Traumatic dental injuries are potentially very complex and can lead to a number of different responses of the pulp and peri-radicular tissues. A thorough understanding of the various potential pulp responses is essential when managing such injuries so appropriate management can be undertaken. Following many injuries, the pulp may survive – but this can only occur if the pulp is managed appropriately at the emergency visit which includes not removing the pulp! However, there are some specific injuries where pulp survival is unlikely. If the pulp necroses and becomes infected, then there is the potential for external inflammatory resorption to develop if there has also been damage to the periodontal ligament and/or external root surface of the tooth. In such situations, a preventive approach can be used to prevent this resorption from developing. A key factor is to recognise which specific injuries make teeth susceptible to this resorption. The timing of the root canal treatment is another key factor along with the medicament regime that is used within the root canal system. This lecture will discuss the injuries where such a preventive approach is indicated and will outline a scientifically-based management protocol for both immature and mature teeth following trauma where external inflammatory resorption is likely to occur.
On conclusion of the lecture, participants should be able to:
1. Discuss the various responses of the pulp following trauma to a tooth.
2. Explain why some pulps survive and others do not survive after trauma to a tooth.
3. Identify teeth that are likely to develop external inflammatory resorption.
4. Compare the various medicaments that can be used to treat external inflammatory resorption.
5. Apply the “preventive approach” to teeth that are likely to develop external inflammatory resorption.