Abstract
The pulp plays a key role in the treatment of traumatic dental injuries (TDIs) and is strongly associated with the outcome, particularly in severe cases. A correct pulp diagnosis is essential as it forms the basis for developing the appropriate management strategy. However, many TDIs are complex, and their treatment requires a profound knowledge of the physiological and pathological responses of the affected tissues. This comprehensive review will look at the dentine-pulp complex and its interaction with the surrounding tissues following TDIs. The literature up to 2020 was reviewed based on several searches on PubMed and the Cochrane Library using relevant terms. In addition to the recently revised guidelines of the International Association of Dental Traumatology, this article aims to provide background information with a focus on endodontic aspects and to gather evidence on which a clinician can make decisions on the choice of the appropriate endodontic approach for traumatized permanent teeth.
Highlights
Traumatic dental injuries (TDIs) are often associated with complex injury patterns, where correct diagnosis is of great importance as it forms the basis for developing the appropriate management strategy
Two corresponding situations follow the same principle: (i) in root fractures the fracture foramen plays the same role as the apical constriction, which means that the coronal part of the pulp is more likely to survive in cervical than in apical fractures and again is more likely to be repaired after traumatic necrosis (Andreasen 1989); and (ii) teeth involved in or after orthodontic movement are often associated with apical root resorption (Tieu et al 2014), which means that the apical constriction is lost and the apical entrance for vessels is enlarged, resulting in a greater probability of successful revascularization
In the absence of other indications for endodontic treatment, permanent teeth maintained in the line of fracture should be followed up clinically and radiographically for at least 1 year even if the response to pulp vitality tests are negative in order to ensure that any unnecessary endodontic treatment is avoided (Kahnberg & Ridell 1979, Kamboozia & Punnia-Moorthy 1993, Brajdic et al 2011, Chrcanovic 2014, Kumar et al 2014, Aulakh et al 2017, Bang et al 2018)
Summary
Traumatic dental injuries (TDIs) are often associated with complex injury patterns, where correct diagnosis is of great importance as it forms the basis for developing the appropriate management strategy. Two corresponding situations follow the same principle: (i) in root fractures the fracture foramen plays the same role as the apical constriction, which means that the coronal part of the pulp is more likely to survive in cervical than in apical fractures and again is more likely to be repaired after traumatic necrosis (Andreasen 1989); and (ii) teeth involved in or after orthodontic movement are often associated with apical root resorption (Tieu et al 2014), which means that the apical constriction is lost and the apical entrance for vessels is enlarged, resulting in a greater probability of successful revascularization.
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