Prognosis of luxated permanent teeth — the development of pulp necrosis

Abstract

A population of 400 patients, comprising 637 luxated permanent teeth was studied prospectively with respect to the development of pulp necrosis after luxation injuries. The patients were treated for traumatic dental injuries over a period of 10 years. While initial treatment was provided according to established treatment guidelines by the attending oral surgeon at the emergency room, follow‐up examination and treatment was provided by one oral surgeon. It appeared that pulp necrosis occurred soon after injury, within 3 months after concussion, within the 1st yr after subluxation and extrusion, and might be diagnosed up to 2 yr after lateral‐ and intrusive luxation. While many factors, when considered one at a time, were found to have a significant or nearly significant died on the development of pulp necrosis (i.e. type of injury, age of patient, stage of root development, degree of dislocation, reduction/repositioning procedure, type of fixation, restorations in place at the lime of injury), a multivariate regression analysis revealed that when the type of injury (diagnosis) and stage of root development were taken into account, the effect of other factors was no longer significant. The risk of pulp necrosis increased with the extent of injury, i.e. concussion and subluxation represented the least risk, followed in ascending order by extrusive‐, lateral‐, and intrusive luxation. Moreover, teeth with completed root formal ion demonstrated a greater risk of pulp necrosis than teeth with incomplete root formation. No treatment effect could be demonstrated. However, as treatment was performed according to established guidelines, which might introduce bias, it would appear justified to conduct randomized clinical studies in order to determine the value of different forms of treatment (e.g. reduction and fixation of luxated teeth) to improve the prognosis with respect to the development of pulp necrosis after injury. In conclusion, the major factors influencing development of pulp necrosis after luxation injuries appear to be the extent of the initial injury to the pulp and periodontium, as reflected by the type of luxation, and the repair potential of the injured tooth, as reflected by the stage of root development.

Dentists' level of knowledge of the treatment plans for periodontal ligament injuries after dentoalveolar trauma

“…4 Regarding the indication for endodontic treatment, there is no difference among the several types of trauma, except for severely intruded teeth. 10 In these cases, pulp revascularization is not expected and, regardless of the clinical observations, endodontic therapy must be performed 1 to 2 weeks after trauma in order to prevent the occurrence of inflammatory root resorption. 4 Intrusive luxation was the periodontal ligament injury that prompted the least number of correct answers, mainly because the dentists did not include endodontic treatment in their treatment plans.…”

Endodontic Management of Luxation Injuries

“…20 Andreasen ve ark.nın diğer bir çalışma-sında ise lateral luksasyon yaralanması sonrası iltihapsal kök rezorpsiyonu gelişme olasılığı %39 bulunmuştur. 17 Bu olguda, iltihapsal kök rezorpsiyonu olasılığının GPG oluşma ihtimalinden daha yüksek olduğu göz önünde bulundurulmuş ve iki ay beklenmesine rağmen GPG oluşumu radyolojik olarak saptanamadığı için kanal tedavisi işlemlerine başlanmıştır. Luksasyon yaralanmalarında kök yü-zeyindeki sement dokusu hasar gördüğü için dentin tübülleri osteoklastik aktiviteye neden olan bakteriyel toksinlerin periodontal ligamente doğru geçişine neden olabilmektedir.…”

Low-level laser therapy effects in traumatized permanent teeth with extrusive luxation in an orthodontic patient

“…5 The incidence of pulp necrosis in permanent teeth with open apices after periodontal tissue injuries was reported as 8%, while in teeth in which the apical foramen is closed, this ratio was reported as 38%. 12 The frequency of pulpal necrosis for extrusive luxation was 26% according to the same study. 12 Endodontic treatment is indicated when the clinical and radiographic symptoms of root canal infection-periapical pathology, external root resorption, fistula development, and sensitivity to percussion-are detected after dental trauma.…”

“…The necessity of beginning an endodontic treatment has been advised when pathological changes are detected during radiographic follow-up continuing for at least a year. 12,15 Color change in the crown, negative response to vitality tests, and periapical radiolucency are classical symptoms of pulpal necrosis. Spontaneous pain, sensitivity to percussion, or occlusion are symptoms that can be related to pulp necrosis.…”

“…Endodontic treatment should be delayed at least until another clinical and/or radiographic symptom of necrosis is detected. 12,15 Endodontic treatment is necessary after extrusive luxation of a tooth with completed root formation. 14 Healing of the periodontal ligament will determine prognosis.…”