Cvek EDT 1992
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.