Diagnosis of Pulpal Healing Complications
1 Recognize the clinical and radiographic signs of pulp healing, pulp necrosis and pulp canal obliteration.
2 Identify time periods following traumatic injuries when healing events can be identified.
3 Recognize the existence of transient apical breakdown.
After a luxation injury, there may be partial or total disruption of the neurovascular supply to the pulp apically. In cases of partial disruption, reduced circulation can still be maintained throughout the pulp, with complete reconstitution of the neurovasculature after a few weeks. In cases of total rupture of the neurovascular supply, gradual revascularization will take place in an apico-coronal direction at a rate of approximately 0.5 mm vessel ingrowth per day.6 Signs of successful revascularization are a narrowing of the pulp canal and positive sensibility testing which usually takes place after 2–3 months (Figures A–D).