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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) 21999441 | McCabe/2011 | 7 studies/1,470 teeth on the frequency of pulpal necrosis | Narrative Review of the Literature | | Key results | 1%-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) 17546867 | Moule/2007 | Review of literature on dental trauma | Narrative Review of the Literature | | Key results | Teeth 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: |
07/10/2014 |
| 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
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) |
post a rationale |
| None available | |
|
Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
post a comment |
| None available | |
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