Pulp survival andhard tissue formation subsequent to dental trauma. A clinical and histological study of uncomplicated crown fractures and luxation injuries

Abstract

Pulp survival and hard tissue formation subsequent to dental trauma A clinical and histological study of uncomplicated crown fractures and luxations injuriesAgneta Robertson, Department of Pedodontics, Faculty of Odontology, Göteborg University and Public Dental Service, City of Göteborg,Sweden. Medicinaregtan 12, S-413 90 Göteborg, Sweden. Traumatic injuries in children and adolescents are a common problem, and the prevalence of such injuries has increased over the last 10-20 years.The purpose of the present investigation was to evaluate long-term results following uncomplicated crown fractures and luxations involvingsubsequent pulp canal obliteration. A total of 198 patients with 488 injured permanent teeth were available for clinical examination (15 yearfollow-up), of which 102 also answered a questionnaire and were interviewed before oral examination. Further, 82 permanent incisors presentingwith pulp canal obliteration (PCO) were followed for a period of 7 to 22 yr. (mean 16 yr.). The histological evaluation of luxation injuries wasperformed on 123 primary teeth from 98 patients. In the experimental study (crown fractures), 64 monkey permanent maxillary and mandibularcentral incisors and canines were subjected to different treatment alternatives at the time of fracture. The findings in the follow-up study showedvery little pulpal response to crown fracture and subsequent restorative procedures as long as there was no concomitant periodontal injury.Approximately every fourth resin composite restoration was rated unacceptable at the clinical examination. The interview showed that half of theindividuals were dissatisfied with the color and/or anatomic form of the composite restoration. PCO was found in all luxation categories, andaccording to the survival curve, the 20-year pulp survival rate diagnosed with X-ray was 84%. Although the risk for pulp necrosis (PN) increasedwith time, routine endodontic intervention of teeth with ongoing PCO of the root canal did not seem justified. The histological study showed thatchanges in dentin were represented by occlusion of the dentinal tubules and deposition of tertiary dentin. The tertiary dentin were classified aseither dentin-like, bone-like or fibrotic. In the experimental study, few changes were observed in the pulp 3 months after crown fractures,irrespective of treatment alternative.