Traumatic intrusion of permanent teeth. Part 2. A clinical study of the effect of preinjury and injury factors, such as sex, age, stage of root development, tooth location, and extent of injury including number of intruded teeth on 140 intruded permanent teeth

Effect of root immaturity and depth of intrusion on spontaneous re-eruption and healing complications: A retrospective analysis

BACKGROUND/AIMS

Dental trauma resulting in tooth intrusion is a severe injury of permanent dentition, with a prevalence of 0.5%-1.9% among traumatic dental injuries. Currently, treatment guidelines for intruded permanent teeth depend on root development and the degree of intrusion. However, the categorization of tooth maturity as mature or immature simplifies a complex continuum of root development stages. This study aims to investigate the impact of various stages of root development on the success of spontaneous re-eruption (SRE) of intruded teeth.

MATERIALS AND METHODS

This retrospective study analysed data from 80 children (125 teeth) aged 6-12 years who experienced dental intrusion between 2018 and 2022. Root maturation was classified based on Cvek's classification, eight were categorized as stage 1, 29 as stage 2, 44 as stage 3, 25 as stage 4, and 19 as stage 5. Intruded teeth with immature roots (Cvek's class 1-4) underwent SRE, while mature teeth (Cvek's class 5) were treated with SRE, orthodontic repositioning, or surgical repositioning based on the degree of intrusion. Primary outcome measures were successful re-eruption and secondary outcomes included observed complications during follow-up.

RESULTS

Regression analysis revealed that the patient's age, degree of root maturation, and degree of intrusion significantly affected spontaneous re-eruption (p < .05). SRE was more successful in teeth with Cvek's stages 1 and 2 compared to stages 3 and 4. Complications were associated with the treatment method, degree of root immaturity, and degree of intrusion.

CONCLUSION

The study demonstrates that as root maturation progresses, the likelihood of re-eruption decreases, and the risk of pulp necrosis and infection increases. Therefore, teeth in later stages of immaturity (Cvek stage 4) should be repositioned orthodontically or surgically without waiting for spontaneous re-eruption.

The consequences of orthodontic extrusion on previously intruded permanent incisors-A retrospective study

AIM

The aim of this study is to compare the adverse effects that occur after orthodontic extrusion of teeth that have been traumatically intruded with those of similar teeth that have not experienced any trauma.

BACKGROUND

The outcome of incisors intrusion can be affected by the patient's age, extent of injury, root development, and malocclusion. Orthodontic extrusion is a potential solution, but it may also cause complications.

MATERIALS AND METHODS

A retrospective study of the effects of extrusion of traumatically intruded teeth was carried out. The study group included 21 teeth in 14 patients. The control group included 32 teeth in 10 patients that underwent orthodontic extrusion with no history of trauma. Patients' age, gender, and stage of root development were recorded. The severity of the intrusion was classified as mild (<3 mm), moderate (3-6 mm), and severe (≥7 mm). A comparison of signs of pulp necrosis and root resorptions between the groups was made.

RESULTS

The central incisor is the tooth that is most injured in 80.9% of cases. A majority of these incidents involve severe intrusion, which was found in 42.9% of cases. 90% of the traumatized teeth had already lost their vitality prior to orthodontic treatment. Various forms of root resorption were observed in the study group. In the control group, 31.2% of teeth showed signs of external root resorption, but no endodontic intervention was carried out during the follow-up period, as these teeth remained vital.

CONCLUSIONS

Following intrusion, there is a high risk for root resorption and pulp necrosis. Orthodontic repositioning should be carried out with caution and mild force to prevent complications. Long-term follow-ups are required to ensure the best possible outcome.

The consequences of Dental trauma

Traumatic dental injuries pose a variety of complex ongoing issues to the dental practitioner. As dental injuries are commonly experienced at a young age, the treatment often takes place during adolescence or early in adulthood years at crucial development stages and very early in the life of the permanent successor. Therefore, the ability to correctly diagnose the injury, and follow an appropriate management plan should increase practitioners' ability to improve both the outcomes of dental trauma and long-term prognosis of the tooth.The consequences of dental trauma can be explored by taking into consideration the type of injury, which enables an assessment of the degree of insult to the pulpal tissues, neurovascular bundle, periodontal ligament and cemental cells. This has a direct influence on post-trauma complications. Early intervention, where indicated, and appropriate follow-up utilising international guidelines is imperative to identify changing diagnoses and act accordingly. This review paper will discuss the classification of traumatic injuries and their associated outcomes with management strategies for emerging disease including potential endodontic and restorative complexities and when to refer to secondary care.

Dental and Dentoalveolar Injuries in the Pediatric Patient

Dental and dentoalveolar injuries are common in the pediatric population. Management is predicated on the type of tooth injured (primary or permanent), extent of injury, the dental and behavioral age of the patient, and ability of the patient to tolerate treatment. Although many dental injuries occur in isolation, a systematic evaluation of the patient is mandatory to confirm the absence of basal bone fractures of the maxilla or mandible, traumatic brain injury, cervical spine injury, and/or facial soft tissue injury. Long-term follow-up is paramount to achieving a functional occlusion and optimal dental health following injury.

Critical appraisal of the 2020 IADT Guidelines: A personal commentary

The 2020 International Association of Dental Traumatology (IADT) Guidelines feature several important changes in the treatment recommendations for traumatic dental injuries (TDIs) from the previous 2012 iteration of these Guidelines. This evidence-based narrative review aims to provide a detailed appraisal of five specific changes incorporated in the 2020 IADT Guidelines, based on the available literature evidence that may have prompted these changes. The paper discusses three excellent additions/changes to the new Guidelines: (i) inclusion of a core outcome set for reporting TDIs; (ii) more conservative management of primary dentition TDIs including the changed recommendations for radiation exposure and managing primary dentition luxation injuries; and (iii) the changes in the treatment recommendations for permanent dentition avulsion injuries. The paper further debates whether two other changes made in the current IADT Guidelines for-(i) intrusion injuries in immature teeth; and (ii) complicated crown-root fractures in mature teeth-have sufficient evidence to support the changed recommendations.

Leveling the curve of Spee using different sized archwires: a randomized clinical trial of blood flow changes

OBJECTIVES

To compare blood flow (BF) changes of teeth subjected to orthodontic forces during curve of Spee (COS) leveling using different archwires (AW).

MATERIAL AND METHODS

Thirty subjects with COS > 5 mm were randomly assigned (1:1:1) into three groups based on the AW used: group 1: 0.017 × 0.025-inch stainless-steel (SS)AW, group 2: 0.019 × 0.025-inch SSAW, and group 3: 0.021 × 0.025-inch β-titanium (TMA)AW. In the 3 groups, a 5 mm-depth reverse COS was placed in the AWs. A laser Doppler flowmeter was used to measure BF at different time intervals (T0-T4).

RESULTS

In the 3 AWs group, BF of all measured teeth was reduced 20 min after force application. Afterwards, the BF values started to increase until the baseline values were almost restored within 1 week. Differences in BF changes between the extrusion and intrusion subgroups were observed within groups 1 and 3 during the first 20 min of force application (P < 0.05). Similar BF changes were recorded using the 3 different AWs. BF changes were associated with tooth type and the amount of COS depth change.

CONCLUSIONS

During CoS leveling, similar BF changes were recorded using the 3 different AWs. Tooth type and the amount of COS depth change were associated with BF changes within the first 20 min of force application. Greater BF reduction was found in premolars compared to incisors during the first 20 min of AW placement.

CLINICAL RELEVANCE

It is important to select a type of applied forces that minimally affect the BF. Intrusive forces appeared to have lower negative effects on the BF of teeth during COS leveling.

TRIAL REGISTRATION

ClinicalTrial.gov (# NCT04549948).

Management of Laterally Luxated Primary Teeth: A Case Report

Lateral luxation can be defined as the traumatic displacement of a tooth in a direction other than axial. The current case report describes the use of composite resin splinting to treat laterally luxated primary maxillary central incisors which resulted in an anterior cross bit. A 5-year-old boy reported to the clinic complaining of pain and mobile front teeth that is his primary right and left central incisors were laterally luxated. After a complete clinical examination and radiographic evaluation, the teeth were repositioned and stabilized for 4 weeks by splinting the laterally luxated tooth to the adjacent teeth. Follow-up examinations revealed that the tissues had healed well and that the corresponding central permanent incisor was healthy and unaffected. This case study highlights the significance of prompt diagnosis, effective treatment, and routine follow-up of traumatized teeth because they may have an adverse effect on both dentitions and "Oral Health-Related Quality of Life". When feasible, conservative treatment should be considered because it may be more suitable in some circumstances.

Survival of immediate implants replacing traumatised teeth in the anterior maxilla

Aim The provision of implants following traumatic dental injuries can hold many challenges, primarily in higher aesthetic regions. The purpose of this retrospective study was to assess the clinical outcomes of immediate implants placed in fresh extraction sites in the anterior maxilla following dental trauma.Materials and methods In total, 60 patients requiring teeth replacement with dental implants in the anterior maxilla were included in the study. Following a delayed loading protocol, the implants were restored with definitive single crowns or bridges. Implant and prosthetic survival, complications and periodontal health were recorded during follow-up.Results A total of 70 implants were placed in the anterior maxilla with three failures reported, resulting in an implant survival rate of 95.7% over a follow-up period of three years. No additional bone augmentation was undertaken and prosthetic survival recorded was 100%, with favourable periodontal outcomes achieved overall.Conclusion This study showed that implants immediately inserted into fresh extraction sites following dental trauma can constitute a predictable treatment strategy, presenting high implant survival rates over the follow-up period observed. Further well-designed controlled clinical trials are required to evaluate longer-term outcomes for this technique.

Implant treatment after traumatic tooth loss: A systematic review

BACKGROUND/AIMS

Treatment after traumatic tooth loss is challenging and is currently guided by expert opinion and the individual patient situation. The aim of this study was to provide an overview on the outcome of dental implant treatment in the anterior maxilla after traumatic tooth loss, based on a systematic review of the existing evidence.

MATERIALS AND METHODS

A systematic search of the literature was performed on PubMed, Cochran Library and Web of Science following the PRISMA guidelines based on a structured research question (PICO). All clinical studies of five patients or more with follow-up of at least 1 year after implant loading were included. Patients were at least 18 years of age. Cohen's Kappa-coefficient was calculated. The Newcastle-Ottawa Scale was applied to assess the quality of the included studies. Descriptive statistical methods were applied.

RESULTS

Nine hundred and ninety-nine articles were identified through the systematic search. Finally, six articles were eligible for inclusion. The studies comprised prospective and retrospective cohort studies and case series. From these, 96 patients with 120 implants were included. The age ranged from 18 to 59 years. The survival rates of implants and superstructures were 97% and 95%, respectively, after a mean follow-up of 3.5 years. Mean marginal bone resorption was 0.56 mm (range 0.21-1.30 mm). Complication rates were 7% and 11% on implant and superstructure level, respectively. Patient-reported outcome measures and objective evaluations showed a high level of satisfaction with the aesthetic outcome. Bone augmentation was performed in 60 implant sites. Three patients underwent pre-surgical orthodontic treatment. The maxillary central incisor was the most frequently replaced tooth (70%).

CONCLUSIONS

This systematic review revealed a low level of evidence on the outcome of dental implant treatment after traumatic tooth loss. Systematic reporting of treatment outcomes of tooth replacements after dental trauma is highly encouraged to further guide dentists for the benefit of these challenging patients.

Intrusive luxation of a permanent maxillary central incisor into the nasal cavity: A case report

This case report out lines a rare complete intrusion of a permanent, maxillary central incisor (tooth 11) into the nasal cavity, with a late diagnosis and treatment. An eight-year-old boy was referred to an oral and maxillofacial surgery service with absence of tooth 11 after an episode of a fall from his own height. Approximately 50 days after the trauma, the patient presented, with a complaint of obstruction of the right nostril. The clinical examination and tomographic evaluation showed that the tooth had been intruded into the nasal cavity on the right side. The tooth in question was removed under general anesthesia by direct approach through the right nostril. The patient was followed up for approximately one year without complications. This case demonstrates the importance of a detailed evaluation during the first examination after intrusive luxation so the correct diagnosis is made and the correct treatment is performed to avoid greater morbidity and complications for the patient.

Critical appraisal of the information available on traumatic dental injuries found in applications

BACKGROUND/AIMS

Traumatic dental injuries (TDI) are a public health problem and the search for information becomes essential to help in their management. The aim of this study was to search existing TDI applications (Apps) to critically describe the characteristics and main information found in them regarding TDI.

METHODOLOGY

Searches were performed in the Play Store (Android) and App Store (iOS), using MeSH terms, synonyms and terms related to dental emergencies and TDI, in English, Spanish and Portuguese. Apps with information on the management of post-TDI emergencies or TDI prevention were included. The type of operating system (Android/iOS), cost (free/paid), target audience (dentist/patient), age of classification (free/>17 years old), language, star rating (1★ to 5★), number of downloads and post-download ratings, type of dentition (primary/permanent), reference used for classification according to TDI type and management (International Association for Dental Traumatology/Andreasen/others/not reported), and available content (prevention/emergency management/preservation/illustrations) were evaluated.

RESULTS

Among 486 apps, 13 were eligible: 11 for Android and 2 for iOS. Most were free (92.3%), for patients (38.4%) and had a free age classification (90.9%). The main language was English (53.8%), and most of the Apps either had no information on star ratings (46.1%) or received 4★ (23.1%). The number of downloads was not reported (23.1%) or was fewer than 100 (23.1%). Most of the Apps were for permanent teeth (61.5%) and had explanations about dental management for TDI emergencies (92.3%) and multiple TDIs (61.5%). Most Apps addressed the importance of monitoring TDIs (76.9%) and contained illustrative images (76.9%). However, many did not report the TDI classification (46.1%), and 38.5% reported TDI prevention.

CONCLUSIONS

Information on dental trauma management according to dental injury, inclusion of images, target audience, type of TDI and their prevention varied in the available Apps. However, most were focused on permanent teeth and addressed several TDI in English language only.

Evaluation of Clinical and Radiographic Findings among Patients with Traumatic Dental Injuries Seeking Delayed Treatment

Background

Time elapsed between trauma and treatment greatly influences the prognosis of traumatic dental injuries (TDIs). The aim of this study was to analyze clinical and radiographic findings related to complications of TDIs among patients seeking delayed treatment of such injuries.

Materials and Methods

123 permanent teeth with a history of previous TDIs were included in the study. Clinical findings analyzed were the type of fracture, type and number of injured teeth, crown discoloration, and pulpal status of the injured tooth (pulpal diagnosis). The radiographic findings analyzed included pulp canal obliteration (PCO), root resorption (RR), and periapical radiolucency (PR). Statistical analysis included descriptive analysis.

Results

Tooth discoloration was the most common presenting complaint (53.65%), while fall (48.78%) was the most frequent cause of trauma. The range of time duration between trauma and presentation for treatment was 5 months to 30 years (average time 12.82 years). Pulp necrosis (PN) was the most common complication (90.24%). Almost half of the teeth with PN had fracture injury and discoloration along with a high frequency of PR (78.37%). Even teeth with a normal appearance were found to have a high incidence of PN (76.92%) and PR (53.84%). The crown discoloration was the second most frequent finding (48.78%). Many teeth (41.66%) with vital pulp were also discolored. Most of the teeth (79.31%) with yellowish discoloration and all teeth with brownish discoloration were nonvital. A high frequency of PN (90%) and PR (78.33%) was found in teeth with discoloration. PR was the most common radiographic finding (69.10%), while PCO and RR were observed in 17.88% and 21.13% of teeth, respectively.

Conclusion

The findings of this study support the fact that delayed treatment of TDIs leads to increased complications. PN was the most common complication followed by tooth discoloration, RR, and PCO among patients seeking delayed treatment after TDIs.

Orthodontic treatment after intrusive dislocation and fracture of the maxillary central incisors

The treatment for intrusive dislocation is a clinical challenge and must be started soon after the intrusion injury. The affected tooth or teeth must be extruded by using light forces. This case report of traumatic intrusion of permanent central incisors aims to describe and discuss the process of repositioning the teeth in the dental arch. After a domestic accident, a 10-year-2-month-old boy suffered 11-mm intrusion of the maxillary central incisors along with enamel-dentin fracture and subluxation of the maxillary lateral incisors. Treatment started 2 days after the incident with an orthodontic extrusion of the maxillary central incisors with a fixed edgewise standard appliance. Orthodontic arches were used, and the force vectors were directed to the desired locations for the repositioning of the teeth. The treatment for extrusion and stabilization of the maxillary central incisors lasted 5 months and 22 days. Orthodontic traction with a fixed appliance is an effective procedure for the extrusion of both permanent maxillary central incisors intruded after trauma. Correct diagnosis, a short period between the trauma and the beginning of treatment, and appropriate mechanics were determining factors for a successful treatment.

External cervical resorption-a review of pathogenesis and potential predisposing factors

External cervical resorption (ECR) refers to a pathological state in which resorption tissues penetrate into the dentin at the cervical aspect of the root. Despite being latent in its initial phase, ECR could cause severe damage to mineralized dental tissue and even involve the pulp if not given timely diagnosis and treatment. Nevertheless, the etiology of ECR is still poorly understood, which adds to the difficulty in early diagnosis. ECR has received growing attention in recent years due to the increasing number of clinical cases. Several potential predisposing factors have been recognized in cross-sectional studies as well as case reports. In the meantime, studies on histopathology and pathogenesis have shed light on possible mechanisms of ECR. This review aims to summarize the latest findings in the pathogenesis and potential predisposing factors of ECR, so as to provide pragmatic reference for clinical practice.

Endodontic management of traumatized permanent teeth: a comprehensive review

The pulp plays a key role in the treatment of traumatic dental injuries (TDIs) and is strongly associated with the outcome, particularly in severe cases. A correct pulp diagnosis is essential as it forms the basis for developing the appropriate management strategy. However, many TDIs are complex, and their treatment requires a profound knowledge of the physiological and pathological responses of the affected tissues. This comprehensive review will look at the dentine-pulp complex and its interaction with the surrounding tissues following TDIs. The literature up to 2020 was reviewed based on several searches on PubMed and the Cochrane Library using relevant terms. In addition to the recently revised guidelines of the International Association of Dental Traumatology, this article aims to provide background information with a focus on endodontic aspects and to gather evidence on which a clinician can make decisions on the choice of the appropriate endodontic approach for traumatized permanent teeth.

Management of severe traumatic intrusion in the permanent dentition

Traumatic intrusion is considered one of the most severe luxation injuries to the permanent dentition. There are limited studies based on minimal evidence supporting suggested management protocols, owing to the rare occurrence of intrusion. The following case report details the multidisciplinary management and 18-month follow-up, in line with current UK guidelines, of a 23-year old adult male who sustained severe intrusion injuries to both permanent maxillary central incisor teeth. Timely, accurate diagnosis and subsequent appropriate management correlates with improved outcomes for traumatic injuries and it is therefore imperative those involved with the acute and long-term management of dentoalveolar trauma are aware of current guidelines.

Role of Plasma-rich Fibrin in the Management of Intrusion Injuries of Teeth

Aim and objective

To establish a new method of treating severe type of intrusion type of injuries to teeth. The prognosis of these injuries is poor. Poor prognosis is attributed to the development of multiple complications from various components of teeth. We described the various phases to prevent and treat various complications.

Background

Most common sequelae to intrusion injuries are alveolar bone loss, resorption of teeth, and gingival recession. Plasma-rich fibrin (PRF) possesses various biological elements for optimal healing and prevention of the above.

Case description

A 9-year-old female patient suffered intrusion injury to 21 with no root fractures. Since intrusion was severe type, surgical repositioning with flexible splinting is done. Complications such as alveolar bone loss and gingival recession have occurred, which were successfully treated with PRF. To prevent development of resorption, calcium hydroxide was used as intracanal medicament and doxycycline was used to prevent surface resorption.

Conclusion

PRF is effective not only in promoting healing, bone deposition but also prevents secondary infection of the wound. Hence, it is simple, easy, and inexpensive biomaterial for treating intrusion injuries of teeth.

Clinical significance

Considering the various properties associated with PRF, it could be a key for treating other type traumatic injuries to teeth.

How to cite this article

Ragulakollu R, Biradar N, Kukkunuru GT, et al. Role of Plasma-rich Fibrin in the Management of Intrusion Injuries of Teeth. Int J Clin Pediatr Dent 2021;14(6):820–824.

Traumatic dental injuries and pulp sequelae in an adolescent population

BACKGROUND/AIMS

Traumatic dental injuries (TDI) occur frequently and may result in pulp sequelae. This includes pulp necrosis with infection, pulp canal obliteration and root resorption. The aim of this study was to assess the prevalence and risk factors of pulp sequelae after TDI among Norwegian adolescents.

MATERIAL AND METHODS

A retrospective longitudinal study, including historical clinical data, was conducted with 16-year-old pupils in western Norway. All first-grade pupils, born in 1997 (n = 5184), attending public high schools, were invited to participate and to respond to an electronically administered closed-ended questionnaire (response rate 39.6%, n = 2055). Consent was given to access the dental records in the Public Dental Health Service in Hordaland, where information regarding TDI (diagnosis and treatment) and radiographs were interpreted. Only TDIs to anterior teeth were recorded (canine to canine in the maxilla and mandible). Outcome variables of TDI were registered and analysed using logistic regression, Kaplan-Meier survival estimates and log-rank test.

RESULTS

The prevalence of TDI in the sample population was 16.4% (338 pupils), with a total of 637 teeth involved. The number of included teeth for analysis was 571 (90.5%). The prevalence of pulp necrosis with infection was 7.5%. Moderate and severe TDI was associated with a higher frequency of pulp necrosis with infection. Pulp canal obliteration and root resorption were found in 2.8% and 2.3% of teeth with TDI, respectively. Dental hard tissue injuries were more prone to the development of pulp necrosis than luxation injuries and combination injuries. The relationship between root development stage and development of pulp necrosis with infection was not statistically significant.

CONCLUSIONS

Occurrence of different pulp sequelae among teeth affected with TDI was low. Moderate and severe TDI were more at risk of developing pulpal complications and hard tissue injuries were at higher risk of developing pulp necrosis with infection.

Dental Trauma

Dental trauma and injuries to the dentition are difficult to treat because the treatment goals serve to restore esthetics and function. The oral and maxillofacial surgeon is often called on to coordinate the efforts of rehabilitation after a dentoalveolar injury. A comprehensive understanding of the ideal treatments and use of endodontic, orthodontic, periodontal, and pediatric dental colleagues leads to the best possible results with regards to a restoration of form and function. This article provides a succinct review of the oral and maxillofacial surgeon's treatment in dentoalveolar trauma. Epidemiology, treatment, and preventative measures are discussed in this article.

Bull horn injury causing traumatic tooth intrusion - ultrasound and CT imaging

Introduction

Traumatic injury to upper alveolus may result in apical displacement of the affected tooth/teeth into the underlying alveolar bone. The tooth while being driven into the socket under the upwardly directed impact force usually causes a crushing fracture of the alveolar socket bone. The tooth may also be displaced through the labial plate of bone or may even impinge upon the bud of the permanent tooth.

Case report

We present a case of tooth intrusion due to bull horn injury and its imaging features on ultrasound and CT scan.

Discussion

Most common teeth involved in dental trauma in children of 6 to 12 year age group, are the maxillary anteriors, and this age group also constitutes the most common group in whom tooth intrusion is seen. Tooth intrusion usually involves a single dental element. Common etiologic causes are injuries, falls, sports accidents, violence and traffic accidents. Traumatic intrusion due to injury by animals is rarely described and is more commonly seen in less developed areas that too in rural set-up where man-animal encounters are frequent.

Conclusion

In such cases, whenever the conventional imaging modalities like the X-rays such as intra oral peri-apical views and orthopantomograms are unavailable, or where use of ionizing radiation is a grave concern (especially in children and pregnant patients), ultrasonography offers a non-invasive diagnostic imaging method which helps in diagnosis of the condition and also helps in supplementing the clinical information, thereby helping in better understanding of the underlying condition.

Incidence of root resorption after concussion, subluxation, lateral luxation, intrusion, and extrusion: a systematic review

OBJECTIVE

Traumatic dental injuries often affect the dental hard tissues, periodontal tissues, and dental pulp. Root resorption (RR) is a significantly concerning phenomenon that could lead to loss of the traumatized tooth. The purpose of this systematic review was to analyze the incidences of different types of RR after concussion, subluxation, lateral luxation, intrusive luxation, and extrusive luxation.

MATERIAL AND METHODS

Seven databases were electronically and manually searched for the identification of observational studies that evaluated the incidence of RR after luxation injuries. Following study selection, data extraction, and risk of bias assessment through MAStARI checklist, the GRADE quality of available evidence was assessed.

RESULTS

In total, 14 studies were included in the present systematic review. Ten and four studies presented a moderate and low RoB, respectively, and the overall GRADE quality of evidence was "very low" for all outcomes. The highest incidence rates of RR were observed for teeth with intrusive luxation, followed by those with extrusive luxation, lateral luxation, subluxation, and concussion. In general, the most common type of RR documented for all injuries was inflammatory RR, followed by replacement RR, surface RR, and internal RR.

CONCLUSIONS

Our findings suggest that RR most commonly occurs in association with intrusive luxation and by inflammatory RR. Awareness regarding the incidence of RR after injuries is useful for clinicians to minimize the risk and severity of its occurrence, because a late diagnosis of RR may limit treatment alternatives and result in tooth loss.

CLINICAL RELEVANCE

Knowledge about the incidence of RR in teeth with concussion and different types of luxation injuries can ensure appropriate follow-up protocols and favorable outcomes.

Retrospective study on sequelae in traumatized permanent teeth

Objective:

This study aimed to identify possible associations of the presence or absence of posttrauma sequelae with the factors inherent to the traumatized tooth and treatment.

Materials and Methods:

This retrospective study was performed through the evaluation of records and radiographs of a center of reference for dental trauma between January 2008 and December 2014. The factors were analyzed and associated with posttrauma sequelae, such as pulp necrosis and root resorption.

Statistical Analysis Used:

A binomial logistic regression model was fit (P < 0.05).

Results:

In luxations, it was possible to observe 37% pulp necrosis, 16% inflammatory root resorption, and 8% replacement resorption. The binomial logistic regression revealed that male gender (P = 0.0392, odds ratio [OR] = 2.79), avulsion injury (P = 0.0009, OR = 12.27), and elapsed time >16 days between the time of trauma to the beginning of the endodontic treatment (P = 0.0450, OR = 7.53) showed a greater chance of presenting a posttrauma complication.

Conclusions:

Gender, type of injury, stage of root development, and time after trauma until the beginning of the endodontic intervention were related to the appearance of sequelae.

A Short Time Period in the Treatment of an Open Apice Intruded Tooth: An 8-year Follow-up

AIM

Among traumatic dental injuries, intrusive dislocation is considered to be one of the most serious injuries. Despite the high success rate in complacent patients, the traditional technique of calcium hydroxide inoculation has drawbacks. The good antimicrobial and sealing properties combined with excellent biocompatibility and high success rates of the mineral trioxide aggregate (MTA) encourage its use.

BACKGROUND

The objective of this study was to report a successful case of intrusive dislocation in a short time with a follow-up of eight years.

CASE DESCRIPTION

A patient, seven years of age, presented intrusive dental dislocation, confirmed by radiographic examination, which revealed besides axial displacement of the central incisor towards the bone, incomplete root development. The passive repositioning was chosen as the treatment modality. After cleansing of the root canal, therapy with hydroxide paste was performed for 30 days, and then the apex was closed using an artificial barrier made with apical MTA buffer to facilitate root canal obturation.

CONCLUSION

Clinical and radiographic signs at 6 months and 8 years of preservation evidence the success of the therapy.

CLINICAL RELEVANCE

Teeth with incomplete root formation when traumatized may have their development process interrupted; consequently their root canals remained ample with thin and fragile walls and the open apex which represents a great challenge to the accomplishment of endodontic therapy. The process of apexification with MTA as in this case is an alternative to traditional therapy based on calcium hydroxide, conferring a faster treatment and a decrease in the odds of fracture of the tooth since from the confection of the apical barrier there is a possibility of being the same restored at an early stage.

HOW TO CITE THIS ARTICLE

de Sá MAB, Nunes E, et al. A Short Time Period in the Treatment of an Open Apice Intruded Tooth: An 8-year Follow-up. Int J Clin Pediatr Dent 2019;12(2):160-163.

The orthodontic-oral surgery interface. Part two: diagnosis and management of anomalies in eruption and transpositions

The orthodontic-oral surgery interface is important for the multidisciplinary management of patients presenting with complex dental anomalies. This article provides an overview of anomalies of eruption and transpositions, their diagnosis, aetiology, presenting features and the different management options. It also highlights the role of the general dental practitioner (GDP) in identifying such anomalies and the importance of timely referral to specialist care.

Guidelines for the Management of Traumatic Dental Injuries: 1. Fractures and Luxations of Permanent Teeth

Traumatic dental injuries (TDIs) of permanent teeth occur frequently in children and young adults. Crown fractures and luxations are the most commonly occurring of all dental injuries. Proper diagnosis, treatment planning and followup are important for improving a favorable outcome. Guidelines should assist dentists and patients in decision making and for providing the best care effectively and efficiently. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion of the IADT board members. The guidelines represent the best current evidence based on literature search and professional opinion. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care of TDIs. In this first article, the IADT Guidelines for management of fractures and luxations of permanent teeth will be presented.

Decoronation: An Alternative Treatment for Replacement Root Resorption

Introduction

Ankylosis and disrupted or altered root development are frequent complications associated with intrusive luxation and tooth avulsion lesions. Various forms of treatment have been described according to the severity of the trauma and root development. The literature shows that decoronation is an ideal treatment in cases where replacement resorption occurs.

Methods

Two clinical cases are presented: involving intrusive luxation [15-year-old female patient with an affected maxillary left lateral incisor (2.2)] and a replanted avulsed tooth [8-year-old male patient with avulsion of the right maxillary central incisor (1.1)]; both cases presented advanced root resorption so that decoronation with a prosthetic tooth replacement was decided as the final treatment option.

Results

In the short-term follow-up, patients were asymptomatic and had no functional problems. Radiographs showed that crestal bone height had been preserved.

Conclusions

Preserving the decoronated root in the alveolar process not only helps to maintain bone volume but also enables vertical bone growth and facilitates the future insertion of an implant.

Frequency of root resorption following trauma to permanent teeth

This retrospective study evaluated the frequency of development of root resorption in dental trauma cases involving supporting tissue. For 249 traumatized teeth of 125 patients aged between 7 and 51 years, we collected data on the gender and age of the patient, the teeth involved, the type of trauma, and the period between dental injury and initial examination. Radiographic parameters examined in relation to root resorption included the presence of inflammatory external root resorption, internal root resorption, replacement resorption, and canal calcification. Data were analyzed by chi-squared test, Fisher's exact test, and mult iple logistic regression (P < 0.05). The results indicated that there was a significant relationship between the period from the date of injury until initial examination and the occurrence of inflammatory external resorption (P = 0.0199), as well as the type of injury (P = 0.0406). Furthermore, external resorption was most frequently associated with intrusive luxation (92.8%), followed by avulsion (89.0%), lateral luxation (80.2%), and extrusive luxation (77.4%). Among the types of dental injury, replacement resorption was observed more frequently in cases of avulsion (87.2%). The only factor that was significantly associated with this type of resorption was the type of injury (P < 0.0001). Root resorption is observed more frequently and its risk of development is higher in cases of severe trauma, especially avulsion and intrusive luxation.

Management of incompletely developed teeth requiring root canal treatment

Endodontic management of the permanent immature tooth continues to be a challenge for both clinicians and researchers. Clinical concerns are primarily related to achieving adequate levels of disinfection as 'aggressive' instrumentation is contraindicated and hence there exists a much greater reliance on endodontic irrigants and medicaments. The open apex has also presented obturation difficulties, notably in controlling length. Long-term apexification procedures with calcium hydroxide have proven to be successful in retaining many of these immature infected teeth but due to their thin dentinal walls and perceived problems associated with long-term placement of calcium hydroxide, they have been found to be prone to cervical fracture and subsequent tooth loss. In recent years there has developed an increasing interest in the possibility of 'regenerating' pulp tissue in an infected immature tooth. It is apparent that although the philosophy and hope of 'regeneration' is commendable, recent histologic studies appear to suggest that the calcified material deposited on the canal wall is bone/cementum rather than dentine, hence the absence of pulp tissue with or without an odontoblast layer.

Scandinavian multicenter study on the treatment of 168 patients with 230 intruded permanent teeth - a retrospective cohort study

BACKGROUND/AIM

The aim of the study was to evaluate the survival of intruded permanent teeth related to treatment in a large number of patients, with special focus on development of pulp necrosis and replacement resorption (ankylosis-related resorption).

MATERIALS AND METHODS

The material consisted of 168 patients (mean age 9.6 years) with 230 intruded permanent teeth from dental trauma clinics in Copenhagen, Denmark, Stockholm, Sweden, and Oslo, Norway. The degree of intrusion was classified as mild (1-<3 mm), moderate (3-7 mm), and severe (>7 mm). Root development was categorized with respect to root formation and development of the apex into three groups of increasing tooth maturity: very immature, immature, and mature.

RESULTS

Awaiting re-eruption was the treatment of choice in 107 teeth (47%), orthodontic repositioning in 28 (12%) and surgical repositioning in 95 (41%) teeth. Pulp necrosis was diagnosed in 173 teeth (75%), infection-related root resorption in 57 (25%) and replacement resorption in 50 teeth (22%). Very immature teeth, teeth diagnosed with mild intrusion, and teeth awaiting re-eruption had significantly (P < 0.05) fewer complications. In a stepwise discriminant function analysis, choice of treatment, root development, and degree of intrusion were significantly (P < 0.05) associated with the development of replacement resorption. Root development and degree of intrusion were significantly (P < 0.05) associated with the development of pulp necrosis.

CONCLUSION

This study indicates that root development and degree of intrusion may be important for the development of pulp necrosis as well as replacement resorption, whereas choice of treatment only seems to influence the development of replacement resorption in intruded permanent teeth. Awaiting re-eruption resulted in the lowest risk for developing replacement resorption.

A multidisciplinary approach to the management of traumatic intrusion in immature permanent teeth

Intrusion in a developing permanent tooth is an extremely complicated traumatic injury and is rarely seen in the permanent dentition. The damage caused by the trauma to the surrounding tooth structures results in a multitude of complications during the healing process. Careful repositioning of the intruded tooth by orthodontic means, revascularisation of the immature tooth to regain vitality, and periodontal treatment to provide the most acceptable aesthetic outcome are described in this case report. It outlines the treatment options to overcome the complications and variable outcomes. The present report emphasises the importance of a multidisciplinary approach to provide complete rehabilitation of a traumatically intruded developing tooth.

Interventions for treating traumatised ankylosed permanent front teeth

BACKGROUND

Teeth that have suffered trauma can fuse to the surrounding bone in a process called dental ankylosis. Ankylosed permanent front teeth fail to erupt during facial growth and can become displaced, thus resulting in functional and aesthetic problems. Dental ankylosis is also associated with root resorption, which may eventually lead to the loss of affected teeth. Different interventions for the management of ankylosed permanent front teeth have been described, but it is unclear which are the most effective.

OBJECTIVES

To evaluate the effectiveness of any intervention that can be used in the treatment of ankylosed permanent front teeth.

SEARCH METHODS

The following electronic databases were searched: the Cochrane Oral Health Group Trials Register (to 3 August 2015), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2015, Issue 7), MEDLINE via OVID (1946 to 3 August 2015), EMBASE via OVID (1980 to 3 August 2015) and LILACS via BIREME (1982 to 3 August 2015). We searched the US National Institutes of Health Trials Register (http://clinicaltrials.gov) and the WHO Clinical Trials Registry Platform for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) comparing any intervention for treating displaced ankylosed permanent front teeth in individuals of any age. Treatments could be compared with one another, with placebo or with no treatment.

DATA COLLECTION AND ANALYSIS

Two independent review authors screened studies independently. Full papers were obtained for potentially relevant trials. Although no study was included, the authors had planned to extract data independently and to analyse the data according to the Cochrane Handbook for Systematic Reviews of Interventions.

MAIN RESULTS

No randomised controlled trials that met the inclusion criteria were identified.

AUTHORS' CONCLUSIONS

We were unable to identify any reports of randomised controlled trials regarding the efficacy of different treatment options for ankylosed permanent front teeth. The lack of high level evidence for the management of this health problem emphasises the need for well designed clinical trials on this topic, which conform to the CONSORT statement (www.consort-statement.org/).

Traumatic Intrusion of a Maxillary Canine Tooth: 3 Cases

Of the six recognized types of tooth luxation injuries, intrusion generally carries the most guarded long-term prognosis due to the high risk of complications, including root resorption, ankylosis, marginal bone loss, and pulp canal obliteration or necrosis. The degree of traumatic intrusion and stage of root development affects the outcome and treatment planning. This report describes the clinical history, oral and radiographic examination findings, and rationale for surgical extraction in 2 dogs and 1 cat with traumatic intrusion of a maxillary canine tooth.

Challenges in treating traumatically intruded and ankylosed permanent incisors: a case report with a multidisciplinary approach

This report discusses the challenges, complications and management of traumatic intrusion injuries affecting the permanent dentition. A case is described where trimming of the incisal edge of a severely intruded and ankylosed upper lateral incisor resulted in an unexpected re-eruption of the tooth. It is suggested that the vibrations from drilling may have disrupted the ankylosis, initiating spontaneous re-eruption and this approach could provide a minimally invasive and conservative pathway to treating ankylosed teeth. Clinical Relevance: To date no effective treatment has been described to reverse the development of replacement root resorption leading to the loss of the affected tooth. The hypothesis proposed here suggests that mechanical vibrations, if strong enough, may disturb the ankylosis and allow re-eruption of the intruded tooth.

Treatment of multiple traumatized anterior teeth associated with an alveolar bone fracture in a 20-year-old patient: A 3-year follow up

Intrusive luxation is a type of recognizable luxation injury represented by a deeper axial displacement of the tooth toward the alveolar bone. Treatment strategies include waiting for the tooth to return to its position, immediate surgical repositioning, and repositioning through dental traction by orthodontic devices. The aim of this case report was to present the management of severe dental trauma and later restoration following IADT. A 20-year-old patient was presented after fainting at home four hours before, resulting in a dento-alveolar trauma. Clinical examinations revealed a traumatic intrusion, in 1.2, 1.1 and 2.1, uncomplicated crown fractures in 1.1 and 2.1 and a complicated crown-root fracture in 2.2. The diagnosis was confirmed with CBCT. Following IADT protocol, the emergency treatment consisted of the surgical repositioning and semi-rigid splinting using orthodontic wire-composite, replacing the buccal bone plate, and postoperative instructions to the patient regarding oral hygiene. After 2 weeks the root canal treated and filled with fiberglass posts in 1.2, 1.1, 2.1 and 2.2. Splint was removed after 4 weeks and the IADT reassessment protocol followed, with revisions at 6-8 weeks, 6 months, a year and annual reviews for 5 years. A year after the treatment, the traumatized teeth were restored with minimally invasive preparations of feldspathic ceramic. Esthetics and function were recorded with a 3-year follow-up period.

Key words:Intrusive luxation, dental trauma, crown-root fracture, dento-alveolar trauma, permanent tooth, CBCT.