Early detection of pulp necrosis and dental vitality after traumatic dental injuries in children and adolescents by 3-Tesla magnetic resonance imaging
Early detection of pulp necrosis and dental vitality after traumatic dental injuries in children and adolescents by 3-Tesla magnetic resonance imaging
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DOI：
10.1016/j.jcms.2015.06.010
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发表时间：
2015-09-01
影响因子：
3.1
通讯作者：
Friedrich, Reinhard E.
中科院分区：
文献类型：
--
作者：
Assaf, Alexandre T.;Zrnc, Tomislav A.;Friedrich, Reinhard E.
目的：超过50%的儿童在童年时期遭受创伤性牙齿损伤（TDI）。在许多情况下，牙医会在再植后平均7-10天进行根管治疗（RCT）。我们的目的是评估是否RCT是必要的，在许多情况下，以及是否振兴受影响的牙齿是可能的，并可通过可视化使用3 T磁共振成像（MRI）。材料和方法：7名健康儿童TDI治疗的受影响的牙齿和减少牙槽突骨折，然后夹板复位。初次治疗后两周，取出夹板。6周后，所有儿童均接受了3特斯拉（3 T）三维高分辨率MRI，配有20通道标准头颈部线圈。儿童的平均年龄（男/女= 5：2）为10.8岁（范围，8-17岁）。此外，所有儿童接受常规牙科检查的牙齿活力和牙齿的敏感性，冷和触痛的concussion.Results：3 T MRI提供了良好的图像，允许牙髓和相邻的牙齿之间的精细辨别。使用四个内部优化的非对比增强序列，包括全景重建，牙髓的评估和分析是充分可行的。我们可以证明再灌注，从而在11个网站的受影响的牙齿的活力。在一名儿童中，MRI能够检测到受影响牙齿TDI后的非再灌注。所有病例的MRI结果均经临床检查证实。由于这一预期的管理和再灌注和牙齿活力的3 T MRI证明，只有一个孩子被治疗的RCT.Conclusion：3 T MRI是一个非常有前途的工具，可视化和检测领域的牙齿和口腔颌面部疾病。通过在TDI儿童中使用新的3 T MRI序列，我们可以证明RCT在每个病例中都是不必要的，从而可以防止将来对儿童进行不必要的治疗。应进行更大规模的研究，以确认临床实践中的潜在益处。(C)2015年欧洲颅颌面外科协会。由Elsevier Ltd.出版。保留所有权利。
Objectives: More than 50% of all children suffer a traumatic dental injury (TDI) during childhood. In many cases, dentists apply root canal treatment (RCT), which is performed on an average of 7-10 days after replantation. Our aim was to evaluate whether RCT is necessary in many cases, and whether revitalization of affected teeth is possible and measurable by visualization using 3T magnetic resonance imaging (MRI).Material and methods: Seven healthy children with TDI were treated by repositioning of the affected teeth and reduction of alveolar process fractures followed by splinting. Two weeks after initial treatment, splints were removed. After 6 weeks, all children received 3-Tesla (3T), three-dimensional, high-resolution MRI with a 20-channel standard head and neck coil. The mean age of the children (male/female = 5:2) was 10.8 years (range, 8-17 years). In addition, all children received conventional dental examination for tooth vitality and dental sensitivity to cold and tenderness on percussion.Results: 3T MRI provided excellent images that allowed fine discrimination between dental pulp and adjacent tooth. Using four in-house optimized, non-contrast-enhanced sequences, including panoramic reconstruction, the assessment and analysis of the dental pulp was sufficiently feasible. We could demonstrate reperfusion and thus vitality of the affected teeth in 11 sites. In one child, MRI was able to detect nonreperfusion after TDI of the affected tooth. MRI results were confirmed by clinical examination in all cases. As a consequence of this expectant management and proof of reperfusion and tooth vitality by 3T MRI, only one child had to be treated by RCT.Conclusion: 3T MRI is a very promising tool for visualization and detection in the field of dental and oromaxillofacial diseases. By using new 3T MRI sequences in children with TDI, we could demonstrate that RCT are not necessary in every case, and thus could prevent unnecessary treatment of children in the future. Larger studies should follow to confirm the potential benefit in clinical practice. (C) 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.