Factors associated with the injury

(a) Size of exposure

There is no evidence to support the statement that fractured teeth with larger exposures have a poorer prognosis. Indeed, in the related field of iatrogenic exposure arising during treatment for caries, no difference in outcome has been shown in relation to the size of the exposure. It has also been shown in traumati-cally induced pulp exposures, in primates, that the size of the exposure does not affect the ability of the pulp to form a satisfactory calcilic barrier beneath calcium hydroxide. Nevertheless, it is possible that the larger the exposure the greater the risk of bacterial contamination and the larger the blood clot on the pulp surface, both factors known to adversely influence healing (sec below). However, the idea that the size of the exposure is important is so (irmly entrenched that it will be a long time before the prevailing view changes. This is especially difficult to reconcile as the recommended treatment procedures frequently involve surgically increasing the size of the pulp exposure. An explanation for this difference of opinion is that small exposures appear clinically as if only the edge of the pulp is involved. With larger fractures, where the fragment, is lost, the pulp associated with the lost fragment remains attached to the main body of the pulp appearing like a pulp polyp protruding from the surface. When seen promptly, before the onset of inflammation, surgical removal of the protruding pari, of the pulp and placement of calcium hydroxide, could be expected to have a satisfactory outcome.

(b) Time since the accident

The treatment of pulp exposure should be carried out as soon as possible after the accident, preferably within a few hours. The longer the pulp is in contact with the oral environment, the greater the risk of contamination. Primate experiments

0 0

Post a comment