Tooth avulsion is a serious injury. There is a high risk that an avulsed tooth will get lost.

However, the direct damage that is inflicted by the trauma to the PDL is small. Thus, basically  there are  excellent chances for healing and long-term retention. There are two main reasons for numerous complications and losses:

1. Inadequate storage during the extraoral phase.

Dry storage as well as most media cannot keep the PDL cells viable, not even vital. The storage in these media is timely limited to minutes or perhaps few hours, if ever.  Only cell compatible culture media allow adequate storage and keep the tissue alive for days.

Furtheron too much time elapses until a knocked out tooth is put into a medium. The replantation at the site of the accident by lay people is not done, desite tremendous efforts for education.

As a consequence a tooth rescue box was developed, containing a specially composed tissue culture medium which has a shelf life of about 3 years at room temperature and which allows the storage of avulsed teeth for up to 48 hours.

It is intended to keep available rescue boxes in all schools in Germany, in all public bathing facilities, and in pertinent sports. Furtheron rescue boxes shall be readily available at all pharmacies, emergency facilities and dental practices. An emergency telephone number is established through which professional advice and the closest location of the rescue box near by can be given. This project is mainly run by and is meanwhile covering a good portion of Germany. The project is scientifically observed by the University of Bonn. See also the pertinent informations on this Website.

2. Inadequate strategy of the endodontic therapy

All avulsed teeth undergo pulp necrosis. In some rare cases immature teeth can be revascularised. However, in most instances the necrotic pulp gets infected and is the reason for infection related resorption and early tooth loss.

It is recommended to start the endodontic treatment about 7 to 10 days after replantation. However this treatment fails in about 40 to 50%. It is beyond dispute that microorganisms cannot be predictably eliminiated from the root canal system once they are established.

An immediate seal of the root canal before replantation prevents microorganisms from entering the root canal. In consequence this simple change in the treatment protocol and the use of a destinct  method  prevented any infection related complications.

It is therefore strongly recommended to not wait for an infection to establish but to do a prophylaxis in its best sense: prevent instead of treat.


The following sites comprise two flowcharts as a help for deciding which therapy - aiming at the PDL or at the Endo - should be used dependend on the specific situation a knocked-out tooth may be in. The flowcharts are supplemented by additional informations which are not fully completed yet. For best usage allow javascript.