Clinical Guidance for Optimal Endodontic Management of Traumatized Permanent Teeth

Clinical Guidance for Optimal Endodontic Management of Traumatized Permanent Teeth, Docvidya, Ketorol-DT, Dental, Dental & Oral Health, Dental Pain, Dentinal Hypersensitivity, Dentist, Endodontics, Assessing the status of the traumatized pulp, Enamel cracks, Dentine exposure, Pulp exposure, Root fracture, Teeth located at the bone fracture line, Immature teeth with necrotic pulps.

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This clinical guidance aims to provide a comprehensive overview of the current best practices and evidence-based strategies for endodontic management of traumatized permanent teeth.

Position statement area

Recommendations for endodontic management

Assessing the status of the traumatized pulp

•	Lack of sensibility response post-trauma doesn't always mean pulp necrosis
•	Thermal tests are the standard for sensibility testing
•	Immature teeth may show false negatives with electric pulp testing due to higher excitation thresholds
•	Consider false positives, especially in children.
•	Clinical and radiological findings are essential for predicting pulp healing potential
•	Assessing pulp perfusion with vitality tests is desirable but lacks a simple clinical approach
•	Post-traumatic crown colour changes have limited diagnostic value; root canal decisions should not rely solely on this factor

Enamel cracks

•	No treatment
•	Adhesive sealing may be considered, although clinical data are lacking

Dentine exposure

•	Immediate definitive adhesive restoration if feasible during emergency treatment.
•	As emergency treatment: preferably adhesive sealing or temporary dentine protection with a calcium hydroxide cement or a glass ionomer cement if subsequent treatment takes place within the next few days.

Pulp exposure

•	Vital pulp treatment preferably with non-staining
•	HCSC as capping material but favourable results can also be achieved
•	with calcium hydroxide.
•	Approach 1: Partial pulpotomy (preferred treatment particularly for large exposures and cases with treatment delay)
•	Approach 2: Direct pulp capping (for minor exposures treated within the first hours after trauma)
•	Root canal treatment only if indicated due to concomitant luxation injury or dictated by restorative reasons (placement of a root canal post).

Root fracture

•	No immediate endodontic intervention irrespective of response to initial sensibility test.
•	Close clinical and radiologic follow-ups to identify pulp necrosis.
•	In case of pulp necrosis: root canal treatment restricted to the coronal fragment and no intervention on the apical fragment.

Teeth located at the bone
fracture line

•	Extraction should be avoided unless there is an absolute indication for the removal.
•	Pulp sensibility may return within one year.
•	Endodontic management and prognosis of the teeth is dictated by the state of the traumatized pulp rather than the alveolar bone fracture itself.

Immature teeth with necrotic pulps

•	Mechanical removal of root dentine should be limited to a minimum. Instead, the focus lies on copious irrigation using sodium hypochlorite to remove necrotic pulp tissue and disinfect the root canal. Irrigant activation is highly recommended.

Following trauma

•	Approach 1: Root canal treatment with apical plug with HCSC followed by reinforcement of the tooth instead of traditional calcium hydroxide apexification.
•	Approach 2: Revitalization.

Endodontic care for traumatized teeth aims to preserve pulp whenever feasible, prioritizing early intervention to prevent infection-related root resorption and optimize outcomes.

GGI-CO-A1-AQS-300023454-NB-G24-0384
For the use of a Registered Medical Practitioner, Hospital or Laboratory only.
Reference:
1.	European Society of Endodontology (ESE) developed by:; Krastl G, Weiger R, Filippi A, Van Waes H, Ebeleseder K, Ree M, Connert T, Widbiller M, Tjäderhane L, Dummer PMH, Galler K. European Society of Endodontology position statement: endodontic management of traumatized permanent teeth. Int Endod J. 2021 Sep;54(9):1473-1481. doi: 10.1111/iej.13543. Epub 2021 Jun 20. PMID: 33934366. Click here to view the original article

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Clinical Guidance for Optimal Endodontic Management of Traumatized Permanent Teeth

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