Pulp Vitality Preservation in Patients Affected by Dental Trauma

Objectives: This study investigates the preservation of pulp vitality in patients who have experienced dental trauma, focusing on the association between trauma type, emergency treatment, and the occurrence of complications over time. Materials and Methods: This longitudinal prospective observational study included 143 patients (85 males, 58 females; mean age 26.92 years) treated for traumatic dental injuries (TDI) at the Restorative Dentistry Department of the Turin Dental School from 2011 to 2024. Inclusion criteria encompassed permanent teeth with mature apical development affected by various types of fractures, concussions, luxations, and avulsions. Patients were followed up at specific intervals: initial visit (T0), within 12 months (T1), and after 12 months (T2). Pulp vitality was assessed using thermal and electric tests, and radiographic examinations were conducted. Results: At the initial assessment (T0), 64.71% of the teeth were vital. This vitality rate remained stable at 7-15 days post-injury (T1). Over longer follow-up periods, uncomplicated crown fractures maintained the highest pulp vitality (70.94% at T2), while complicated crown fractures showed a significant drop in vitality (21.43% at T2). The statistical analysis revealed significant differences in pulp vitality based on the type of trauma (p<0.0001) and emergency treatment (p<0.0001). Notably, teeth with concussions had a better prognosis for pulp vitality than those with luxations or avulsions (p<0.0001). Long-term complications such as tooth mobility and discoloration were significantly associated with the type of trauma and emergency treatment (p<0.05). Conclusion: The type of dental trauma significantly influences both immediate and long-term pulp vitality. While certain emergency treatments are effective in maintaining short-term vitality, long-term outcomes are more influenced by the initial trauma's severity and patient-specific factors. This study underscores the importance of immediate and appropriate emergency treatment and continuous follow-up to manage and mitigate complications. Further research with larger samples and extended follow-up periods is recommended to explore these associations more comprehensively.