Dentoalveolar Injuries Classification-Management-Biological Consequences

Abstract

tooth, vital pulp therapy should be attempted because of the tremendous advantages of maintaining the vitality of the pulp. b. Time between the accident and treatment: In the 24 hours after a traumatic injury, the initial reaction of the pulp is proliferative with no more than 2 mm of pulp inflammation. After 24 hours, chances of direct bacterial contamination increases. c. Concomitant periodontal injury: A periodontal injury compromises the nutritional supply of the pulp. In the horizontal root fracture which may show bleeding from the sulcus, the coronal segment is displaced, but generally the apical segment is not displaced. The chance of pulp necrosis is about 25% may result from displacement, but in the apical segment is rare due to the apical pulp circulation is not disrupted. Radiographic diagnosis is made by one occlusal film and three preiapical films (one at 0 degree, then one each at + and -15 degrees from the vertical axis of the tooth). There are four healing patterns have been described the first three types are considered successful. The fourth is typical when the coronal segment loses its vitality which is: a. Healing with calcified tissue: The ideal healing is calcific healing. A calcific callus is formed at the fracture site on the root surface and inside the canal wall. b. Healing with interproximal connective tissue. c. Healing with bone & connective tissue. d. Interproximal inflammatory tissue without healing. With root fractures that have maintained the vitality of the pulp, the main goal of treatment is to enhance the healing process. Prognosis increases with quick treatment, close reduction of the root segments, and splinting. When the fracture is in the level of or coronal to the crest of the alveolar bone (Figure 5), the prognosis is poor. This case is managed by stabilizing the coronal fragment with rigid splint for 2 to 4 months. If reattachment of the fractured segments is not possible, extraction of the coronal segment is indicated. When the fracture in the midroot (Figure 6), non rigid splinting for 2 to 4 weeks is the treatment of choice. The probability of pulp necrosis is for the most part is limited to the coronal segment. The pulp lumen is wide at the apical extent of the coronal segment so that the apexification may be indicated. In rare cases when both coronal and apical pulps are necrotic, full RCT through the fracture is difficult, and the necrotic apical segments may be removed surgically. And when the fracture is in the apical part (Figure 7) of the root, the pulp will mostly be vital and the tooth will have little or no mobility .It has the best prognosis.