Pulpal Response after Acute Dental Injury in the Permanent Dentition: Clinical Implications—A Review

•Pulpal responses after avulsion, luxation, crown- and root fractures are described.•Competition between ingrowth of new neurovasculature versus infection is outlined.•Neurovascular impairment leads to pulp canal obliteration, resorption, or pulp death.•Intermediary stations in pulpal response (TAB) can lead to pulpal healing.•A more conservative treatment approach in young patients is addressed.

IntroductionPulpal reactions after acute dental injury have been puzzling for many clinicians. The management of dental trauma and an understanding of clinical and treatment factors in outcomes arose from multivariate statistical analyses of archive material from Copenhagen.MethodsThe aim of this article was to review the works of this period with respect to pulpal reaction after acute mechanical trauma. These traumas include luxation, avulsion, root fracture, and crown fracture. A PubMed search identified other literature where multivariate analysis was used, and these results were compared with earlier pioneering studies.Results and ConclusionsThis article will describe pulpal responses after the said acute injuries and outline the competition that takes place between ingrowth of a new neurovascular system into the traumatized tissue versus bacterial invasion. If there is an intact neurovascular supply to the pulp, then the same immunologic defenses that are found in the rest of the body can function and defend against infection. If this is disturbed in any way, alterations in the pulp (eg, pulp canal obliteration, resorption processes) or pulp death (pulp necrosis) will occur. Intermediary stations in pulpal response (ie, transient apical breakdown) mimicked the cardinal signs of pulp necrosis, which could be reversible and lead to pulpal healing. These processes will also be addressed with respect to a more conservative treatment approach. In young patients, it is of the utmost importance that pulp vitality be maintained to ensure continued root growth and development and an intact dentition.