UWA Dental School, The University of Western Australia, Perth, Western Australia, Australia.
Aust Dent J. 2023 Jun;68 Suppl 1:S123-S140. doi: 10.1111/adj.12989. Epub 2023 Oct 31.
The dental pulp may respond favourably or unfavourably to traumatic dental injuries. The most serious unfavourable responses are pulp necrosis and infection of the root canal system. These cause apical periodontitis and/or external inflammatory resorption of the tooth. The following injuries require root canal treatment as part of their emergency management-(A) complicated crown fractures (but some may be suitable for conservative pulp treatments, such as pulp capping, partial pulpotomy or pulpotomy), (B) complicated crown-root fractures, (C) supra-crestal coronal third root fractures and (D) injuries where pulp necrosis is predictable or highly likely to occur AND where there has been damage to the root surface and/or periodontal ligament with the aim of preventing external inflammatory resorption. This latter group of injuries are avulsion, intrusion, lateral luxation with a crown fracture, extrusion with a crown fracture (all in fully developed teeth) plus avulsion with a crown fracture and intrusion with a crown fracture (both in incompletely developed teeth). All other injuries should not have root canal treatment commenced as part of the emergency management, but they must be reviewed regularly to monitor the pulp for any adverse changes to its status, particularly pulp necrosis and infection of the root canal system.
牙髓可能对创伤性牙损伤有良好或不良的反应。最严重的不良反应是牙髓坏死和根管系统感染。这些会导致根尖周炎和/或牙齿的外部炎症性吸收。以下损伤需要根管治疗作为其紧急管理的一部分-(A) 复杂冠部骨折（但有些可能适合于保守性牙髓治疗，如牙髓盖髓术、部分活髓切断术或活髓切断术），(B) 复杂冠根骨折，(C) 牙冠以上的中三分之一根折，以及(D) 预计或极有可能发生牙髓坏死且根面和/或牙周膜受损的损伤，目的是预防外部炎症性吸收。后一组损伤包括脱位、嵌入、伴有冠部骨折的侧向脱位、伴有冠部骨折的挤压性脱位（均发生在完全发育的牙齿中），加上伴有冠部骨折的脱位和伴有冠部骨折的嵌入（均发生在不完全发育的牙齿中）。所有其他损伤都不应该作为紧急管理的一部分开始进行根管治疗，但必须定期复查以监测牙髓状态的任何不良变化，特别是牙髓坏死和根管系统感染。
