TRANSIENT APICAL BREAKDOWN

Here we present a case of a young healthy male who sustained facial trauma involving monkey bars and affecting tooth #9. He had subsequently had a splint placed at the ER to rectify a subluxation injury and was referred to our office for follow-up and necessary treatment. Upon initial evaluation, the tooth was still slightl symptomatic and tested negatively to pulp vitality testing. Additionally, there appeared to be a lesion on radiograph. As the traumatic incident was recent, we recommended that the tooth be re-evaluated at a future date (in this case 3 months) and instructed the parents on signs/symptoms in which to be aware that would warrant treatment. Upon 3 month evaluation, the patient was asymptomatic and showed no clinical signs of pathology. Moreover, the tooth now was responsive to pulp vitality testing. Lastly, the radiograph showed what appears to be spontaneous resolution of the lesion. This process is known as transient apical breakdown. It is important not to get caught up in the results of pulp vitality testing particularly when done immediately after a traumatic incident. Teeth such as this one may not be responsive for up to 2-3 months. Recall is imperative. We were glad that no treatment was necessary here.