Pulpal healing after luxation injuries and root fracture in the permanent dentition

Abstract

Pulpal healing patterns were studied in a clinical material of 637 luxated and 95 root-fractured permanent incisors followed routinely for up to 11 years. It was found that pulpal healing patterns could generally be divided into 3 groups according to the degree of injury sustained by the pulp: little, moderate or severe. Thus after luxation injuries, pulp survival could be without radiographic change (PS), with pulp canal obliteration (PCO) or nonhealing (pulp necrosis (PN]. After root fracture, similar healing patterns could be observed: healing by hard tissue union of fragments (HT), by connective tissue union of fragments (CT) or by nonunion due to interposition of granulation tissue between fragments (GT) resulting from PN of the coronal fragment. In both trauma situations, healing or nonhealing could be determined by type of luxation injury, stage of root development and type of fixation used (forceful application of orthodontic bands vs. passively applied acid-etch fixation). Pulpal healing complications (PN or GT) were based on clinical findings (coronal discoloration, loss of pulpal sensibility) and radiographic findings (resorption processes of the lamina dura at the root apex or at the level of the root fracture). However, in both injury groups the same changes could also be seen to be intermediate steps in the pulpal healing process. Based on findings from these studies, hypotheses for the mechanics of pulpal healing are proposed as well as guidelines for acute and later treatment of dental luxations, root fractures and the diagnosis of healing complications.

Dental trauma involving root fracture and periodontal ligament injury: a 10-year retrospective study

“…Regarding the first-aid sites, 67 patients were taken to hospitals and emergency rooms (42%), 19 were first treated at private dental offices (12%) and 14 were directly referred to the School of Dentistry of Araçatuba (9%). However, in a large number of forms (61, corresponding to 37% of the cases), this information was not available.…”

“…1 Among the complementary tests, percussion and thermal sensitivity tests were largely performed to obtain information regarding damage to periodontal ligament and pulp tissue, respectively. 1,15,19 Pulp sensitivity tests require the patient's cooperation, which is frequently not achieved during first-aid care. Therefore, the validity of these tests is controversial.…”

“…This would avoid pulp necrosis leading to external inflammatory root resorption. 1,14,15,[19][20][21] Intracanal calcium hydroxide dressing placement and changes are widely employed procedures due to the well-recognized anti-bacterial and healing properties of calcium hydroxide. 22 It also has the ability of preventing and/or arresting the process in cases of ongoing external inflammatory root resorption.…”

Endodontic Management of Luxation Injuries

“…Diğer taraftan, travma sonrası yapılan ilk ölçümde dişlerin EPT'ye negatif yanıt vermesi, ilerleyen dönemde pulpa nekrozu oluşa-cağının kesin göstergesi değildir. 19 Kök gelişimini tamamlamış dişlerde travma sonrası saptanan nekroz bulgusu ilerleyen dö-nemde GPG yoluyla geri dönebilmekte ve diş vitalitesi oluşabilmektedir. 20 GPG, travma sonrası nörovasküler desteği hasar gören dişlerin doğal iyileşme sürecinin bir parçasıdır.…”

Delayed Esthetic Rehabilitation of a Complicated Crown Fracture at an Early Age on the Maxillary Anterior Region: Case Report

“…7,8 Travmaya uğramış dişlerde kronkök kırıklarının yanı sıra pulpa nekrozu, pulpa dejenerasyonu, kök rezorpsiyonu ve marjinal alveolar kemik kaybı gibi komplikasyonlar da gözle-nebilmektedir. 7,9 Bu dişlerde tedavi şeklini travma sonrası geçen süre, yer değiştirme ya da mobilitenin derecesi, kırık bölgesi, hastanın yaşı ve kök gelişiminin durumu belirlemektedir. 7,10 Travma sonrası pulpanın iltihabi durumuna bağlı olarak kök ucu gelişiminin durduğu dişlerde apeksifikasyon tedavisi uygulanabilmektedir.…”