Histopathologic Features of Pulp Following Uncomplicated Crown Fracture of an Immature Tooth With Concomitant Subluxation Seven Days After the Injury. A Case Report.

Abstract

Reports on the histopathologic features of pulp tissue following traumatic injuries are scarce. The aim of the present clinical and histological report was to provide some novel insights about the histological condition of the pulp tissue of an immature permanent tooth, shortly after a combined injury of uncomplicated crown fracture with concomitant subluxation. A seven-year-old male patient presented with a localized buccal swelling apically on tooth #21 and with a radiographic app. One week earlier, the patient had suffered an uncomplicated crown fracture, and the referral dentist had solely performed a permanent restoration by rebonding the fracture fragment of the crown. The diagnosis was pulp necrosis, and a regenerative endodontic procedure was decided due to the wide-open apex of the injured tooth. After access cavity preparation was performed, it was evident that no degeneration of the pulp had occurred, so the tissue was removed using a sterile barbed broach and processed for histopathologic examination. A whitish tissue specimen of soft consistency, 0.8 cm in length and 5 μm thick, was processed for histologic evaluation. An extensive coagulative necrosis of the pulp tissue was revealed with dense aggregates of neutrophils along with areas of abscess formation. Some scattered lymphocytes were observed as well, together with areas of dystrophic calcifications. Finally, no bacteria were observed in any section of the specimen. Pulp necrosis may occur shortly after a combined traumatic injury of uncomplicated crown fracture with subluxation. In such cases, pulpal inflammation and the arise of symptoms may not be necessarily associated with the presence of bacteria. The present histological observation demonstrates that some kinds of inflammatory processes, after traumatic dental injuries, may initiate and evolve potentially without the presence of bacteria at the inflammatory site.