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ABSTRACT
Objective: To evaluate the effect of extrusion on immature permanent tooth PBF values during a 6-month post-trauma period and to compare the accuracy of cold tests on pulp sensibility of traumatized teeth with that of electric pulp tests (EPT).
Methods: The study group comprised of 26 extruded immature maxillary incisors in 25 trauma patients. The respective contralateral homologous teeth (n=25) were included as a positive control group. Teeth in the study group were treated by repositioning and splinting. Pulp vitality readings for traumatized and control teeth were taken with LDF, EPT and cold test on the day of splint-removal (2-3 weeks after traumaT1) as well as 6 weeks (T2), 3 months (T3) and 6 months (T4) post-trauma. Student t and Mann-Whitney U-tests were used to compare data among groups. Statistical significance was set at P <0.05.
Results: LDF gave positive vitality readings (>4.5 PU) in all patients from T1 to T4 (with the exception of 1 patient at T1).
Conclusions: LDF was able to accurately identify vitality in traumatized immature teeth even during the first few weeks following trauma, whereas conventional sensibility tests were unable to accurately recognize vitality shortly after trauma.
KEYWORDS: Dental trauma, Electric pulp testing, Extrusion injury, Immature teeth, Laser Doppler Flowmetry, Pulpal blood flow, Thermal testing.
doi: https://doi.org/10.12669/pjms.344.15524
INTRODUCTION
Luxation injuries of permanent teeth are true dental emergencies that occur most frequently in children between the ages of 8 and 15.1 One of the most serious of these injuries is extrusive luxation, in which the tooth is centrally displaced from its socket and exhibits increased mobility. Extrusive luxation is a complex wound involving disruption of the periodontal ligament, cementum and pulp neurovascular supply.2
Pulp necrosis has been reported to be the most common complication after extrusive injuries.2 However, correctly diagnosing necrosis is particularly challenging for the pediatric dentist, particularly in young children and in cases of dentoalveolar trauma. Pulp vitality is commonly measured using thermal and electrical sensibility tests,3 which evaluate pulp vitality indirectly by measuring pulpal nerve response, rather than directly monitoring vascularity. However, teeth that have temporarily or permanently lost sensory function due to trauma may not respond to sensibility testing despite the presence of an intact vasculature.4
Direct measurement of pulpal blood flow (PBF) provides the...