The maintenance of pulp health 17 years after root fracture in a maxillary incisor illustrating the diagnostic benefits of cone bean computed tomography

Makowiecki, Piotr; Witek, Agnieszka; Buczkowska-Radlińska, Jadwiga

doi:10.1111/iej.12221

Cited by 10 publications

(10 citation statements)

References 20 publications

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“…Kullman and Al Sane in a systematic review in 2012 reported a lack of evidence‐based research on radiographic methods although there was support for the current recommendations in the IADT guidelines. A PubMed search using the same search words for articles published since 2012 revealed no papers with specific recommendations on guidelines, while a number of articles advocated judicious use of CBCT when considered clinically appropriate . From a research and clinical perspective, the advantages of standardized documentation utilizing CBCT were recently demonstrated in a case series of avulsed teeth where replantation was delayed and where ankylosis‐related resorption eventuated.…”

Section: Radiographic Techniquementioning

confidence: 99%

Diagnosis of acute dental trauma: the importance of standardized documentation: a review

Andreasen

Kahler

2015

Dental Traumatology

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-In 1985 Andreasen and Andreasen published a paper on the diagnosis of luxation injuries and outlined the importance of standardized clinical, radiographic, and photographic techniques. Now 30 years later, these recommendations remain current in the International Association of Dental Traumatology (IADT) guidelines for the management of dental trauma and describe circumstances surrounding the time of injury, the extent of trauma (e.g., type of luxation injury), healing potential (e.g., stage of root development) as well as information concerning subsequent treatment. The purpose of this review was to include findings for other types of trauma and to discuss more recent studies that augment and/or improve on the original findings from 30 years ago. The present review discusses the use of a standardized clinical registration (pulpal sensibility testing, laser Doppler flowmetry, mobility testing), radiographic survey, and photographic registration of the traumatized patient. Moreover, the value of digital radiographs and recent developments in computer tomography with respect to possible enhancement of the trauma diagnosis are discussed.

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Section: Radiographic Techniquementioning

confidence: 99%

Diagnosis of acute dental trauma: the importance of standardized documentation: a review

Andreasen

Kahler

2015

Dental Traumatology

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“…Due to superimposition of anatomical and restorative entities, projection radiography has a low sensitivity for detection of fractures. CBCT was considered the most reliable imaging modality to resolve these difficulties [18,19,26]. In our case, sagittal CBCT slices show the location of fractures and dislocation of the coronal fragment in tooth 11.…”

Section: Discussionmentioning

confidence: 83%

A "borderline" dental trauma with 12 y of evolution justifying CBCT as diagnostic method

Yendreka¹,

Fonseca²

2018

biomedicalresearch

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The case of a female with a history of trauma to her maxillary central incisors 12 y ago is presented. The right tooth showed signs of root-fracture healing with a dislocated coronal fragment, total pulp canal obliteration (PCO) and contradictory signs and symptoms. The left tooth showed an indistinguishable fracture line but partial PCO in the apical fragment and normal clinical signs. Although the patient was referred for endodontic treatment of the right central incisor, Cone-beam computed tomography (CBCT) was suggested to confirm the nature of the condition. Because CBCT should not be used routinely for endodontic diagnosis but may be justified in "borderline" cases, it was performed in according to the current legal recommendations, avoiding the unnecessary endodontic treatment. PCO is discussed, as the condition involves not only a radiographic reduction of the pulp canal but also an adaptive morphological pattern of pulp response to trauma.

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“…Only in one of the 42 analyzed cases, after 36 months from the therapy, tooth extraction was required because of diastasis, mobility and phlogosis. The healing of the horizontal root fractures without treatment is presented in many reports with a rate superior to 80% [ 7 , 15 ]. Makowiecki et al ., reported a case, found incidentally on a routine radiographic examination, maintaining the pulpal health up to 17 years after root fracture [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…Horizontal root fractures in the apical and middle third are not always symptomatic, and can be incidentally identified during routine examinations. In these cases, treatment is often non required and spontaneous healing is frequently reported [ 13 - 15 ]. In the other cases, the patient can report pain during chewing.…”

Section: Introductionmentioning

confidence: 99%

The Horizontal Root Fractures. Diagnosis, Clinical Management and Three-Year Follow-Up

et al. 2018

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Objective:The aim of this retrospective analysis is to describe and to evaluate the middle third horizontal root fractures, long term clinical management results and to estimate the effect of treatments factors upon healing and survival rate.Methods:Our clinical study included 42 patients presenting a middle third horizontal root fracture in permanent dentition. For each patient at t0 the parameters recorded were: diastasis, mobility, sensibility, periodontal inflammation, pulpal pathology, associated fracture and dislocation of the coronal fragment. The follow-up was performed after 6 (t1), 12 (t2) and 36 (t3) months after the trauma, both clinically and radiologically. Clinical examination, vitality tests and a radiological evaluation (periapical x-ray) were performed.Results:At t0 it was observed: diastasis (14, 3%), mobility (28, 6%), thermal sensibility (61, 9%), periodontal inflammation (4, 8%), pulpal pathology (38, 1%) and dislocation of the coronal fragment (47, 6%) of the patients. The treatment plan started with the coronal fragment repositioning and the blockage (splint) with the adjacent teeth in 47, 6% of cases.A root canal treatment was performed at t0 in 52,4% of the fractured teeth. Statistical analysis showed the highest level of significance between pulpal lesions (t0) and associated fractures. The mobility, sensibility and pulpar lesions parameters, showed a reduction in relation to the follow up timing, with a main variation remarkably evident between t0 and t1. The ratio between observation time and the presence of diastasis was statistically significant.Conclusion:The analysis of the clinical results exhibits the high success rate of a conservative approach in the treatment of teeth fractured in the middle third of the root.

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The maintenance of pulp health 17 years after root fracture in a maxillary incisor illustrating the diagnostic benefits of cone bean computed tomography

Abstract: The dental pulp is characterized by the ability to heal spontaneously in cases of root fracture. CBCT has advantages in diagnosing root fractures over intra-oral radiographs. CBCT should be employed with caution due to its increased radiation dose compared with periapical radiography.

Cited by 10 publications

References 20 publications

Diagnosis of acute dental trauma: the importance of standardized documentation: a review

Diagnosis of acute dental trauma: the importance of standardized documentation: a review

A "borderline" dental trauma with 12 y of evolution justifying CBCT as diagnostic method

The Horizontal Root Fractures. Diagnosis, Clinical Management and Three-Year Follow-Up

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