Dental Trauma, Root Resorption, and Regenerative Endodontic Procedures
Trauma essentials
Classify injuries: enamel-dentin fracture, crown-root fracture, root fracture, concussion, subluxation, extrusion, lateral luxation, intrusion and avulsion. For avulsion, extraoral dry time is the dominant prognostic factor: replant immediately if possible, otherwise store in milk, saline, or a balanced salt solution - never dry. Handle the root by the crown, replant with gentle pressure, and splint flexibly. Splinting duration is about 2 weeks for luxation injuries and 4 weeks for root fractures. Traumatised teeth often test negative to sensibility for weeks to months; do not diagnose necrosis prematurely.
Resorption
Inflammatory (infection-related) resorption follows pulpal necrosis with bacterial contamination and requires prompt canal disinfection with a calcium hydroxide medicament. Replacement resorption follows extensive cementum damage and proceeds to ankylosis; there is no reliable treatment. Cervical invasive resorption arises from clastic cells at the CEJ, is often invisible clinically, and is detected with CBCT; treatment involves debridement and medicament or sealing of the defect. Surface resorption is self-limiting.
Regenerative endodontics
Indicated for immature permanent teeth with necrotic pulps and open apices. Principles: minimal or no instrumentation beyond the coronal third, generous low-concentration sodium hypochlorite (about 1.5%) to preserve stem cells, an intracanal medicament (calcium hydroxide or triple antibiotic paste), induction of a blood clot into the canal, and a coronal seal with a calcium-silicate plug. Follow-up assesses continued root development and resolution of periapical disease.
Traps
- Rigid splinting increases the risk of ankylosis.
- Prolonged calcium hydroxide in avulsed teeth increases fracture risk.
- Not every open-apex tooth needs revascularisation; conventional apexification may be appropriate.
Rule of thumb: with trauma, the earlier the intervention and the shorter the extraoral dry time, the better the prognosis.