Diagnosis and treatment of pulp necrosis in permanent anterior teeth with root fracture

A follow-up study was made of 20 traumatized permanent incisors with pulp necrosis observed as a sequel to root fracture. The material included 19 patients aged 8-17 years (mean 11.6 years) at the time of injury. Negative response to electric stimulation was noted in 16 teeth from the first examination. In four teeth an initial positive response changed to negative within 2-9 months. The negative response was supported by additional signs and symptoms of necrosis in 19 teeth. Radiolucencies adjacent to the fracture line or coronal discolorations were the most important diagnostic factors. Discolorations occurred within 2 months, whereas radiographic changes in the fracture area took from 3 to 5 months to develop. Four teeth were extracted without attempting endodontic therapy. Endodontic treatment confined to the coronal fragment was performed in 16 teeth. In most cases the canal was filled temporarily with calcium hydroxide until a closure at the fracture site was observed. Two apical fragments showing radiographic changes were surgically removed in conjunction with the permanent filling of the coronal fragments. During the postoperative observation period one tooth was extracted due to communication between the fracture area and the oral cavity. The treatment of the remaining 15 teeth was judged as successful after a mean observation period of 4.2 years, ranging from 2 to 5 years.