Post-traumatic complications of severe luxations and replanted teeth

Risk of pulp necrosis and related complications in the permanent anterior teeth with lateral luxation: A systematic review and meta-analysis

This systematic review aimed to evaluate the evidence related to the occurrence of pulp necrosis and related complications in permanent anterior teeth with lateral luxation. It was envisaged to address the ambiguity related to the recommendation for pulp extirpation in teeth with mature root apex. An a priori protocol was formulated as per the best practices of evidence-based medicine and registered in PROSPERO. A comprehensive search was performed electronically in PubMed, LILACS, Web of Science, EMBASE, Scopus, and Cochrane on July 10,2023 without any restriction of language or year of publication. The screening of titles and abstracts and later the full-text articles were performed. Later, the data extraction was performed by using a self-designed sheet, risk of bias (ROB) assessment was done, meta-analysis was performed, and the GRADE approach was used to assess the quality of evidence. The qualitative synthesis was performed on 13 studies done from 1985 to 2020 in hospital settings. There was variability in the minimum and total observation periods, sample sizes, and characteristics of the sample population. The overall pooled prevalence of pulp necrosis was found to be 57% (95% CI: 42, 72%). It was 12% (95% CI: 8%, 18%, I2 = 0%) in immature teeth, and 58% (95% CI: 42, 73%, I2 = 86%) in mature teeth. The pooled prevalence of EIRR was found to be 11% (95% CI: 4, 27%, I2 = 95%) with greater risk in teeth with mature root apex (RR: 1.26, 95% CI: 1.12, 1.42, I2 = 0%). The ROB was moderate or high in nine studies and the GRADE of evidence was very low in 14 of 15 outcomes. There are greater chances of pulp necrosis in teeth with lateral luxation, especially with mature apex. However, it can still be less than 60% in most cases with the prevalence of EIRR less than 20%. Hence, an absolute recommendation for endodontic intervention in mature teeth with lateral luxation must be interpreted with slight caution.

Treatment priorities and arrival time of traumatic dental injuries-An 8-year retrospective study

BACKGROUND/AIM

Most of the previous studies in the available literature discussed the time of arrival in general to the healthcare system, while a minority studied the relationship between the type of trauma and arrival. The aim of this retrospective study is to assess the arrival time of traumatic dental injuries (TDIs) depending on the urgency of treatment according to Andreasen.

MATERIALS AND METHODS

This 8-year retrospective study was carried out at the Department of Pediatric Dentistry at the University Dental Clinic in Zagreb, Croatia. Andreasen's classification was used to define the kind of TDI as well as to divide them by the need for urgent treatment or treatment priorities in three groups: acute, subacute, and delayed.

RESULTS

The sample consisted of 1040 children (59% male and 41% female) with a median age of 7. Each year, the age group most affected by TDIs was 6-12 years old. While there is a general increase in the prevalence of TDIs overall, there is a decline in TDIs among children aged 6-12 and an increase among preschoolers and adolescents (below 6 and above 12 years old). Throughout the years, 52.73% red/acute and 41.16% yellow/subacute TDIs were not treated on time due to delayed arrival. More patients from Zagreb come in the first 24 h, while more patients from outside Zagreb come to the clinic a month or more after their injuries. Patients which suffered TDI accompanied with soft-tissue injury arrived sooner.

CONCLUSIONS

It is necessary to introduce monitoring and education of patients under the age of 6 and over 12, as well as their parents/caregivers. New programs should be implemented and new referent centers that specialize in treating TDIs outside of Zagreb should be established.

Knowledge of emergency dental management among a localized sample of athletic trainers

BACKGROUND/AIMS

Athletic trainers are often the point person when sports-related traumatic dental injuries (TDIs) occur. The aim of this study was to assess knowledge levels of the management of TDIs among athletic trainers in the Midwest United States, as well as evaluate variables that may influence knowledge levels.

MATERIAL AND METHODS

A survey was sent to athletic trainers licensed in Minnesota, Nebraska, and Iowa. The survey included 28 multiple-choice and fill in the blank questions split into three sections. The three sections included background, emergency management of TDIs, and opinion questions.

RESULTS

Of the participants, 100% recalled receiving medical first aid training. However, only 71% recalled receiving formal training on emergency management of dental injuries. Although 75% were confident in managing a dental injury, over 63% of participants scored less than 70% in the knowledge score section. Majority of the participants (98.4%) reported that they believe training on the management of TDIs is important. Athletic trainers working with contact sports were more likely to have experienced managing TDIs more recently than those working in noncontact sports.

CONCLUSIONS

This study shows the gaps in knowledge among athletic trainers pertaining to management of TDIs and emphasizes the importance of sports community having adequate education on emergency management of such dental injuries.

[The quality of dental care in children with permanent teeth trauma according to analysis of medical records in an emergency unit of a municipal dental clinic]

THE AIM OF THE STUDY

Was to assess the efficacy and timing of emergency dental care in children with permanent teeth trauma according to analysis of medical records in an emergency unit of a municipal dental clinic.

MATERIAL AND METHODS

The study involved 320 medical records of pediatric patients admitted to emergency dental care unit of a municipal dental clinic in 2021 because of maxillofacial trauma from which 221 records of children with acute dental trauma were extracted. The quality of documentation of the medical records, rationale for diagnosis and adequacy of emergency dental treatment were analyzed.

RESULTS

No records included diagnosis code according to ICD-10. Trauma history was described in the majority of records by in 67% of them no trauma time was stated with proper precision. In 67.6% of permanent teeth trauma cases emergency aid was carried out inadequately. All patients with uncomplicated crown fractures were dismissed with no treatment. In complicated crown fractures needing pulp vitality preservation the pulp was devitalized or just anesthetized. Tooth replantation in avulsion cases was not performed. In 13.5% of records the treatment was not properly described. In 67.6% of records there were no recommendations for follow-ups.

CONCLUSION

There is a strong need for the improvement of knowledge of traumatic dental injuries management among Russian pediatric dentists by elaboration and implementation of protocols for dental traumas treatment.

Evaluation of Knowledge and Practice of Resident Dentists in Iasi, Romania in the Management of Traumatic Dental Injuries: A Cross-Sectional Study

Dentists play an essential role in the treatment of dental and periodontal traumatic injuries by providing early and correct treatment. The purpose of the present study was to assess the level of knowledge of dental residents regarding dental trauma. The cross-sectional study was conducted at the Faculty of Dental Medicine within the "Grigore T. Popa" University of Medicine and Pharmacy in Iasi, Romania on a sample of 366 residents in General Dentistry, Pediatric Dentistry and Periodontology. To assess their knowledge, a questionnaire was created containing 18 questions about the clinical signs and therapy of dental trauma, with a focus on tooth avulsion. A very low level of knowledge (<25%) was found only for the type of splinting required to maintain an avulsed tooth on the arch. The highest number of correct answers was provided by the residents in Periodontology. Physiological serum as storage medium was recognized by a percentage of 75.9-80% of the subjects, and 60-77% of them recognized pulp necrosis as complication of dental avulsion. The study underlines the need to introduce in the curriculum of all categories of residents additional information, not only in the already existent theoretical form, but also as possible scenarios of various clinical situations.

Effects of different calcium-silicate based materials on fracture resistance of immature permanent teeth with replacement root resorption and osteoclastogenesis

Objectives

This study evaluated the effects of Biodentine (BD), Bio-C Repair (BCR), and mineral trioxide aggregate (MTA) plug on the fracture resistance of simulated immature teeth with replacement root resorption (RRR) and in vitro-induced osteoclastogenesis.

Materials and Methods

Sixty bovine incisors simulating immature teeth and RRR were divided into 5 groups: BD and BCR groups, with samples completely filled with the respective materials; MTA group, which utilized a 3-mm apical MTA plug; RRR group, which received no root canal filling; and normal periodontal ligament (PL) group, which had no RRR and no root canal filling. All the teeth underwent cycling loading, and compression strength testing was performed using a universal testing machine. RAW 264.7 macrophages were treated with 1:16 extracts of BD, BCR, and MTA containing receptor activator of nuclear factor-kappa B ligand (RANKL) for 5 days. RANKL-induced osteoclast differentiation was assessed by staining with tartrate-resistant acid phosphatase. The fracture load and osteoclast number were analyzed using 1-way ANOVA and Tukey's test (α = 0.05).

Results

No significant difference in fracture resistance was observed among the groups (p > 0.05). All materials similarly inhibited osteoclastogenesis (p > 0.05), except for BCR, which led to a lower percentage of osteoclasts than did MTA (p < 0.0001).

Conclusions

The treatment options for non-vital immature teeth with RRR did not strengthen the teeth and promoted a similar resistance to fractures in all cases. BD, MTA, and BCR showed inhibitory effects on osteoclast differentiation, with BCR yielding improved results compared to the other materials.

Intentional replantation and management of avulsion related ankylosis and external cervical resorption. A 10-year follow up case report

Replantation is the treatment of choice for avulsed permanent teeth; ankylosis and cervical root resorption are among survival complications. A 9.5-year-old boy presented with an avulsed maxillary permanent central incisor with an open root apex following a school accident. The tooth was kept in milk, after a dry time of 15-20 min. Its replantation was performed 60 min after the accident. At 8 months, apexification with apical plug was attempted upon radiographic evidence of apical periodontitis. Ankylosis sound with infraocclusion and radiographic evidence of external cervical root resorption (ECR) were evident at 3 years and 3 months. At the patient's return one year later with esthetic concerns (2 mm infraocclusion) there was a 5 mm diameter ECR cavity. After intentional atraumatic extraction the resorptive cavity was debrided and restored with Biodentine; subsequently the tooth was reimplanted and splinted at an extruded position. At the 10-year follow up since the first avulsion the tooth remains esthetically pleasing, asymptomatic, non-ankylotic and functional. The present case supports intentional replantation as an option in managing infraoccluded teeth with advanced ECR.

Prevalence of dental trauma in Brazilian children and adolescents: a systematic review and meta-analysis

This study aimed to investigate the prevalence of dental trauma in Brazilian children and adolescents. A systematic review was conducted considering eight databases: MEDLINE (via PubMed), LILACS, BBO, Scopus, Embase, Web of Science, Open Access Theses and Dissertations, and OpenThesis. Only prevalence studies that used a probabilistic sampling method were included, without restriction on year or language of publication. The JBI critical appraisal tools for prevalence studies were used to assess the individual risk of bias. The individual studies were combined in the meta-analysis using the random-effects model. The heterogeneity between the studies was analyzed by Cochran's Q and the I-square statistics. A meta-regression analysis was performed to evaluate the sources of heterogeneity. The GRADE approach assessed the certainty of evidence across included studies. The search resulted in 2,069 records, of which 36 were included in the study. The eligible studies were published from 2000 to 2021, with a total sample of 40,194 children and adolescents. Most studies (75%) had a low risk of bias. In permanent teeth, the prevalence of dental trauma was 21% (95%CI: 16.0; 26.0) and in deciduous teeth; 35% (95%CI: 26.0; 44.0). The prevalence of dental trauma among boys was higher than among girls for both dentitions. Based on a low certainty, the prevalence of traumatic dental injuries in Brazilian children and adolescents is higher than that found worldwide both in deciduous and permanent teeth. Also, the prevalence of dental trauma among boys is higher than among girls.

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.

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.

[Modern approach to the treatment of children with constant teeth avulsion]

THE AIM OF THE STUDY

Was to analyze treatment outcomes in children with constant teeth avulsion treated in Central Research Institute of Dentistry and Maxillofacial Surgery (CRIDMS).

MATERIALS AND METHODS

The study comprised 39 children aged 7-16 years treated in CRIDMS in 2015-2020. In 38 cases from 39 replantation was performed more than 24 hours after trauma. Because of delayed replantation endodontic treatment was needed in 35 cases from 38 (in one case the avulsed tooth was missing). In all 38 cases replantation was followed by splinting with either resin splint made according to original technique proposed by the authors or semi-flexible splints from orthodontic wire fixed with resin composite.

RESULTS

In one case from 39 the avulsed tooth was missing because a dentist the child first consulted was unaware of the possibility of replantation. In 38 children followed-up for 6-57 months the replanted teeth survived and were clinically asymptomatic. There were, however, obvious radiological signs of replacement resorption in 27 (71.1%) cases. Inflammatory resorption was detected in two cases (5.2%) with immature teeth undergoing apexification with calcium hydroxide.

CONCLUSION

Replacement root resorption after tooth avulsion may be seen as relatively favorable outcome preserving more bone tissue than early tooth removal. The rate of replacement resorption, however, would be less in less delayed replantation. The study results proved the necessity for additional education of parents and pediatric dentists on the first aid and treatment tactics for teeth avulsion.

Extrusive Luxation Injuries in Young Patients: A Retrospective Study with 5-Year Follow-Up

(1) Background: The purpose of this study was to analyze the influence of the chosen diagnostic and therapeutic approach (repositioning and splinting methods) on the risk, frequency and timing of the onset of pulp canal obliteration and pulp necrosis following extrusive luxation in young patients with permanent dentition. (2) Methods: From an initial sample of 50 subjects affected by extrusive luxation, were selected the clinical data of 13 patients presenting extrusive luxation but no other type of injury to the dental hard tissue. All teeth were examined according to a standardized protocol. Follow-up examinations were performed at regular intervals for 5 years. Statistical associations between pulp consequences and several covariates were assessed using the Mann-Whitney test and Fisher's exact test. (3) Results: Among the 13 studied teeth, only 1 healed completely, whereas 9 showed pulp obliteration and 3 developed pulp necrosis. No tooth with obliteration developed pulp necrosis. The average time to treatment was 11.9 h. The treatment approaches used were manual repositioning, orthodontic repositioning and stabilization splinting. "Time to treatment" was the only covariate that showed a weak statistical association with the onset of pulp consequences. (4) Conclusions: There is still uncertainty over the most appropriate therapeutic approach to adopt in young patients with extrusive luxation injuries, particularly for repositioning of the injured tooth. Extruded teeth should be treated as soon as possible after the traumatic event. This study highlighted the value of orthodontic repositioning of the extruded tooth, which does not seem to aggravate the conditions of the dental pulp. In addition, the study confirmed that prophylactic endodontic treatment is not appropriate for immature teeth affected by extrusive luxation injuries, given the extreme rarity of pulp necrosis in teeth already affected by pulp obliteration.

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.

Dental trauma education intervention as a positive influence among undergraduate students

Objective

To investigate the effect of dental trauma educational intervention among undergraduate students of a Federal University in Brazil.

Materials and Methods

Students (n = 125) enrolled in the dentistry (n = 70), nursing (n = 33), and speech therapy (n = 22) courses were invited to attend a dental trauma lecture and also to answer a questionnaire about their confidence in managing crown fracture and tooth avulsion, before (T0) and immediately after (T1) the lecture. McNemar's test (P < 0.05) with logistic regression compared the answers between the courses.

Results

Female gender (78.4%) aged from 18 to 22 years (73.6%) predominated among all the participants. Dentistry students scored higher correct answers (54.3%) in T0 when compared to nursing (12%) and speech therapy (9%) students, concerning the storage medium for tooth fragment transportation. Likewise, few dentistry students (22.9%) and no nursing and speech therapy students knew about the ideal storage medium for an avulsed tooth when immediate replantation was unviable. After educational intervention, a significant improvement was found between T0 and T1 (P < 0.001) for all courses, mainly regarding tooth avulsion with almost 100% of correct answers. Furthermore, logistic regression demonstrated that dentistry students had three times more knowledge absorption than nursing and speech therapy ones.

Conclusions

The educational intervention demonstrated a significant positive impact regarding the knowledge of dental trauma emergency management among health students. Accordingly, it is essential to spread this information among health professionals to save teeth, especially in cases of avulsion.

Prognosis and complications of mature teeth after lateral luxation: A systematic review

BACKGROUND

Dental trauma injuries are frequent in children and adolescents and can result in a sequela of future complications. Lateral luxation injuries are diagnosed when a tooth becomes displaced in a position other than axial and is often associated with alveolar bone fracture. Although the tooth is not immediately lost, pulp canal obliteration or pulpal necrosis can occur. The objective of this systematic review was to gather existing data on lateral luxation injuries to mature teeth to evaluate their overall prognosis and reported complications.

TYPES OF STUDIES REVIEWED

The authors conducted a systematic search of the literature using MEDLINE, PubMed, Embase, and Cochrane databases in February 2019. They hand searched reference lists to identify additional literature. The authors included prospective and retrospective observational studies in the search. They screened a total of 291 articles, downloaded 28 articles, and included 4 articles in the study.

RESULTS

The most frequent complication reported for mature teeth with lateral luxation was pulpal necrosis (44.2%). Less frequent findings included surface resorption (14.0%), inflammatory resorption (8.5%), pulp canal obliteration (8.1%), and replacement resorption (0.9%). The included studies were cohort studies, which resulted in great heterogeneity, and the authors could not attempt a meta-analysis.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

A large number of permanent teeth that experience lateral luxation are at risk of developing pulpal necrosis and other complications. Careful follow-up is required for these patients to treat complications as early as possible. Furthermore, the authors of this systematic review emphasize the importance of consistent reporting of dental trauma outcomes.

A 4-year follow-up case of extrusive luxation in a patient with cerebral palsy

Cerebral palsy (CP) is a condition caused by brain damage before, during, or shortly after birth. Communication can be a challenge when treating patients with CP. Some patients can communicate verbally, while others use augmentative alternative communication tools or have individualized means of communication. Therefore, professional dental treatment in individuals with CP is challenging, especially if the patient is affected by dental trauma and requires emergency treatment. This report shows how individualized communication skills assessment allowed us to successfully manage a 9-year-old patient with CP, who suffered extrusive luxation of the permanent lower incisor. In the present case, the teeth were repositioned briefly after the trauma had occurred and then stabilized with a flexible splint according to international guidelines. The teeth remained vital and periodontal repair was observed during the 4-year follow-up.

[Outcomes of traumatic dental injuries in children]

The aim of the study was to review literature data on incidence and outcomes of traumatic dental injuries (TDI) in pediatric population. A systematic search was conducted using Elibray, Pubmed/Medline, Scopus databases in October 2018. Reference lists were also hand-searched to identify additional literature. The most prevalent complication of TDI is pulp necrosis (PN) which triggers inflammatory root resorption (IRR). PN and IRR are however much more specific for mature permanent teeth. In immature teeth pulp revascularization may occur even after avulsion. Pulpectomy timing is well defined for mature teeth only. It is accepted that pulp extirpation should be performed in the first 10 days after trauma. In immature teeth no criteria exist with pulp electrosensitivity having very low negative prognostic value as drop of pulp sensitivity because of trauma not necessary indicate PN. Follow-up protocol for immature teeth with various TDI would be useful for proper timing of pulpectomy and prevention of IRR.

Incidence of Root Resorption after the Replantation of Avulsed Teeth: A Meta-analysis

INTRODUCTION

An avulsion injury is a serious trauma to pulp and periodontal tissues. After avulsion and replantation, teeth are at risk of infection and root resorption, which may affect treatment outcome and survival rate. Thus, the purpose of this systematic review was to evaluate the incidence of root resorption after the replantation of avulsed teeth.

METHODS

Two reviewers searched 7 electronic databases for observational studies involving human subjects that evaluated the incidence of root resorption after tooth avulsion. Risk of bias (RoB) was evaluated using the Meta-Analysis of Statistics Assessment and Review Instrument, and the quality of available evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation tool.

RESULTS

Of the 1507 articles, 23 met the inclusion criteria. A meta-analysis was conducted and showed that the incidence of internal root resorption was 1.2% (95% confidence interval [CI], 0.02-5.50). Regarding external root resorption, the incidence of surface root resorption was 13.3% (95% CI, 6.21-22.62), that of inflammatory root resorption was 23.2% (95% CI, 13.94-34.19), and that of replacement root resorption was 51.0% (95% CI, 40.10-62.00). Two studies presented a high RoB, 16 had a moderate RoB, and 11 had a low RoB. The overall level of evidence identified was very low.

CONCLUSIONS

The incidence of root resorption after avulsion and replantation in descending order was replacement root resorption > inflammatory root resorption > surface root resorption > internal root resorption.

Prognosis and complications of immature teeth following lateral luxation: A systematic review

BACKGROUND/AIMS

Lateral luxation injuries are a type of traumatic dental injury in which the tooth becomes displaced in the palatal/lingual or labial direction. This injury is common among children and can result in pulp canal obliteration or pulp necrosis. The objective of this systematic review was to gather existing data on lateral luxation injuries to immature teeth to evaluate their overall prognosis.

METHODS

A systematic search was conducted using Medline, Pubmed, Scopus, Lilacs, EMBASE and Cochrane databases in October 2017. Reference lists were also hand-searched to identify additional literature. Prospective and retrospective observational studies were included. A total of 502 articles were screened and six articles were included in the study.

RESULTS

Pulp canal obliteration was the most frequent complication of immature teeth with lateral luxation (31.3%). This was followed by pulp necrosis (17.5%), inflammatory resorption (5.7%), and surface resorption (3.2%). Due to the heterogeneity of the studies, a meta-analysis was not attempted. There was great variation in the reported outcomes among the studies.

CONCLUSION

Accurate prognosis evaluation of traumatic dental injuries is difficult due to the nature of current studies being retrospective or prospective cohort studies. Lateral luxation is a common traumatic dental injury and has life-long concerns for a patient. It is important for future studies to report on the same outcomes to increase the quality of evidence regarding prognosis and treatment interventions, not only for lateral luxation injuries, but for all traumatic dental injuries.

Traumatic Dental Injuries Resulting from Sports Activities; Immediate Treatment and Five Years Follow-Up: An Observational Study

Background:

Traumatic dental injuries (TDIs) represent 18-30% of all oral pathologies and a considerable number of these are sports related. It is very important to treat sports-related injuries and prevent complications. However, very few studies investigate the most expedient therapeutic strategies for the treatment of dental trauma correlated to sports.

Objective:

The aim of this work was to focus on the average recovery time for different lesions, to assess adequate times for each athlete, to identify any association with complications and to investigate whether or not the use of mouth-guards interfered with a full recovery to normal health.

Methods:

This study involved a group of 30 athletes (15 male and 15 female) who had dental injuries of varying severity.

For the purposes of data collection, two classifications were taken into account: a classification for hard tissue trauma and another for periodontal lesions. The athletes were subdivided in “type of lesion’ groups”.They were then treated depending on their individual lesions and followed up for 5 years. A statistical analysis was carried out to study the association between recovery time, lesion types and occurrence of complications.

Results:

The time for recovery was different for each type of lesion and ranged from 3-5 days (only uncomplicated fractures) to 14 days (all hard-periodontal tissue traumas). The total number of recorded pulp complications amounted to 6 cases. Among 30 athletes, 20 had begun and maintained, during the five-year follow-up period, the habit of using mouth-guards when practicing their sport activities.

Conclusions:

Recovery time and the severity of lesions are statistically associated: the more serious the injury, the more time an athlete needs to recover and return to competitive sports events. Furthermore, recovery time and precautionary measures (mouth-guards) did not influence the onset of complications. The subjects’ habit of wearing a mouth guard continued even after the end of the therapy and follow-up periods.

Therapeutic Approach to Pulp Canal Calcification as Sequelae of Dental Avulsion

Tooth avulsion represents the most complicated dental injury, and the classic treatment is tooth replantation. The most common sequelae are pulp canal calcification (PCC) and pulp necrosis. The presence of pulp necrosis after PCC is reported in up to 30% of the cases and is a challenge due to the difficulty of endodontic treatment. This case report describes the surgical treatment of a replanted tooth presenting PCC and periapical pathology eight years after the trauma. An endodontic surgery was performed to remove the apical granuloma, to prepare the apical root, and to seal the apical region with an endodontic cement. In a three-year follow-up, there was an absence of inflammatory signs and symptoms or apical lesion. This report shows the importance of close follow-up after dentoalveolar injuries. After the initial dental trauma and its consequences to pulpal tissues, the executed procedures allowed a favourable outcome.

Occurrence and timing of complications following traumatic dental injuries: A retrospective study in a dental trauma department

Background

This study explores the pattern of complications occurrence resulting from traumatic dental injuries, the relation of this pattern to the number of years from the time of the injury to its first diagnosis, and other contributing characteristics such as root development and trauma characteristic.

Material and Methods

Patients’ data treated following dental trauma from 2002 to 2014 were classified and grouped according to age, gender, tooth type, injury type, diagnosis and the time that elapsed between the traumatic event and the diagnosis of complications (TIC). The distribution function of the quantitative parameters was determined with the Kolmogorov-Smirnov test. Fisher exact test was used to test differences between categorical parameters.

Results

The review identified 166 patients (114 male and 52 female), with a total of 287 traumatized teeth, and a mean of 1.8 injured teeth per incident. Maxillary teeth were involved significantly more often in traumatic dental injuries. The follow-up period range (TIC) had a mean of 2.99 years. The most frequent complication was pulp necrosis (34.2%). The most frequent complication related to avulsion was ankylotic root resorption (50%) diagnosed after a median TIC of 1.18 years. Open apices at the occurrence of trauma were observed in 52 teeth. Of these, 54.9% experienced pulp necrosis and 9.8% inflammatory root resorption with a median TIC of 1.63 years. Teeth that experienced multiple traumatic events showed significantly more late pulp necrosis compared to teeth that experienced a single traumatic injury (61.9% vs. 25.3%, respectively, p<0.0001).

Conclusions

Follow-up periods should be based on the type of traumatic dental injury and the severity of the potential complications for the tooth. Current recommendations for follow-up after traumatic dental injury should be revised to reflect the need for more frequent and overall prolonged follow-up.

Key words:Dental trauma, avulsion, open apex, pulp necrosis, root resorption, follow-up, complications.