Prognóstico pulpar de dentes permanentes com rizogênese incompleta reimplantados após avulsão traumática: estudo clínico longitudinal

Abstract

Pulp prognosis of permanent teeth with incomplete rhizogenesis replanted after traumatic avulsion: longitudinal clinical study Tooth avulsion implies total displacement of the tooth out its soket leading to rupture of all fibers of the periodontal ligament as well as the apical vascular-nervous bundle. Replantation is the treatment of choice, although its long-term prognosis is unpredictable. While some reimplanted teeth remain in the mouth for years, others are lost quickly causing serious psychological, aesthetic, functional and financial damage. Few longitudinal clinical studies have evaluated the pulp prognosis of reimplanted permanent teeth. This study consisted of a historical cohort to assess the pulp prognosis of 133 permanent teeth with incomplete rhizogenesis replanted after traumatic avulsion in 117 patients treated at the Dental Trauma Clinic of the Faculty of Dentistry at Federal University of Minas Gerais, from 1994 to 2018. Dental records were evaluated to collect data such as: gender, age of the patient at the time of trauma, stage of root development, storage medium and length of extra-alveolar period of the avulsed tooth, prescription of systemic antibiotic therapy, immobilization time, presence of concomitant uncomplicated crown fractures in the avulsed tooth. The pulp response pattern was determined based on clinical and radiographic data and classified as healing as follows: pulp survival without radiographic changes, pulp canal obliteration and invagination of bone-like mineralized tissue in the pulp cavity. Pulp necrosis was classified as non healing. Statistical analysis was done using the program R (version 3.5.3, Vienna, Austria, 2018). A logistic regression was performed to explore possible associations between the studied co-variables and the occurrence of healing inside the pulp cavity. Pulp necrosis represented the most frequent finding (82.7%) followed by bone-like tissue invagination into root canal space (9.77%), maintenance of pulp vitality (5.26%) and root canal obliteration (2.25%). The final multivariate model demonstrated that the chances of pulp healing were greater for teeth with stages of rhizogenesis 2 (OR 17.4, 95% CI 2.8-106.6, p = 0.003) and 3 (OR 6.9, 95% CI 1.4 -3.9, p = 0.019), teeth stored in milk (OR 5.5, 95% CI 1.1 - 26.5, p = 0.038) and teeth reimplanted within 15 minutes (OR 25.9, 95% CI 3.7 - 183.3, p = 0.001). The present results demonstrated that healing represented a rare event, occurring mainly in teeth reimplanted with early stages of root development after storage in physiological media such as milk for short periods of time.