pulpanekros

Pulpanekrose, or pulpal necrosis, is the death of dental pulp tissue resulting from loss of vitality due to injury, infection, or chronic irritation. It can occur after extensive caries, dental trauma, cracks or fractures, repeated procedures that irritate the pulp, or aging, when blood supply to the pulp declines. Necrosis may be partial or complete and the tooth may remain asymptomatic or develop signs of infection.

In a necrotic pulp, living pulp tissue is gradually replaced by dead tissue and bacteria can invade the root canal system. Clinically, a necrotic tooth often test non-responsive to pulp vitality tests (such as cold or electric pulp testing) and may show gaps in responsiveness compared with adjacent teeth. Radiographs can reveal periapical radiolucencies or other signs of chronic or acute infection, although early changes may be absent.

Management depends on the tooth's restoratability and the presence of infection. The standard treatment for a necrotic, restorable tooth is endodontic therapy (root canal treatment), which aims to remove necrotic tissue, disinfect the canal system, and obturate it to prevent reinfection. If the tooth is non-restorable or patient preferences dictate, extraction may be performed. In immature teeth with incomplete root formation, apexification with calcium hydroxide or mineral trioxide aggregate (MTA), or regenerative endodontic procedures, may be considered to promote continued root development. Surgical endodontic approaches may be used for persistent periapical pathology when conventional root canal therapy is not sufficient.

Prognosis depends on timely and proper treatment, disinfection efficacy, and the remaining structure of the tooth. When treated appropriately, the prognosis for a necrotic tooth is generally favorable.