Authors: AAE.
Title: Keep it alive.
Journal: Colleagues for Excellence
Date: Dec 1998
Citation: Fall/Winter 1998
Category: Trauma
Evidence-based Ranking: 5
Discussion: Accurate diagnosis of traumatic injuries depends on assessing many details. History of the injury: such as when, where and how the trauma occurred. If an accident happened outside or in unsanitary conditions, a tetanus booster may be necessary. Radiographs: from a variety of views and angles to help to identify changes caused by the injury. The maturity of the root and the size of the apical foramen is a consideration. Factors affecting pulpal survival: The type of injury, the stage of root development and the degree of infection are factors that affect circulation to the injured area and impact pulp vitality. Pulp capping and pulpotomy are procedures that permit apexogenesis to occur and may avert the need for root canal therapy. The choice of treatment depends on the size of the exposure, the presence of hemorrhage and the length of time since the injury. Calcium hydroxide’s alkaline pH encourages calcification and prevents bacterial growth. A hard-setting calcium hydroxide is used for pulp capping and pulpotomy procedures. Follow-up examinations are essential to monitor the continued health of the pulp. Pulp capping and partial pulpotomy with calcium hydroxide are successful in almost 96% of trauma cases. If the pulp tissue is necrotic and must be removed, apexification, a process that stimulates the formation of a calcified barrier across the apex, is an alternative. The root will not mature but, if treatment is successful, a hard-tissue bridge will form across the apical opening. There are five types of luxation injuries: concussion, subluxation, lateral luxation, extrusive luxation, and intrusive luxation. Lateral, extrusive and intrusive luxations involve major vascular disruption as well as damage to the periodontal ligament. The open apex improves access to the blood supply and promotes conditions that enhance the pulp’s natural capacity to revascularize. Problems often follow severe luxations, especially intrusive injuries. Tooth discoloration, sensitivity, mobility and swelling are signs of trouble. Therefore, short and long-term monitoring are essential to detect changes in the status of the pulp.

Reviewer’s Comments: Guideline for treatment of immature teeth.