Pulp canal obliteration after extrusive and lateral luxation in young permanent teeth: A scoping review. 2021

E Spinas, and M Deias, and A Mameli, and L Giannetti
Department of Surgical Sciences, Sports Dental Research Center, University of Cagliari, Cagliari, Italy.

OBJECTIVE In the literature, no single therapeutic approach is preferred for treating dental pulp responses such as pulp canal obliteration (PCO). Some authors still recommend preventive endodontic treatment, whereas others choose not to intervene, to avoid causing possible iatrogenic complications. This review was conducted to explore, in the current scientific literature, the degree of knowledge concerning the onset and development of PCO and pulp necrosis (PN) following dental trauma (i.e. extrusive luxation and lateral luxation) in children and young adults (6-20 years). The authors also evaluated whether and to what extent the stage of dental root development at the time of traumatic dental injury (TDI) influences these pulp responses, and whether PN can arise in teeth already affected by PCO. MATERIALS AND METHODS The literature search was carried out during the period October 2019 to January 2020, using the following databases: PubMed/MEDLINE, SCOPUS and Web of Science. Articles in English reporting on young patients with PCO or PN in permanent teeth affected by trauma were included. Theresearch, whose questions were summarised according to the PICO method, considered the following aspects: patient age, type of TDI, stage of root development, initial treatment, presence of calcification or necrosis, time to onset of the two outcomes (PCO and PN), and duration of follow-up. The articles found were evaluated by two reviewers; in the event of disagreement regarding the inclusion of an article, a third reviewer was called upon to decide. RESULTS The initial screening of the databases, using the selected search keywords, yielded a total of 343 articles. After exclusion of duplicates and articles not meeting the inclusion criteria, 11 articles remained. Of these, only four completely met the inclusion criteria. Closer analysis of these four publications revealed that they would not easily yield standardised sets of clinical data that might be homogenised in order to produce clear meta-analytical data. Hence the need to limit the data collected to the following seven items: number and type of injuries, type of initial intervention, duration of follow-up, main pulp responses, number and type of pulp responses. CONCLUSIONS PCO is a physiological pulp response associated with a traumatic event, usually a luxation injury. It is diagnosed on the basis of combined radiographic and clinical-anamnesticdata. Signs of PCO start to appear at around one year after the traumatic event, and its development reaches completion by about five years post-trauma. PN, on the other hand, is clearly apparent within the first year. Endodontic treatment, be it carried out as a preventive measure or following detection of PCO, is inappropriate and can cause serious iatrogenic damage. Treatment is indicated only in cases of definite PN.

UI MeSH Term Description Entries
D002648 Child A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL. Children
D003786 Dental Pulp Cavity The space in a tooth bounded by the dentin and containing the dental pulp. The portion of the cavity within the crown of the tooth is the pulp chamber; the portion within the root is the pulp canal or root canal. Pulp Canal,Pulp Chamber,Root Canal,Cavities, Dental Pulp,Cavity, Dental Pulp,Dental Pulp Cavities,Pulp Cavities, Dental,Pulp Cavity, Dental,Canal, Pulp,Canal, Root,Canals, Pulp,Canals, Root,Chamber, Pulp,Chambers, Pulp,Pulp Canals,Pulp Chambers,Root Canals
D003790 Dental Pulp Necrosis Death of pulp tissue with or without bacterial invasion. When the necrosis is due to ischemia with superimposed bacterial infection, it is referred to as pulp gangrene. When the necrosis is non-bacterial in origin, it is called pulp mummification. Dental Pulp Autolysis,Dental Pulp Gangrene,Necrosis, Dental Pulp,Pulp Gangrene,Pulp Mummification,Pulp Necrosis,Autolysis, Dental Pulp,Gangrene, Dental Pulp,Necroses, Pulp,Pulp Autolysis, Dental,Pulp Gangrene, Dental,Pulp Necroses,Pulp Necrosis, Dental,Autolyses, Dental Pulp,Dental Pulp Autolyses,Dental Pulp Necroses,Gangrene, Pulp,Gangrenes, Pulp,Mummification, Pulp,Mummifications, Pulp,Necroses, Dental Pulp,Necrosis, Pulp,Pulp Autolyses, Dental,Pulp Gangrenes,Pulp Mummifications,Pulp Necroses, Dental
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D014084 Tooth Avulsion Partial or complete displacement of a tooth from its alveolar support. It is commonly the result of trauma. (From Boucher's Clinical Dental Terminology, 4th ed, p312) Avulsed Tooth,Dislocation, Tooth,Tooth Luxation,Avulsion, Tooth,Avulsions, Tooth,Dislocations, Tooth,Luxation, Tooth,Luxations, Tooth,Tooth Avulsions,Tooth Dislocation,Tooth Dislocations,Tooth Luxations,Tooth, Avulsed
D055815 Young Adult A person between 19 and 24 years of age. Adult, Young,Adults, Young,Young Adults
D019229 Dentition, Permanent The 32 teeth of adulthood that either replace or are added to the complement of deciduous teeth. (Boucher's Clinical Dental Terminology, 4th ed) Dentition, Adult,Dentition, Secondary,Adult Dentition,Permanent Dentition,Secondary Dentition

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