Pulp Space Obliteration Potential after Reimplantation of Avulsed Immature Teeth

Background: Calcific metamorphosis following reimplantation of avulsed teeth is the rule rather than the exception in case of immature teeth. In such cases, partial or total pulp obliteration is expected, which may prevent necessary root canal treatment, causes discoloration and masks sensitivity testing. In this review, we are trying to determine the optimum time for intervention before pulp obliteration becomes a problem the clinicians wish they never encountered.

Objectives: To determine when calcification following reimplantation begins and what are its complications.

Methods:

Selection criteria: Clinical cases with pulpal calcification following reimplantation of avulsed teeth.

Search strategy: Electronic search of Medline (Ovid), Pubmed, EMBASE (Ovid) and Web of science. Pubmed and web of science found nearly all the selected abstracts by databases. Initially, 52 abstracts were selected using the initial inclusion criteria and selection process. Finally, only 7 were selected.

Results: Two studies by the same author found that 60% of teeth reimplanted at early stage of root development showed partial or complete pulpal obliteration which occurred within 6m(months). In another study, 47% of the cases with mature roots showed partial pulp obliteration compared to the immature roots which were 11%. Pulp revascularization occurred in reimplanted teeth within 4m in one study and in another formed two types of hard tissue in immature teeth; one type deposited on the dentinal walls, the other separated from the walls and continued with periapical bone. Immature teeth showed pulp obliteration in 18.8 % after one year evaluation. Two reported cases showed signs of root development after 3m and pulp obliteration after 6m.

Conclusions: It appears that immediate reimplantation of teeth will lead to pulp obliteration within the first year. This type of calcification needs further attention at the molecular level to determine its cause so that the clinician can deal with these cases adeptly