.59;3.34], p<0.00001), propolis solution (pooled SMD 1.73, 95%CI [1.12;2.33], p<0.00001), oral rehydration salts (pooled SMD 4.16, 95%CI [2.10;6.23], p<0.00001), rice water and cling film compared with storage in milk. The cell viability rate was significantly lower in teeth stored in saline solutions (pooled SMD -4.35, 95%CI [-7.55;-1.14], p=0.008), tap water, buttermilk, castor oil, GC Tooth Mousse and turmeric extract than those stored in milk. There is insufficient evidence to recommend for or against temporary storage of an avulsed tooth in saliva compared with alternative solutions. The certainty of evidence was considered low to very low due to limitations in study design, indirect study populations and outcome measures, and imprecision. CONCLUSION: Although milk was shown to extend the periodontal ligament cell viability before replantation compared with saline or tap water, the following media have also demonstrated efficacy at preserving the cell viability: Hank's Balanced Salt Solution, propolis, oral rehydration salts, rice water, and cling film.