The Lit Review Forum

Cvek EDT 1992 Effect of Traumatic Injuries Prognosis of luxated non-vital maxillary incisors treated with calcium hydroxide and filled with gutta-percha. A retrospective clinical study. Purpose: To report the periapical healing in luxated, non-vital teeth up to 4 year recall and to assess the frequency of cervical root fractures and its relation to different clinical parameters. M & M: 885 non-vital luxated max. incisors (296-subluxated, 589-luxated) · Stage of root development (1-5 stages: 1, 2, 3: root length less than 1/2, 1/2, 2/3, 4: open apex, 5:close apex · Tx: root canals were cleaned and shaped with saline, Biosept or 0.5% or 5% NaOCl. Antibacterial dressings, Chloromycetin Topical, 2% or 5% IKI were used before Ca(OH)2 in some teeth. · All filled with Ca(OH)2 and controlled at 3 or 6 month intervals. (immature teeth:24 mos, mature:11 mos) · After hard tissue barrier and PDL healing obtained, teeth were filled with GP (chloropercha using lateral cond) · F/U every 6 mos. up to 4 years. Radiographs were used to evaluate periapical healing. Pathologic changes (resorption, ankylosis, and fracture) were recorded. Statistics: Chi-Square (p<0.05) Results: No difference found b/t lateral and central incisors nor teeth with or without antibacterial dressing before Ca(OH)2 Tx. · Periapical healing: o After Ca(OH)2 Tx: 95% healing. No significant difference in the periapical healing or overfilling between immature and mature teeth. o 4 year after GP filling: 91% healing. No difference between immature and mature teeth. Overfilled teeth had higher frequency of recurrent periapical changes. · Root resorption o During Ca(OH)2 Tx: arrest of resorption and re-established PDL was seen in 97% of the teeth. o 4 year F/U: all teeth remained healed. o Ankylosis: occurred in 13 teeth, which were all intruded and repositioned by force. · Cervical root fracture o 168 teeth. (103 during Ca(OH)2 Tx, 65 after GP filling) o Frequency: immature > mature. Immature teeth: § Stage of root development--- least developed roots-77%, most developed roots-28%. § With cervical defect (61%) > without cervical defect (34%) Punch: · High frequency of periapical healing could be achieved by Ca(OH)2 and subsequent GP filling in non-vital mature and immature luxated incisors. · Ankylosis is related to severe intrusive luxation. · Higher frequency of root fracture was found in immature teeth with less developed root and with cervical defects. Critique: Retrospective study, tx performed by 58 different dentists/students, chloropercha technique used.