Int J Stomatol

Int J Stomatol ›› 2021, Vol. 48 ›› Issue (6): 675-682.doi: 10.7518/gjkq.2021083

• Reviews • Previous Articles     Next Articles

Evaluation of pulp status and selection of treatment in young permanent teeth after trauma

Gao Huihui1(),Deng Shuli2,He Xinmin2,Hu Ji,an2()   

  1. 1. Dept. of Dentistry, School of Medicine, Zhejiang University, Dept. of Cariology and En-dodontics, The Affiliated Stomatological Hospital, School of Medicine, Zhejiang University, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou 310006, China
    2. Dept. of Cariology and Endodontics, The Affiliated Stomatological Hospital, School of Medicine, Zhejiang University, Key Laboratory of Oral Biomedical Research of Zhe-jiang Province, Hangzhou 310006, China
  • Received:2020-12-10 Revised:2021-05-14 Online:2021-11-01 Published:2021-10-28
  • Contact: Ji,an Hu E-mail:21818478@zju.edu.cn;hja@zju.edu.cn
  • Supported by:
    National Health and Family Planning Commission Fund(WKJ-ZJ-1624);Zhejiang Education Department of General Scientific Research Project(Y201942154)

RichHTML

468

PDF (PC)

2665

Abstract:

Tooth trauma is the damage of hard tissue and (or) periapical tissue caused by external force. It may induce pathological changes of dental-pulp tissue, thereby affecting the prognosis and long-term preservation of the affected teeth. In particular, permanent teeth have the unique anatomical and physiological characteristics of incomplete root deve-lopment, large apical foramen, and adequate blood supply. Once young permanent teeth suffer from trauma, the treatment of the affected teeth becomes greatly challenging. It also provides a physiological basis for the preservation of living pulp and pulp regeneration. In this paper, we review the different pulp states of young permanent teeth after trauma and the corresponding vital-pulp preservation treatment to provide a basis for oral clinicians to select the appropriate treatment stra-tegy.

Key words: tooth trauma, immature permanent teeth, dental-pulp state, vital pulp therapy

CLC Number: 

  • R781.33

TrendMD: 

Tab 1

Treatment methods under different dental pulp conditions in common young permanent tooth trauma types"

项目 硬组织损伤 牙周组织损伤
简单冠折 复杂冠/冠-根折 牙震荡 不完全脱位损伤 全脱位损伤 嵌入型损伤
保存
活髓
方式		 1）边缘磨光/充填修复;
2）牙本质封闭/间接盖髓+充填修复		 1）露髓孔直径<0.5 mm、时间短、断面干净：DPC[28];
2）露髓孔直径>0.5 mm、暴露时间长：活髓切断术		 定期监测牙髓状态,
牙髓坏死概率较小[13]		 定期监测牙髓状态,
可恢复牙髓血流供应[6]		 定期监测牙髓状态,
可恢复牙髓血流供应[6]		 定期监测牙髓状态,
牙髓坏死概率大[13]
随访
内容		 临床检查：牙冠颜色、叩诊、松动度、根尖周是否有窦道/瘘管、牙髓活力测试等 影像学检查：根尖周组织及牙根发育情况、是否存在牙根吸收、髓腔闭锁等
不良
结果
处理		 牙髓炎：根据炎症范围采用牙髓切断术[36] 牙髓坏死及根尖周病变：1）当牙根长度<2/3、根尖孔直径>1 mm时,行牙髓血运重建术[56];2）根尖孔直径0.5~1.0 mm、患牙有足够的根管壁厚度及长度,行根尖诱导成形术[45,46];3）牙根发育接近完成,根尖孔直径<0.5 mm或已行牙髓血运重建术及根尖诱导成形术后未形成明显根尖止点时,行根尖屏障术
[1] Mustafa Ali M, Al Zoubi L, Eissa M, et al. Changes in the epidemiology and aetiology of dental trauma-tic injuries in permanent teeth in children before and after German unification[J]. Eur Arch Paediatr Dent, 2019, 20(1):41-46.
doi: 10.1007/s40368-018-0383-3
[2] James V, Vandersluis YR, Zhang EWJ, et al. Dental injuries in younger emergency department patients[J]. CJEM, 2018, 20(3):425-431.
doi: 10.1017/cem.2017.52
[3] Rêgo ICQ, Vilarinho SMM, Rodrigues CKF, et al. Oral and cranio-maxillofacial trauma in children and adolescents in an emergency setting at a Brazilian hospital[J]. Dent Traumatol, 2020, 36(2):167-173.
doi: 10.1111/edt.v36.2
[4] Yu CY, Abbott PV. Responses of the pulp, periradi-cular and soft tissues following trauma to the permanent teeth[J]. Aust Dent J, 2016, 61(Suppl 1):39-58.
doi: 10.1111/adj.2016.61.issue-S1
[5] Angelova Volponi A, Zaugg LK, Neves V, et al. Too-th repair and regeneration[J]. Curr Oral Health Rep, 2018, 5(4):295-303.
doi: 10.1007/s40496-018-0196-9
[6] Andreasen FM, Yu ZJ, Thomsen BL. Relationship between pulp dimensions and development of pulp necrosis after luxation injuries in the permanent dentition[J]. Dent Traumatol, 1986, 2(3):90-98.
doi: 10.1111/edt.1986.2.issue-3
[7] Taschieri S, Del Fabbro M, Samaranayake L, et al. Microbial invasion of dentinal tubules: a literature review and a new perspective[J]. J Investig Clin Dent, 2014, 5(3):163-170.
doi: 10.1111/jicd.12109
[8] Moradi S, Bidar M, Zarrabi MH, et al. Dental pulp reaction to exposure at different time intervals in open apex canine teeth of cats[J]. Iran Endod J, 2009, 4(2):49-52.
[9] Abbott PV. Diagnosis and management of transverse root fractures[J]. J Endod, 2019, 45(12s):S13-S27.
doi: 10.1016/j.joen.2019.05.009
[10] Andreasen FM, Pedersen BV. Prognosis of luxated permanent teeth: the development of pulp necrosis[J]. Endod Dent Traumatol, 1985, 1(6):207-220.
pmid: 3867505
[11] 管悦, 秦满. 年轻恒牙脱出性损伤后牙髓预后及相关因素分析[J]. 中华口腔医学杂志, 2008, 43(9):520-523.
Guan Y, Qin M. A retrospective study of pulp hea-ling after luxation injuries[J]. Chin J Stomatol, 2008, 43(9):520-523.
[12] 黄超, 刘艳丽, 王伟, 等. 外伤牙髓保存的研究进展[J]. 牙体牙髓牙周病学杂志, 2016, 26(5):318-321, 324.
Huang C, Liu YL, Wang W, et al. Pulp preservation following dental trauma[J]. Chin J Conserv Dent, 2016, 26(5):318-321, 324.
[13] Spinas E, Pipi L, Dettori C. Extrusive luxation injuries in young patients: a retrospective study with 5-year follow-up[J]. Dent J, 2020, 8(4):136.
doi: 10.3390/dj8040136
[14] Haug SR, Heyeraas KJ. Modulation of dental inflammation by the sympathetic nervous system[J]. J Dent Res, 2006, 85(6):488-495.
pmid: 16723642
[15] Andreasen FM, Kahler B. Pulpal response after acu-te dental injury in the permanent dentition: clinical implications-a review[J]. J Endod, 2015, 41(3):299-308.
doi: 10.1016/j.joen.2014.11.015 pmid: 25601716
[16] Ersahan S, Sabuncuoglu FA, Oktay EA. The efficacy of laser Doppler flowmetry, electric pulp test and cold test in diagnosing revascularization of extrusi-vely luxated immature maxillary incisors[J]. Pak J Med Sci, 2018, 34(4):787-793.
doi: 10.12669/pjms.344.15524 pmid: 30190729
[17] Ahn SY, Kim D, Park SH. Long-term prognosis of pulpal status of traumatized teeth exhibiting contradictory results between pulp sensibility test and ultrasound Doppler flowmetry: a retrospective study[J]. J Endod, 2018, 44(3):395-404.
doi: 10.1016/j.joen.2017.12.001
[18] Bargrizan M, Ashari MA, Ahmadi M, et al. The use of pulse oximetry in evaluation of pulp vitality in immature permanent teeth[J]. Dent Traumatol, 2016, 32(1):43-47.
doi: 10.1111/edt.12215 pmid: 26358664
[19] Caldeira CL, Barletta FB, Ilha MC, et al. Pulse oxi-metry: a useful test for evaluating pulp vitality in traumatized teeth[J]. Dent Traumatol, 2016, 32(5):385-389.
doi: 10.1111/edt.12279 pmid: 27140332
[20] Anusha B, Madhusudhana K, Chinni SK, et al. Assessment of pulp oxygen saturation levels by pulse oximetry for pulpal diseases-a diagnostic study[J]. J Clin Diagn Res, 2017, 11(9): ZC36-ZC39.
[21] Souza RA, Gomes SCN, Dantas JDCP, et al. Importance of the diagnosis in the pulpotomy of immature permanent teeth[J]. Braz Dent J, 2007, 18(3):244-247.
doi: 10.1590/S0103-64402007000300013
[22] Andreasen FM. Pulpal healing after luxation injuries and root fracture in the permanent dentition[J]. Endod Dent Traumatol, 1989, 5(3):111-131.
pmid: 2699588
[23] Ning T, Shao J, Zhang X, et al. Ageing affects the proliferation and mineralization of rat dental pulp stem cells under inflammatory conditions[J]. Int Endod J, 2020, 53(1):72-83.
doi: 10.1111/iej.13205 pmid: 31419325
[24] Li Y, Zhao S, Nan X, et al. Repair of human perio-dontal bone defects by autologous grafting stem cells derived from inflammatory dental pulp tissues[J]. Stem Cell Res Ther, 2016, 7(1):141.
doi: 10.1186/s13287-016-0404-2
[25] Kodonas K, Fardi A, Gogos C, et al. Scientometric analysis of vital pulp therapy studies[J]. Int Endod J, 2021, 54(2):220-230.
doi: 10.1111/iej.v54.2
[26] Olsburgh S, Jacoby T, Krejci I. Crown fractures in the permanent dentition: pulpal and restorative considerations[J]. Dent Traumatol, 2002, 18(3):103-115.
pmid: 12110103
[27] Katge FA, Patil DP. Comparative analysis of 2 cal-cium silicate-based cements (biodentine and mineral trioxide aggregate) as direct pulp-capping agent in young permanent molars: a split mouth study[J]. J Endod, 2017, 43(4):507-513.
doi: 10.1016/j.joen.2016.11.026
[28] Kratunova E, Silva D. Pulp therapy for primary and immature permanent teeth: an overview[J]. Gen Dent, 2018, 66(6):30-38.
pmid: 30444704
[29] Hatipoglu Ö. Factors affecting the decision-making of direct pulp capping procedures amongst Turkish dental practitioners[J]. Eur Endod J, 2018, 3(3):167-173.
[30] Kunert M, Lukomska-Szymanska M. Bio-inductive materials in direct and indirect pulp capping-a review article[J]. Materials, 2020, 13(5):1204.
doi: 10.3390/ma13051204
[31] Paula AB, Laranjo M, Marto CM, et al. Evaluation of dentinogenesis inducer biomaterials: an in vivo study[J]. J Appl Oral Sci, 2020, 28:e20190023.
[32] Tanalp J, Karapınar-Kazandağ M, Dölekoğlu S, et al. Comparison of the radiopacities of different root-end filling and repair materials[J]. Sci World J, 2013, 2013:594950.
[33] Mahgoub N, Alqadasi B, Aldhorae K, et al. Compa-rison between iRoot BP Plus (EndoSequence root repair material) and mineral trioxide aggregate as pulp-capping agents: a systematic review[J]. J Int Soc Prev Community Dent, 2019, 9(6):542-552.
doi: 10.4103/jispcd.JISPCD_249_19 pmid: 32039073
[34] Cvek M. A clinical report on partial pulpotomy and capping with calcium hydroxide in permanent incisors with complicated crown fracture[J]. J Endod, 1978, 4(8):232-237.
doi: 10.1016/S0099-2399(78)80153-8
[35] Gudkina J, Mindere A, Locane G, et al. Review of the success of pulp exposure treatment of cariously and traumatically exposed pulps in immature permanent incisors and molars[J]. Stomatologija, 2012, 14(3):71-80.
[36] Harms CS, Schäfer E, Dammaschke T. Clinical eva-luation of direct pulp capping using a calcium silicate cement-treatment outcomes over an average period of 2.3 years[J]. Clin Oral Investig, 2019, 23(9):3491-3499.
doi: 10.1007/s00784-018-2767-5
[37] Asgary S, Fazlyab M, Sabbagh S, et al. Outcomes of different vital pulp therapy techniques on symptomatic permanent teeth: a case series[J]. Iran Endod J, 2014, 9(4):295-300.
[38] Bimstein E, Rotstein I. Cvek pulpotomy-revisited[J]. Dent Traumatol, 2016, 32(6):438-442.
doi: 10.1111/edt.12297 pmid: 27397639
[39] Khouja F, Abdelaziz M, Bortolotto T, et al. Intra-pul-pal and subsurface temperature rise during tooth irradiation with 808 nm diode laser: an in vitro study[J]. Eur J Paediatr Dent, 2017, 18(1):56-60.
doi: 10.23804/ejpd.2017.18.01.12 pmid: 28494605
[40] Türkün M, Türkün LS, Celik EU, et al. Bactericidal effect of Er, Cr: YSGG laser on Streptococcus mutans[J]. Dent Mater J, 2006, 25(1):81-86.
pmid: 16706301
[41] Olivi G, Genovese MD, Caprioglio C. Evidence-based dentistry on laser paediatric dentistry: review and outlook[J]. Eur J Paediatr Dent, 2009, 10(1):29-40.
pmid: 19364243
[42] Tozar KN, Erkmen Almaz M. Evaluation of the efficacy of erbium, chromium-doped yttrium, scandium, gallium, and garnet laser in partial pulpotomy in permanent immature molars: a randomized controlled trial[J]. J Endod, 2020, 46(5):575-583.
doi: 10.1016/j.joen.2020.02.003
[43] Chrepa V, Pitcher B, Henry MA, et al. Survival of the apical papilla and its resident stem cells in a case of advanced pulpal necrosis and apical periodontitis[J]. J Endod, 2017, 43(4):561-567.
doi: 10.1016/j.joen.2016.09.024
[44] Frank RM, Sargentini-Maier ML, Turlot JC, et al. Comparison of lead levels in human permanent tee-th from Strasbourg, Mexico City, and rural zones of Alsace[J]. J Dent Res, 1990, 69(1):90-93.
pmid: 2303602
[45] Linsuwanont P, Kulvitit S, Santiwong B. Reinforcement of simulated immature permanent teeth after mineral trioxide aggregate apexification[J]. J Endod, 2018, 44(1):163-167.
doi: S0099-2399(17)31032-4 pmid: 29153732
[46] Cvek M. Prognosis of luxated non-vital maxillary incisors treated with calcium hydroxide and filled with gutta-percha. A retrospective clinical study[J]. Dent Traumatol, 1992, 8(2):45-55.
doi: 10.1111/edt.1992.8.issue-2
[47] Andreasen JO, Farik B, Munksgaard EC. Long-term calcium hydroxide as a root canal dressing may increase risk of root fracture[J]. Dent Traumatol, 2002, 18(3):134-137.
pmid: 12110105
[48] Li CS, Zheng Z, Deng XH, et al. Apexification ma-nagement of mandibular second premolar with a blunderbuss apex and periapical lesion of an adult patient[J]. Case Rep Dent, 2019, 2019:7546842.
[49] Songtrakul K, Azarpajouh T, Malek M, et al. Modified apexification procedure for immature permanent teeth with a necrotic pulp/apical periodontitis: a case series[J]. J Endod, 2020, 46(1):116-123.
doi: S0099-2399(19)30748-4 pmid: 31761331
[50] Lin J, Zeng Q, Wei X, et al. Regenerative endodontics versus apexification in immature permanent tee-th with apical periodontitis: a prospective rando-mized controlled study[J]. J Endod, 2017, 43(11):1821-1827.
doi: 10.1016/j.joen.2017.06.023
[51] Alvandifar S, Madani Z, Bizhani A. Evaluation of tooth discoloration after treatment with mineral trioxide aggregate, calcium-enriched mixture, and Biodentine® in the presence and absence of blood[J]. Dent Res J (Isfahan), 2019, 16(6):377-383.
doi: 10.4103/1735-3327.270787
[52] 凌均棨, 林家成. 牙髓血运重建术治疗进展[J]. 口腔医学, 2019, 39(10):865-872.
Ling JQ, Lin JC. Research progress of regenerative endodontics[J]. Stomatology, 2019, 39(10):865-872.
[53] Kim SG, Malek M, Sigurdsson A, et al. Regenerative endodontics: a comprehensive review[J]. Int Endod J, 2018, 51(12):1367-1388.
doi: 10.1111/iej.12954 pmid: 29777616
[54] Hargreaves KM, Diogenes A, Teixeira FB. Treatment options: biological basis of regenerative endodontic procedures[J]. Pediatr Dent, 2013, 35(2):129-140.
pmid: 23635981
[55] Iwaya SI, Ikawa M, Kubota M. Revascularization of an immature permanent tooth with apical periodontitis and sinus tract[J]. Dent Traumatol, 2001, 17(4):185-187.
pmid: 11585146
[56] 刘斌, 梁景平. 牙髓再生的临床应用与未来[J]. 中华口腔医学杂志, 2020, 55(1):50-55.
Liu B, Liang JP. Regenerative endodontics: clinical application status and future perspective[J]. Chin J Stomatol, 2020, 55(1):50-55.
[57] de Souza BDM, Dutra KL, Reyes-Carmona J, et al. Incidence of root resorption after concussion, subluxation, lateral luxation, intrusion, and extrusion: a systematic review[J]. Clin Oral Investig, 2020, 24(3):1101-1111.
doi: 10.1007/s00784-020-03199-3
[58] Santiago CN, Pinto SS, Sassone LM, et al. Revascularization technique for the treatment of external inflammatory root resorption: a report of 3 cases[J]. J Endod, 2015, 41(9):1560-1564.
doi: 10.1016/j.joen.2015.03.019
[59] Yoshpe M, Einy S, Ruparel N, et al. Regenerative endodontics: a potential solution for external root resorption (case series)[J]. J Endod, 2020, 46(2):192-199.
doi: 10.1016/j.joen.2019.10.023
[60] Lu J, Liu H, Lu ZJ, et al. Regenerative endodontic procedures for traumatized immature permanent tee-th with severe external root resorption and root perforation[J]. J Endod, 2020, 46(11):1610-1615.
doi: 10.1016/j.joen.2020.07.022
[1] Zhou Can,Zeng Qian,Wei Xi.. Prospects for the application of concentrated growth factor in vital pulp therapy [J]. Int J Stomatol, 2022, 49(6): 684-689.
[2] Yidi Jiang,Chenglin Wang,Ling Ye. Complications of regenerative endodontics [J]. Inter J Stomatol, 2019, 46(1): 73-77.
[3] Lei Qiyin, Chen Ke.. Research progress on the clinical treatment of regenerative endodontics in immature permanent teeth [J]. Inter J Stomatol, 2017, 44(3): 267-272.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] . [J]. Foreign Med Sci: Stomatol, 1999, 26(06): .
[2] . [J]. Foreign Med Sci: Stomatol, 1999, 26(05): .
[3] . [J]. Foreign Med Sci: Stomatol, 1999, 26(05): .
[4] . [J]. Foreign Med Sci: Stomatol, 1999, 26(05): .
[5] . [J]. Foreign Med Sci: Stomatol, 1999, 26(05): .
[6] . [J]. Foreign Med Sci: Stomatol, 1999, 26(04): .
[7] . [J]. Foreign Med Sci: Stomatol, 2005, 32(06): 458 -460 .
[8] . [J]. Foreign Med Sci: Stomatol, 2005, 32(06): 452 -454 .
[9] . [J]. Inter J Stomatol, 2008, 35(S1): .
[10] . [J]. Inter J Stomatol, 2008, 35(S1): .