Long-term management of avulsed "hopeless" teeth in the adult dentition

Objective This case will demonstrate a thoughtful approach to the management of avulsed/replanted teeth in the adult dentition and their long-term maintenance. Often times these teeth are either not replanted, or extracted soon after replantation when resorptive lesions appear and the teeth are deemed "hopeless". The term "hopeless tooth" (HT) has become more popular since the advent of implants. Implants allowed for a simple solution to the HT by extraction and immediate replacement with a fixture and a restoration. However, now that we are realizing that implants do not last forever and also have attendant problems, saving the HT takes on a new light. Clinical considerations Prolonging the life of the HT can preserve bone and give the patient a functional, esthetic tooth for many years. With each additional year, clinicians garner new skills, and technology improves our future treatment outcomes. This will allow clinicians to improve and extend the life of future replacements. Conclusions If there is minimal risk to adjacent structures, retaining the HT has many advantages for the patient and clinician. Clinicians should adopt a policy of thinking ahead and asking "What's Next"? when their prospective treatment fails or needs to be replaced. By prolonging the life of the HT, the "best ultimate treatment" has a greater chance to outlive the patient. Clinical significance With the advent of single tooth implants, the term "hopeless tooth" has become more popular. It is easier to justify extraction of a tooth when it is deemed "hopeless". Many of these teeth could be saved. The advantages of this philosophy will be elucidated.