title: Early detection of pulp necrosis and dental vitality after traumatic dental injuries in children and adolescents by 3-Tesla magnetic resonance imaging.
abstract: OBJECTIVE
  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).
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. Max Heiland, MD, DMD, PhD), University Medical Center Hamburg Eppendorf, University of Hamburg, Martinistr. 52, 20246 Hamburg, Germany. Electronic address: a.assaf@uke.uni-hamburg.de.
authors.forename: Alexandre T
authors.initials: AT
authors.lastname: Assaf
authors.affiliation: Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. Dr. H.F. Zeilhofer, MD, DMD, PhD), University Hospital Basel, University of Basel, Spitalstr. 21, 4056 Basel, Switzerland.
authors.forename: Tomislav A
authors.initials: TA
authors.lastname: Zrnc
authors.affiliation: Department for Diagnostics and Interventional Radiology (Head: Prof. Dr. G. Adam, MD, PhD), University Medical Center Hamburg Eppendorf, University of Hamburg, Martinistr. 52, 78, 20246 Hamburg, Germany.
authors.forename: Chressen C
authors.initials: CC
authors.lastname: Remus
authors.affiliation: Department of Diagnostics and Interventional Neuroradiology (Head: Prof. J. Fiehler, MD, PhD), University Medical Center Hamburg Eppendorf, University of Hamburg, Martinistr. 52, 20246 Hamburg, Germany.
authors.forename: Arun
authors.initials: A
authors.lastname: Khokale
authors.affiliation: Department for Diagnostics and Interventional Radiology (Head: Dr. H. Denkhaus, MD), Marien Hospital Hamburg, Alfredstraße 9, 22087 Hamburg, Germany.
authors.forename: Christian R
authors.initials: CR
authors.lastname: Habermann
authors.affiliation: Department of Diagnostics and Interventional Neuroradiology (Head: Prof. J. Fiehler, MD, PhD), University Medical Center Hamburg Eppendorf, University of Hamburg, Martinistr. 52, 20246 Hamburg, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Schulze
authors.affiliation: Department of Diagnostics and Interventional Neuroradiology (Head: Prof. J. Fiehler, MD, PhD), University Medical Center Hamburg Eppendorf, University of Hamburg, Martinistr. 52, 20246 Hamburg, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Fiehler
authors.affiliation: Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. Max Heiland, MD, DMD, PhD), University Medical Center Hamburg Eppendorf, University of Hamburg, Martinistr. 52, 20246 Hamburg, Germany.
authors.forename: Max
authors.initials: M
authors.lastname: Heiland
authors.affiliation: Department of Diagnostics and Interventional Neuroradiology (Head: Prof. J. Fiehler, MD, PhD), University Medical Center Hamburg Eppendorf, University of Hamburg, Martinistr. 52, 20246 Hamburg, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Sedlacik
authors.affiliation: Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. Max Heiland, MD, DMD, PhD), University Medical Center Hamburg Eppendorf, University of Hamburg, Martinistr. 52, 20246 Hamburg, Germany.
authors.forename: Reinhard E
authors.initials: RE
authors.lastname: Friedrich
mesh_terms: D000293:Adolescent; D000539:Alveolar Process / Q000293:injuries; D019412:Anatomy, Cross-Sectional / Q000379:methods; D002648:Child; D003782:Dental Pulp / Q000098:blood supply / Q000000981:diagnostic imaging / Q000502:physiology*; D003790:Dental Pulp Necrosis / Q000000981:diagnostic imaging*; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007091:Image Processing, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008440:Maxillary Fractures / Q000628:therapy; D012390:Root Canal Therapy; D013165:Splints; D014084:Tooth Avulsion / Q000628:therapy; D018677:Tooth Injuries / Q000150:complications* / Q000628:therapy; D014090:Tooth Replantation / Q000379:methods
keywords: 3 Tesla (3T); Dental trauma; Magnetic resonance imaging (MRI); Pulp perfusion; Tooth vitality; Traumatic dental injuries (TDI)