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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