Traumatized anterior teeth as related to their cause and place

Abstract An investigation on some epidemiologic factors in children with traumatized anterior teeth was carried out on 6090 Iraqis and 3507 Sudanese primary schoolchildren. There were no significant differences found between Iraqi males and females as to the cause of trauma. In the Sudanese the rate of accidents due to more aggressive actions were significantly higher in boys. The place of trauma being inside or outside the school was also investigated and it was found that accidents occurred significantly more outside school than inside in all the age groups in both countries.     

Long-term prognosis of traumatized permanent anterior teeth showing calcifying processes in the pulp cavity.

122 traumatized teeth with radiographic evidence of abnormal hard tissue formation in the pulp cavity were examined 10-23 years (mean 16 years) after the time of injury. Judged radiographically, partial obliteration (pulp chamber not discernible, root canal markedly narrowed but clearly visible) had occurred in 44 teeth (36%). Normal periradicular conditions were found in all teeth with partial obliteration. Seventy-eight teeth (64%) were recorded as totally obliterated. Pathologic periradicular changes indicating pulp necrosis as a sequel to the total obliteration was observed in 16 teeth (21%). The late development of pulp necrosis was significantly related to teeth classified as severely injured, and to teeth with complete root formation at the time of injury. Furthermore, a comparatively rapid progress of the calcifying process appeared to be correlated with periradicular radiolucency.     

Traumatized anterior teeth in children. A 24-month follow-up study

The objectives of this Malaysian study were to investigate the relationship between severity of trauma and interval before treatment, and the effect of delayed treatment on prognosis. A total of 123 traumatized permanent incisors were observed over a 24-month period. Results of this study suggest that the interval between trauma and emergency treatment is directly related to the severity of injury and the level of dental awareness of the patients. However, prognosis of these teeth is greatly influenced by the interval between trauma and initial treatment. Pathological pulp changes in these teeth can occur as late as two years after injury and this justifies the necessity for a long observation period following treatment.     

Long-term prognosis of traumatized permanent anterior teeth showing calcifying processes in the pulp cavity

ABSTRACT— 122 traumatized teeth with radiographic evidence of abnormal hard tissue formation in the pulp cavity were examined 10–23 years (mean 16 years) after the time of injury. Judged radiographically, partial obliteration (pulp chamber not discernible, root canal markedly narrowed but clearly visible) had occurred in 44 teeth (36%). Normal periradicular conditions were found in all teeth with partial obliteration. Seventy-eight teeth (64%) were recorded as totally obliterated. Pathologic periradicular changes indicating pulp necrosis as a sequel to the total obliteration were observed in 16 teeth (21%). The late development of pulp necrosis was significantly related to teeth classified as severely injured, and to teeth with complete root formation at the time of injury. Furthermore, a comparatively rapid progress of the calcifying process appeared to be correlated with periradicular radiolucency.     

Traumatized anterior teeth amongst high school students in northern Sydney

A bstract — The prevalence and severity of fractures of anterior teeth among 12 287 high school students in two areas of northern Sydney was recorded. Overall, six per cent of students had suffered fractures involving dentine or pulp. Twenty-three per cent of these teeth were non vital. In the less affluent area more fractured teeth remained untreated. Trauma prevalence was twice as high amongst boys as girls; body contact, sports, and bicycles contributed most to this finding.     

The ability of pulp sensibility tests to evaluate the pulp status in primary teeth

BACKGROUND. Accurate determination of the pulp status is the most important part of conservative pulp therapy. AIM. The aim of this study was to assess the ability of thermal and electrical pulp tests to assess the pulp status in primary teeth. DESIGN. Seventy-eight primary molar teeth in 36 children were investigated. Fifty-six teeth had unknown pulp status in need of endodontic treatment, and 22 were intact teeth with no signs of pulp disease. Cold, hot and electrical pulp testing (EPT) were performed on each tooth. The gold standard was established by direct inspection of the pulp after an access cavity had been made. The sensitivity, specificity, positive and negative predictive values for each test and different sequential combinations of pulp testing were calculated. Sequential combination test analysis was used for data analysis. RESULTS. The highest accuracy was found for EPT, followed by heat and cold tests. No significant difference was found between the accuracy of EPT and the heat test (P-values > 0.05); however, the accuracy of EPT was significantly higher than that of the cold test (P-value< 0.05). CONCLUSION. Based on this study, EPT can be used as a reliable test for diagnosing the pulp status in primary teeth.     

Current developments in pulp therapy for primary teeth

Premature loss of primary teeth can lead to malocclusion and/or to esthetic, phonetic, or functional problems. Maintaining the integrity and health of the oral tissues is the primary objective of pulp treatment. It is important to attempt to preserve pulp vitality whenever possible; however, when this is not feasible, the pulp can be entirely eliminated without significantly compromising the function of the tooth. This article provides a concise review of the normal histological characteristics of the primary pulp and briefly describes the dentinogenesis process and the factors affecting the dentin–pulp complex response to stimuli. Finally, the biological basis and rationale for the various modalities of pulpal treatment for the primary dentition are discussed and data on the success rates for the different treatment is presented.     

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.     

Endodontic treatment of primary teeth. Pulp exposure and pulp necrosis

With management of the deep caries in primary teeth we have to take account into the coping strategies of the patient and the state of the development of the dentition. That's why in most cases a root canal treatment of primary incisors or even a pulpotomy is not indicated. Often Intellectual Decision Not To Restore is a good alternative for treatment of deep caries in primary incisors. In deep caries lesions of primary canines and molars preferably minimal invasive techniques as indirect pulp capping are performed. In case of a exposure, the dentist can choose between several types of treatment. Improved techniques have lead to clinical satisfying results of the calcium hydroxide pulpotomy. A partial pulpotomy is if possible the treatment of choice. A resin modified glass ionomer cement is used to cover the pulp wound because it has good sealing properties and it is easy to handle. To limit the burden in young children a root canal treatment in primary teeth is seldom indicated. Overfilling with calcium hydroxide in root canal treatment of primary teeth never causes problems.     

Histomorphologic changes in the gingiva and pulp of overretained primary teeth

This study examined the influence of overretention on the tissues of human primary teeth. The range of overretention was two to thirty-two years. Light microscopy and computerized morphometry were utilized for histologic assessment of twenty-five sites of twenty-one teeth. Dentinoclasts were found on the resorbing root surface of nine teeth; polymorphonuclear leucocytes were found in the pulp of fourteen teeth; and monocytes were present in all pulps. The apical and coronal ends of the junctional epithelium were apical to the cemento-enamel junction in eighteen and fourteen teeth, respectively. Significant correlations were found between the extent of overretention and gingival height, the length of the junctional epithelium and the extent of apical migration of the junctional epithelium. Present and previous findings indicate that odontoclastic activity in the pulp is reduced with overretention; and while at the beginning of overretention there is a lower percentage of pulps with polymorphonuclear leucocytes in the pulp, with an extended period of overretention an increase in this percentage takes place.