Prognóstico pulpar após obliteração da cavidade pulpar em dentes permanentes traumatizados: estudo clínico longitudinal

Abstract

The development of secondary pulp necrosis following post-traumatic pulp canal obliteration (PCO) is a late complication that poses a challenge during the endodontic therapy. However, the pathogenesis and determinants of such shortcoming remain unclear. The present study consisted in a historical cohoort aiming to evaluate the longterm pulp survival after post-traumatic PCO in 337 permanent teeth from 254 patients referred for treatment at the Dental Trauma Clinic of the School of Dentistry of UFMG. Clinical and radiographic data were extracted from patients’ records to assess pulp outcome, classified as pulp necrosis when the periapical index (PAI) was ≥ 3, or pulp survival categorized into the absence of periapical changes with no response to sensibility tests (PCO – sensibility) and absence of periapical changes with a positive response to sensibility tests (PCO + sensibility). Secondary pulp necrosis was diagnosed in 27 teeth (8%), all of them with total PCO (T-PCO). The overall pulp survival rate without pulp necrosis was 75% after 20 years of follow-up. A Cox regression model demonstrated that none of the potential predictors, such as type of TDI, patient’s age, stage of root development at the time of trauma, and PCO onset timing, could be associated with the late development of secondary pulp necrosis after PCO. The current results demonstrated that teeth with PCO had a favourable pulp prognosis in the long term, giving an important contribuition to decision-making during the follow-up of such cases pointing to a more conservative approach.