ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Traumatized Anterior Tooth with Pulpal Calcification Can Be Treated with an Esthetic Restoration and Radiographic Follow-Up
Clinical Question In an adult with a history of trauma to an anterior tooth resulting in calcification of the pulpal canal and coronal discoloration, is a root canal or esthetic restoration with radiographic follow-up the best treatment plan?
Clinical Bottom Line An esthetic restoration and routine radiographic follow-ups are an adequate treatment plan for an adult patient with a traumatized anterior tooth resulting in pulpal calcification.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 21999441McCabe/20117 studies/1,470 teeth on the frequency of pulpal necrosisNarrative Review of the Literature
Key results1%-16% of teeth with a history of trauma will undergo pulpal necrosis. Histological examinations of teeth with pulpal obliteration with no clinical or radiographic signs of disease revealed no signs of inflammation. A majority of the literature supports no endodontic intervention, unless pulpal necrosis is implied from periapical pathosis and/or symptoms and a negative response to EPT has been identified. Since the failure rate of root canal treatment is low, it is reasonable to manage such teeth conservatively through clinical observation and routine radiographic examination.
#2) 17546867Moule/2007Review of literature on dental traumaNarrative Review of the Literature
Key resultsTeeth that undergo subluxation have a 6%-17% chance of developing pulpal necrosis and a 9%-12% chance of developing pulpal canal calcification. Only a small percentage of teeth that undergo pulpal calcification develop pulpal necrosis and become infected. Pulpal necrosis has a higher incidence if the canal appears totally calcified, trauma occurs after the root is fully formed and severe periodontal injury has occurred, or when teeth show rapid calcification. Pulpal necrosis and infection have been reported to occur up to 20 years post trauma. However, most teeth with pulpal calcification remain healthy and do not require endodontic therapy. Most teeth do not respond to thermal pulp tests but do respond to electrical stimulus. Therefore, EPT should be used to test the vitality of the pulp. The author found the current evidence to be limited and that more research is needed to better determine the correct treatment.
Evidence Search ("Dental Pulp Calcification"[Mesh]) AND "Root Canal Therapy"[Mesh] "Root Canal Therapy"[Majr] AND "Practice Guidelines as Topic"[Majr]
Comments on
The Evidence
The McCabe study was a narrative review on pulp chamber and root canal obliteration in anterior teeth. However, no search methods or selection criteria were mentioned in the article. The Moule study was also a narrative review on endodontic management regarding trauma to teeth. The methods were very limited and only mentioned the use of MEDLINE and the use of the key word “dental trauma.” There were no selection criteria mentioned.
Applicability This treatment option is much more ideal for a patient as to time and cost. Root canal treatments are a treatment plan that many patients dread. Being able to avoid this treatment saves the patient both time in the dental chair and money.
Specialty/Discipline (Endodontics) (General Dentistry) (Restorative Dentistry)
Keywords Root canal therapy, dental pulp calcification, discolored anterior tooth, calcific metamorphosis, anterior tooth trauma
ID# 2747
Date of submission: 07/10/2014spacer
E-mail martinla@livemail.uthscsa.edu
Author Leigh Veilleux
Co-author(s) Supriya Patel
Co-author(s) e-mail Patelsg@livemail.uthscsa.edu
Faculty mentor/Co-author Kenneth Hargreaves, DDS, PhD
Faculty mentor/Co-author e-mail Hargreaves.uthscsa.edu
Basic Science Rationale
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Comments on the CAT
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