Dental Trauma: Tooth Displacement and Nerve Health

Dental displacement due to impact?

1.
The reason for the nerve necrosis in the tooth after the impact is likely due to tissue injury that did not heal properly.
Trauma can cause damage to the dental pulp, leading to inflammation and eventual necrosis if the blood supply is compromised.
2.
Once a tooth has been determined to be non-vital (inactive), it is unlikely that it will regain vitality.
However, in rare cases, if the pulp is only partially damaged and there is some remaining healthy tissue, there might be a chance for recovery, but this is not common.
3.
If the nerve recovers to a normal state, there is still a possibility of future necrosis, especially if the tooth experiences further trauma or if there are underlying issues such as infection or decay that could compromise the pulp again.
Regarding the foreign body sensation and discomfort when biting after the ceramic veneer placement, it is possible that the veneer is not fitting properly, which can lead to pressure points and discomfort.
A proper evaluation by your dentist is necessary to determine if adjustments or remaking the veneer is needed.
As for the temporomandibular joint (TMJ) fracture, reviewing the CT scan and post-operative X-rays will help assess the displacement of the joint bones.
It is essential to consult with your oral surgeon or a specialist to determine if realignment is necessary based on the images provided.

Bo, 20~29 year old female. Ask Date: 2023/02/25

Dr. Zeng Guanghui reply Dentistry

1.
The periodontal tissues and nerves within the impacted tooth may be damaged, and the risk of damage increases if the tooth is displaced.
2.
If there is no vitality detected in the tooth after five months post-trauma, it is unlikely to regain vitality.
3.
If the nerve has returned to normal, it is unlikely to necrose in the short term, but this is not guaranteed in the long term.
4.
Ceramic veneers typically do not cause a foreign body sensation; however, if biting leads to discomfort or pain, it is advisable to consult a dentist to assess whether the dental nerve has been stimulated.
5.
It is recommended to seek a detailed evaluation from an oral surgeon.
Dr.
Tseng Guang-Hui, Department of Dentistry, Nantou Hospital.

Reply Date: 2023/02/25

More Info

Dental trauma, particularly involving tooth displacement and nerve health, can be a complex issue that requires careful evaluation and management. Based on your situation, let's address your questions systematically.

1. Causes of Nerve Death After Trauma: When a tooth experiences trauma, such as being displaced or intruded, the nerve (pulp) can become damaged due to several factors. The primary reason for nerve death is often related to the injury to the blood supply that nourishes the nerve tissue. If the tooth is displaced, the surrounding tissues may be bruised or torn, leading to inflammation and a compromised blood supply. This can result in pulp necrosis, where the nerve tissue dies. Additionally, the impact can cause direct damage to the nerve fibers themselves. If the tooth was not repositioned promptly, the chances of nerve recovery diminish over time.

2. Possibility of Nerve Recovery: Once a tooth has been assessed as non-vital (or "non-active"), the likelihood of it regaining vitality is quite low, especially if significant time has passed since the injury. In some rare cases, if the pulp is only partially damaged, there may be a chance for recovery, but this is not common. The health of the surrounding tissues and the extent of the initial injury play crucial roles in determining whether any recovery is possible.

3. Risk of Future Nerve Death: Even if the nerve were to recover temporarily, there is still a risk of future necrosis. Factors such as ongoing trauma, infection, or further displacement can lead to a recurrence of nerve death. Additionally, the health of the tooth structure and the integrity of any restorations (like crowns or veneers) can impact the long-term vitality of the tooth.

Regarding the discomfort you are experiencing with the ceramic veneer, it is possible that the veneer is not fitting properly, which can lead to pressure points and discomfort when biting. If the veneer does not align correctly with the opposing teeth, it can cause an uneven bite, leading to pain and a sensation of foreignness. It is essential to have this evaluated by your dentist, who can assess the fit and make necessary adjustments.

As for your concerns about the temporomandibular joint (TMJ) and the associated bone fractures, it is crucial to follow up with your oral surgeon or a specialist in TMJ disorders. The imaging you provided can help in assessing the extent of the injury and determining whether surgical intervention is necessary. If there is significant displacement of the joint or associated structures, surgical correction may be required to restore function and alleviate pain.

In summary, dental trauma can lead to complex outcomes involving nerve health and tooth vitality. It is essential to have ongoing evaluations with your dental care provider to monitor the health of your teeth and surrounding structures. Regular follow-ups can help in managing any complications that arise and ensure that you receive appropriate treatment for both your dental and TMJ concerns. Always communicate any changes in symptoms or discomfort to your healthcare provider to facilitate timely interventions.

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