Pulp necrosis following luxated injury to teeth in a patient with uncontrolled type II diabetes mellitus: a case report

Article information

Restor Dent Endod. 2012;37(1):61-65

Publication date (electronic) : 2012 March 02

doi : https://doi.org/10.5395/rde.2012.37.1.61

Haneol Shin, DDS , Seung-Jong Lee, DDS, MS , Il-Young Jung, DDS, MSD, PhD , Chan-Young Lee, DDS, MSD, DDSc

Department of Conservative Dentistry, Yonsei University College of Dentistry, Seoul, Korea.

Correspondence to Chan-Young Lee, DDS, MSD, DDSc. Professor, Department of Conservative Dentistry, Yonsei University College of Dentistry, 50 Yonsei-ro, Seodaemun-gu, Seoul, Korea 120-752. TEL, +82-2-2228-8701; FAX, +82-2-313-7575; chanyoungl@yuhs.ac

Received 2011 December 16; Revised 2012 January 16; Accepted 2012 January 20.

Abstract

Patients with diabetes mellitus show delayed wound healing and increased susceptibility to infection. Therefore, the effects of diabetes on pulpal and periodontal healing should be taken into consideration when treating diabetic dental traumatized patients. This case presents the treatment for dental traumatized 20 yr old female with uncontrolled type II diabetes. The traumatized upper central incisors had showed pulpal healing in early days. However, 7 mon after the trauma, the teeth had been diagnosed with pulp necrosis with apical abscess. Eventually, non surgical root canal treatment on the teeth had been performed.

Keywords: Diabetes mellitus; Luxation; Pulp necrosis; Transient apical breakdown

References

1. Andreasen FM, Pedersen BV. Prognosis of luxated permanent teeth-the development of pulp necrosis. Endod Dent Traumatol 1985. 1207–220.

2. Roy S, Trudeau K, Roy S, Behl Y, Dhar S, Chronopoulos A. New insights into hyperglycemia-induced molecular changes in microvascular cells. J Dent Res 2010. 89116–127.

3. Delamaire M, Maugendre D, Moreno M, Le Goff MC, Allannic H, Genetet B. Impaired leucocyte functions in diabetic patients. Diabet Med 1997. 1429–34.

4. McMahon MM, Bistrian BR. Host defenses and susceptibility to infection in patients with diabetes mellitus. Infect Dis Clin North Am 1995. 91–9.

5. Andreasen FM. Transient apical breakdown and its relation to color and sensibility changes after luxation injuries to teeth. Endod Dent Traumatol 1986. 29–19.

6. Andreasen FM. Transient root resorption after dental trauma: the clinician's dilemma. J Esthet Restor Dent 2003. 1580–92.

7. Andreasen FM. Histological and bacteriological study of pulps extirpated after luxation injuries. Endod Dent Traumatol 1988. 4170–181.

8. Evans D, Reid J, Strang R, Stirrups D. A comparison of laser Doppler flowmetry with other methods of assessing the vitality of traumatised anterior teeth. Endod Dent Traumatol 1999. 15284–290.

9. Lee JY, Yanpiset K, Sigurdsson A, Vann WF Jr. Laser Doppler flowmetry for monitoring traumatized teeth. Dent Traumatol 2001. 17231–235.

10. Mesaros SV, Trope M. Revascularization of traumatized teeth assessed by laser Doppler flowmetry: case report. Endod Dent Traumatol 1997. 1324–30.

11. Yoon MJ, Kim E, Lee SJ, Bae YM, Kim S, Park SH. Pulpal blood flow measurement with ultrasound Doppler imaging. J Endod 2010. 36419–422.

12. Yoon TS, Kong HG, Kim E. Pulp vitality and coronal discoloration following traumatic injuries. J Korean Acad Conserv Dent 2010. 35492–496.

13. Kim JH, Bae KS, Seo DG, Hong ST, Lee Y, Hong SP, Kum KY. The role of type 2 diabetes as a predisposing risk factor on the pulpo-periapical pathogenesis: review article. J Korean Acad Conserv Dent 2009. 34169–176.

14. He H, Liu R, Desta T, Leone C, Gerstenfeld LC, Graves DT. Diabetes causes decreased osteoclastogenesis, reduced bone formation, and enhanced apoptosis of osteoblastic cells in bacteria stimulated bone loss. Endocrinology 2004. 145447–452.

15. Britto LR, Katz J, Guelmann M, Heft M. Periradicular radiographic assessment in diabetic and control individuals. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003. 96449–452.

16. Fouad AF, Burleson J. The effect of diabetes mellitus on endodontic treatment outcome: data from an electronic patient record. J Am Dent Assoc 2003. 13443–51.

17. Wang CH, Chueh LH, Chen SC, Feng YC, Hsiao CK, Chiang CP. Impact of diabetes mellitus, hypertension, and coronary artery disease on tooth extraction after nonsurgical endodontic treatment. J Endod 2011. 371–5.

Article information Continued

(open-access) :

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Figure 1

Radiograph of maxillary central incisors after traumatic injury.

Figure 2

(a) Radiograph was taken 2 weeks after traumatic injury. Small periapical radiolucencies associated both central incisors were observed; (b) Radiograph was taken 6 weeks after traumatic injury. Root resorptions as well as periapical radiolucencies in both teeth were evident; (c) Radiograph was taken 6 months after traumatic injury. There were no definite changes in root resorptions and periapical radiolucencies compared to radiograph at 6 weeks after trauma; (d) Radiograph was taken 7 months after traumatic injury. Periapical radiolucency of upper left central incisal had been increased; (e) Radiograph was taken after endodontic treatment on maxillary left central incisor. Note the increase of periapical radiolucency on right central incisor.

Figure 3

(a) Ultrasound Doppler images of upper anterior teeth at 6 weeks after traumatic injury. Pulsating signs in both upper central incisors were not clear like upper left lateral incisor, but observed faintly; (b) Ultrasound Doppler image of upper anterior teeth at 6 months after traumatic injury. Distinct pulsating sign were observed in all 4 anterior teeth; (c) Ultrasound Doppler images of upper anterior teeth at 7 months after traumatic injury. Pulsating sign on upper left central incisor had been disappeared; (d) Ultrasound Doppler images of upper anterior teeth at 11 months after traumatic injury. Pulsating sign on upper right central incisor was disappeared. Left central incisor had been root canal treated (negative control) and had no pulsating sign either.

Figure 4

Radiograph was taken after endodontic treatment on right upper central incisor. Periapical radiolucencies on both teeth were remained.