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Subluxated tooth #9

From: Mark Dreyer To: ROOTS Sent: Monday, February 27, 2006 5:22 PM Subject: [roots] Treat or not? 10 yr old kid subluxated tooth #9 last July. No hx of symptoms of any kind. Non-responsive to thermal and ept. My question is this: is it possible for a pulp to remain vital yet non-responsive to vitality testing almost a year after trauma of this sort? I thought so, and that's why I didn't make the call to treat this tooth based soley on non-response to testing. Rather I recommended 6 months recalls for a couple years to evaluate radiographically prior to making a definitive tx recommendation. I'm concerned that the apex of the adjacent central is more developed than this one...perhaps proof of non-vitality of the traumatized tooth? Does anyone think tx should be initiated here for sure or is monitoring ok? Mark Dreyer

Mark, Based on the information you have provided I recommend initiating the endo. In addition to the "necrotic" response to pulp testing, apical development and root development is arrested as indicated by the difference in canal width between #8 & #9. If you have any further doubt, do a test cavity and I'm confident you will go all the way into the pulp space without any pain to the patient. #9 looks a little darker on the photo also. The chances of regenerating a pulp in a root that has developed this far is minimal. I don't see an advantage to delaying treatment. If the pulp space gets infected the prognosis drops by 10-15% I would estimate. Dentin tubules in immature teeth are much larger than in an adult and can hold a lot more bacterial contamination which is more difficult to eliminate. Access, debride, Ca(OH)2 for 2-3 weeks and obturate. Ultrasonic instrumentation/irrigation will be helpful.- Randy Hedrick Mark, I would be going in rather than waiting, based on your reported findings. It's so much easier to make the call when I'm just looking at this on a monitor ;-)) - Kendel Thanks Randy and Kendel for your responses. It looks like tx is what is warranted here. - Mark Mark, That means the nerves are dead but the vessels not. If the roots have not formed, that means the pluripotent cells are absent and ther's no activity. Invariably it is going to fail completely. If you wait, then you may get that tooth dicoloured and then you may have to try bleeching and it may add some internal resorpion.... SO I would recommend treat it as early as possible. - vipin Thanks Vipin...that seems to be the consensus from everyone that's responded. - Mark

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