Pulp healing in immature replanted permanent teeth: A competing risk analysis

Area of Science:

• Endodontics
• Dental Traumatology
• Regenerative Dentistry

Background:

• Tooth avulsion severs the pulp's neurovascular supply.
• Immature teeth show potential for revascularization and pulp healing.
• Root canal treatment may be avoidable in immature avulsed teeth.

Purpose of the Study:

• To identify prognostic factors for pulp response after replantation.
• To evaluate healing versus non-healing outcomes in immature permanent teeth.
• To analyze the impact of clinical variables on pulp vitality post-replantation.

Main Methods:

• Retrospective review of 133 replanted immature permanent teeth from 117 patients.
• Classification of pulp outcomes as healing or non-healing (necrosis with infection).
• Competing risk model used to assess prognostic factors.

Main Results:

• Pulp necrosis with infection occurred in 78.2% of teeth; healing in 12.8%.
• Short extra-alveolar periods (<15 min) significantly increased pulp healing odds (csHR: 7.83).
• Advanced root development (Moorrees' stages 4-5) increased necrosis risk compared to stage 2.

Conclusions:

• Pulp healing is infrequent after replantation of young permanent teeth.
• Short extra-alveolar time (<15 min) is crucial for pulp healing.
• Early root development stages are associated with a lower risk of pulp necrosis.