Abstract

Long-term sequelae of dental injuries in the permanent dentition.

Prof. Dr. Kurt Alois Ebeleseder
In the permanent dentition, the most frequent healing complication after trauma is pulp necrosis. It is often a consequence of dislocation which causes an impaired blood circulation resulting in a clinically symptomless pulp infection. Acute pulpitis is seen in pulps which have survived the trauma but are confronted with microleakage after restoration. In few cases, the pulp has to be sacrificed for the fixation of a post.
Late consequences of loss of vitality are dyscoloration, chronical apical periodontitis and proneness to root fracture.
Root resorption is always a sign of damage to the cementum which can happen in different ways. In surface resorption, cementum directly damaged by the trauma is removed and repaired. This resorption process can be prolonged and triggered by endodontic infection and is then called extern inflammatory root resorption. If bacteria from the gingival sulcus reach the resorption area, it is also prolonged and called cervical resorption. Replacement resorption is seen in teeth without periodontal repair when bone directly gets contact to the necrotic cementum. Internal resorption is seen in teeth with partial pulpal repair.
Marginal bone can be lost by the development of a posttraumatic periodontal pocket (vertical loss) and after intrusion trauma (horizontal loss). Direct infection of alveolar bone results in sequestration. Indirect loss of alveolar bone is seen in ankylotic teeth with vertical growth inhibition. Loss of teeth is also connected with subsequent bone loss.
The loss of a tooth is the most severe complication after dental trauma. The reasons for a final root fracture are thin and chemically degradated canal walls after apexification, metallic posts and progressive cervical resorption. In some cases, teeth are lost due to overtreatment or treatment errors. Finally, new trauma can result in tooth loss.