Accidental avulsion of a recently traumatised maxillary anterior tooth during rubber dam application

Avulsion injuries are usually seen in the anterior maxillary teeth as a result of trauma. Avulsion as an endodontic mishap is extremely rare. This report highlights an unusual instance of exarticulation of a recently traumatised maxillary central incisor tooth when the rubber dam was applied during a routine non-surgical endodontic procedure. The tooth was immediately repositioned and stabilised with wire composite splint. Endodontic treatment was initiated after rubber dam isolation with a modified technique. Calcium hydroxide was used as intracanal medicament dressing, and obturation was done after 2 weeks. The treatment was successful with uneventful periodontal healing at 24-month follow-up. The presence of well-demarcated periodontal ligament space and absence of any resorptive area on the radiograph could be defined as a successful outcome for the present case.

[Short-term prognosis of laterally luxated primary teeth left without treatment: a retrospective study of 45 consecutive cases]

PURPOSE

To study the clinical prognosis of laterally luxated primary teeth after 6-month follow-up without treatment.

METHODS

Patients with laterally luxated primary teeth, visiting Department of Pediatric Dentistry, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from March 2018 to March 2019, were selected for the study. Based on the inclusion and exclusion criteria, totally 45 patients with 57 primary teeth were included. The reposition outcomes and pulp prognosis were reviewed at the end of follow-up. The data were analyzed using SPSS 23.0 software package.

RESULTS

During a 6-month follow-up, 92.98% of the luxated teeth showed spontaneous reposition while only 31.58% of the traumatic teeth were back to the original position. Regarding the pulp healing complications, 54.39% of the luxated teeth exhibited no clinical symptoms, and 14.04% of the evaluated teeth displayed pulp canal obliteration, and pulp necrosis happened in 31.58% of the injured teeth. There was significant difference in the reposition outcome between labial-palatal luxation and mesial-distal luxation(P<0.05), but no significant difference was found in pulp prognosis between the two luxation types(P>0.05). Spontaneous reposition and crown discoloration observed in most of the evaluated cases, were the earliest signs after one-month follow-up. Periapical translucent image and root resorption due to periapical inflammation showed within the first three months after injury, pulp canal obliteration appeared after 6 months.

CONCLUSIONS

In general, most of the laterally luxated teeth left without treatment can reposition spontaneously and show lower incidence of pulp necrosis compared with mature permanent teeth in half a year after injury. The direction of luxation does not affect pulp prognosis but has an influence on teeth reposition procedure.

Surgical Extrusion of Anterior Teeth with Intrusion Traumatic Injury: A Report of two Cases

Intrusion is the most severe luxation injury type, which results in both soft and hard tissue damage. In severe intrusions, the crown must be re-positioned in the arch to avoid periapical pathology and marginal bone loss. There is minimal information about the effect of treatment delay on pulpal and periodontal healing in intrusion trauma. The present paper reports on two cases of severe intrusive luxation applied late at different times treated with surgical extrusion. The first patient, an 11-year-old female, referred to Tokat GOP pediatric dentistry clinic three days after the intrusion tooth 21. The second patient, a 13-year-old male, referred to our clinic fifteen days after a traffic accident. The intruded teeth were positioned surgically and splinted. Surgical extrusion should be preferred as soon as possible to initiate root canal treatment in teeth, the crown of which is fully embedded in the alveolar bone.

Computerized three-dimensional design for accurate orienting and dimensioning artificial dental socket for tooth autotransplantation

OBJECTIVE

To present an improved, accurate, and efficient method for planning and preparing an artificial socket for autotransplantation, by using a three-dimensional (3D) surgical guide and a replica of the transplanted donor tooth. The guide and the tooth replica were fabricated using a computerized 3D simulation. A case treated with this approach is presented.

METHOD AND MATERIALS

Cone beam computed tomography (CBCT) and computerized 3D simulations (Simplant plus registration as stereolithography) were used for planning the optimal artificial socket position and dimensions, within the limitations of the alveolar bone borders and the adjacent teeth roots, and for producing a metal replica of the transplanted tooth. The replica was used to assure the correct socket preparation and orientation before extraction and replantation of the donor premolar.

RESULTS

The entire procedure time for autotransplantation of a permanent second premolar to the incisor site without the buccal plate was about 45 minutes. At 15 months' follow up, clinical examination of the transplanted tooth demonstrated both normal mobility and no sensitivity to cold stimulation. A radiographic examination revealed continuous root development and pulp obliteration. The adjacent teeth maintained their vitality with no pathologic signs.

CONCLUSION

We present an improved technique for autotransplantation based on computerized 3D simulations and guidance for accurate dimensioning and optimal locating of the artificial socket relative to the alveolar bone borders and the adjacent teeth roots. This technique may significantly simplify the autotransplantation procedure and will probably also increase its success rate and use in young patients, even in cases with absence of a buccal plate.

Delayed tooth reimplantation with 4-year follow-up: the management of ankylosis during facial growth

This case report describes the consequences of delayed (24 hours) reimplantation of an avulsed maxillary central incisor, findings over a 4-year follow-up period, and the management of ankylosis during facial growth. After a traumatic event, a 10-year-old boy was taken to a hospital emergency department due to injuries to his face, including avulsion of the maxillary left central incisor. Despite the short amount of time before arriving at the hospital (10 minutes) and use of the correct storage medium (milk), the tooth was not reimplanted, and the parents did not receive instructions to seek dental treatment. The next day, the child was brought to a dental school because he objected to the loss of his tooth. The treatment chosen was delayed tooth reimplantation. At the 1-year follow-up, the reimplanted tooth was infraoccluded, and periapical radiography revealed signs of ankylosis and initial replacement root resorption. At the 2- and 3-year follow-up examinations, resorption and infraocclusion of the central incisor had progressed. In this case, the delayed reimplantation resulted in ankylosis that had a significant clinical impact due to the patient's facial growth. Direct resin restoration of the reimplanted tooth was therefore performed 3 years after trauma. Despite continued resorption and infraocclusion of the tooth observed 4 years posttrauma, the esthetic, low-cost treatment was well accepted, and the patient's quality of life was improved until definitive treatment can be performed.

Intrusive luxation of an immature permanent incisor: a 10-year follow-up

Intrusive luxation in the permanent dentition is rare and considered the most severe form of dental trauma. Intrusion is characterized by the axial displacement of the tooth into the alveolar bone. It normally affects pulpal vitality and the periodontal ligament. The most common forms of treatment are waiting for spontaneous reeruption, repositioning with orthodontic procedures, or immediate surgical repositioning. A well-planned approach to the treatment of an intrusive luxation is necessary to obtain a successful result. This case report describes treatment of an 8-year-old boy who suffered intrusive luxation of his permanent maxillary right central incisor while root formation was incomplete. The patient was followed clinically and radiographically for 10 years.

Mandibular Canine Tooth Luxation Injury in a Dog

A mixed breed dog was presented for lateral luxation of the mandibular left canine tooth following oral trauma. This case report describes the management of this injury including reduction, stabilization using a wire reinforced acrylic splint, and standard endodontic therapy of the mandibular left canine tooth.

CBCT-Aided Multidisciplinary Approach to Salvaging an Intruded Tooth

Among the most severe types of traumatic dental injuries is intrusive luxation, which displaces the affected tooth deeper into the alveolus, causing significant damage to the pulp and all of the supporting structures. This article describes a unique case of intrusive luxation of the mature left maxillary central incisor in an 18-year-old male patient. The diagnosis was confirmed using cone-beam computed tomography (CBCT), after which the intruded tooth was successfully repositioned by endodontic and orthodontic management. This was followed by prosthodontic rehabilitation. This case report also discusses the role of CBCT in effectively diagnosing this type of injury.

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.

Post-traumatic complications of severe luxations and replanted teeth

AIM

The aim of this study was to evaluate the main post-traumatic complications of severe luxation and replanted teeth using clinical and radiographic analyses.

MATERIALS AND METHODS

Eighty-three patients aged between 7 and 55 years old presenting 180 traumatized teeth that suffered extrusive luxation (n=67), lateral luxation (n=69), intrusive luxation (n=10) and tooth avulsion (n=34) followed by replantation were evaluated. The follow-up period was 24 months. The complications examined were: pulp canal obliteration, pulp necrosis and root resorption (infammatory and replacement). Furthermore, the relationship between time elapsed before receiving dental attendance and development of infammatory resorption was observed.

RESULTS

Pulp necrosis was the main complication, occurring in 147 teeth (82.7%). All of the teeth that suffered intrusive luxation and tooth avulsion were diagnosed with pulp necrosis, with significant difference in comparison with another traumas (p<0.001/Fisher's exact test). Infammatory root resorption was observed in 20.5% of the cases and replacement resorption was more related to tooth replantation (94.1%), showing significant prevalence among tooth luxations (p<0.001/Fisher's exact test). In addition, it was noted that patients who seek treatment 9 weeks after the trauma episode presented 10 times more chance of developing infammatory resorption when compared with patients who seek treatment soon after dental trauma (Odds ratio test).

CONCLUSION

It may be concluded that pulp necrosis was the main post-traumatic complication observed in traumatized teeth and that delay in seeking treatment may damage the prognosis of severe luxation and replanted teeth.

CLINICAL SIGNIFICANCE

Clinical studies describing the main complications that may affect traumatized teeth present great relevance to make the population aware of the importance of seeking immediate treatment and to alert the professional to the need for follow-up. When traumatic injuries are diagnosed and treated early, post-traumatic complications may be controlled, allowing conservation of the tooth in oral cavity.

Revascularization in an immature necrotic permanent incisor after severe intrusive luxation injury: a case report

BACKGROUND

Pulp necrosis as a result of trauma is common in almost all intruded teeth, and the ideal treatment method for intruded immature and necrotic teeth has not yet been determined. Therefore, the aim of this report was to present a case of pulp revascularisation in a severely intruded immature maxillary right incisor.

CASE REPORT

After clinical and radiographic examination, the incisor was defined as necrotic. Revascularisation therapy was performed over multiple appointments. After 21 months of recall appointments, healing of the periapical area and apical closure were seen to be complete. However, at the 27-month appointment, the vitality tests were negative and revascularisation of the right incisor, which had intrusion injuries, had not occurred. The tooth underwent root canal treatment. Finally, the tooth spontaneously erupted into the vestibule and was repositioned with orthodontic appliances.

CONCLUSION

Although revascularisation can promote continued root development and root dentin apposition, long-term root canal treatment may be required due to treatment results with periapical inflammation in intruded teeth with open apices.

Autogenous tooth transplants for the pediatric dental patient: report of three cases

There are select instances where autogenous tooth transplantation should be considered as part of the overall management of the developing occlusion in the child patient. These circumstances occur when there are missing mandibular premolars in Class II malocclusions with good faces, unevenly distributed agenesis, missing or lost incisors, and ectopic teeth. The purposes of this paper were to educate pediatric dentists about the autogenous tooth transplantation technique, its success, its potential advantages and disadvantages and to report on three cases treated with autogenesis tooth transplantation.

Management of a severely malpositioned replanted avulsed tooth: a case report

This case report details the treatment and follow-up of an avulsed and malrepositioned maxillary anterior tooth. Treatment of the malrepositioned tooth included re-extraction and replantation as well as root canal therapy. Initial success at 1-year post-trauma was overshadowed by the development of external root resorption and a horizontal root fracture, which occurred between 1 and 2 years after trauma. The development of external root resorption can be attributed either secondarily to the original trauma or due to active orthodontic treatment.

Revascularization of immature permanent incisors after severe extrusive luxation injury

Pulp necrosis is an uncommon sequel to extrusive luxation in immature teeth with incomplete apical closure. In this report, we describe the management of severely extruded immature maxillary incisors and the outcome of revascularization to treat subsequent pulp necrosis. An 8.5-Year-old boy with severe dentoalveolar trauma to the anterior maxillary region as a result of a fall was provided emergency treatment consisting of reduction of the dislodged labial cortical bone and repositioning of the central incisors, which had suffered extrusive luxation. When he presented with spontaneous pain involving the traumatized incisors a week later, the teeth were treated via a revascularization protocol using sodium hypochlorite irrigation followed by 3 weeks of intracanal calcium hydroxide, then a coronal seal of mineral trioxide aggregate and resin composite. Complete periradicular healing was observed after 3 Months, followed by progressive thickening of the root walls and apical closure. Follow-up observations confirmed the efficacy of the regenerative treatment as a viable alternative to conventional apexification in endodontically involved, traumatized immature teeth.

Clinical indications for digital imaging in dento-alveolar trauma. Part 1: traumatic injuries

Traumatized teeth present a clinical challenge with regard to their diagnosis, treatment plan, and prognosis. Recent developments in imaging systems have enabled clinicians to visualize structural changes effectively. Computed tomography, magnetic resonance imaging and cone beam computed tomography are among the most commonly used systems for dental and maxillofacial surgery. The purpose of this review is to describe the advantages and disadvantages of each technique and the clinical application for dento-alveolar trauma. Three clinical cases are described to illustrate the potential use of the NewTom 3G for diagnosis and treatment plan of dento-alveolar traumatic injuries.

Traumatic displacement of teeth into maxillary sinus cavity: an unusual dentoalveolar fracture

We present an unusual dentoalveolar fracture case who had displacement of teeth into maxillary sinus cavity. This patient was 15 years old. He had oral bleeding and lost teeth after falling from the top of a building. Examination of maxillofacial region showed that there were left maxillary teeth lost, alveolar fracture, gingival bleeding and laserations. Maxillofacial bones were found intact. Canine, both premolars and the first molar teeth on left maxilla were lost. Pantomographic evaluation viewed two teeth in the left maxillary sinus. In addition, computerized tomography clearly showed oroantral fistula, alveolar fracture and teeth into maxillary sinus. Extraction of teeth from sinus cavity was performed as well as repair of oroantral fistula and alveolar fracture. This patient is thought that dentoalveolar injury may be more serious than expected according to the oral examination and it requires careful evaluation, even if dentoalveolar trauma does not pose a significant morbid risk.

Is the Resorption External or Internal?

Resorption of teeth is reviewed from a diagnostic perspective to clarify the confusion as to whether it is external or internal. The key features of the various types (external surface, transient apical breakdown, external inflammatory, external replacement, external cervical and internal) are described and illustrated by cases. Management and appropriate treatment is dependent on the correct diagnosis.

CLINICAL RELEVANCE

Diagnosis of resorption is essential to the appropriate management.

Severe sequelae of acute dental trauma in the primary dentition ? a case report

The incidence of traumatic injuries to primary teeth is high. Previous studies report frequencies ranging from 4% to 33% of all children. The damage limitation and the prevention of sequelae are goals that shall direct the treatment for dental trauma. Inappropriate approaches to dental trauma can cause more damage than the trauma itself. This article describes the diagnosis, management and follow-up of a 5-year-old boy who presented with uncommon sequelae of an inappropriate approach following a severe luxation of the primary maxillary right central incisors 2 years ago.

Use of hydroxyapatite in tooth replantation radiographically followed up for 14 years: a case report

A lateral incisor was replanted 4 h after trauma. The tooth subsequently developed external root resorption treated with calcium hydroxide initially and with a hydroxyapatite root filling subsequently. Radiographs of the replanted tooth were obtained to follow up the patient for 14 years.

Tooth loss and subluxation in the primary dentition: a twelve-year follow-up case report

The case of a five-year-old child is reported, who suffered dento-alveolar injury including subluxation of the right upper lateral incisor and avulsion of the upper central incisors and left upper lateral incisor and laceration in the mucosa. The case was followed for 12 years until complete root formation and alignment of the anterior permanent teeth.

[Treatment of young permanent teeth following luxation based on two clinical cases]

Treatment of young permanent teeth following luxation based on two clinical cases The most problematic field of pediatric dentistry is the treatment of dental trauma. There has been a remarkable increase in the number of dental injuries resulting in damaged periodontal tissues at the pediatric dentistry department of the University of Debrecen. The aim of the authors' present study was to call attention to the most common problems emerging during the treatment of dental trauma of young permanent teeth following luxation based on two clinical cases. Furthermore, the article offers guidance for the more effective therapy of traumatized teeth according the IADT protocols in Hungarian.

[Diagnostic image (169). A man with partial atelectasis after an accident. Partial atelectasis on the right lower lobe due to a dislocated dental fragment]

A 23-year-old man fell from a height of 7 metres and developed partial atelectasis of the right lower lobe of the lung, due to a dislocated dental fragment.

Complete tooth extraction: a case report

Advanced Trauma and Life Support protocol is used in trauma situations to identify life-threatening injuries, and after those are addressed, it provides a systematic approach to identify minor injuries. A 17-year-old male, who was involved in a motor vehicle accident, was treated for an open toe fracture. He also had an "avulsion injury" to his left hand and was missing a tooth. On follow-up two days later, he was found to have a tooth in his left hand after he presented with cellulitis of a hand wound. He was appropriately treated with foreign body removal, incision and drainage, and antibiotics. This case is not only presented for being unique but also to emphasize the importance of the secondary survey and serial examinations instructed by Advanced Trauma and Life Support.

Lingual displacement of an entire lower third molar. Report of a case with suggestions for prevention and management

Perfect knowledge of regional anatomy is the main factor in the prevention of tooth displacement during lower third molar extraction. Some technical expedients should be used to avoid the occurrence of this accident and to manage it if it anyway happens. The patient was seen just 2 days after his left lower third molar was lingually displaced during surgical extraction. Two mucoperiosteal flaps were made under general anaesthesia, one on each side of the mandible, to obtain good exposure of the previous bone access and to retrieve the tooth. No further complications occurred. Lower third molar extraction becomes complicated if tooth displacement happens. Predisposing factors of this accident are analyzed and the rules to minimize the risk of its occurrence and to simplify the retrieval of the displaced tooth are discussed.

[Long-term outcome of dentoalveolar trauma in relation to post-traumatic instability]

PURPOSE

The aim of this retrospective study was to investigate the long-term outcomes of dental injuries. Subluxated and laterally luxated teeth were evaluated according to the findings of CO2 sensitivity, obliteration, pulpal sclerosis, and the duration of post-traumatic fixation of the injured teeth.

MATERIAL AND METHODS

The data of 725 patients were analyzed retrospectively over a period of 14 years. Of these, 108 patients could be investigated for a long-term follow-up. Dental trauma was classified according to the degree of luxation (I-III).

RESULTS

There was a significant correlation between the degree of luxation and the post-traumatic findings of CO2 sensitivity. There was no significant correlation between the degree of luxation and the post-traumatic findings of apical inflammation, pulpal sclerosis, and/or obliteration. Long-term fixation of injured teeth had no effect on the short- and long-term occurrence of pathologic processes at the root such as root resorption.

CONCLUSION

The post-traumatic finding of CO2 sensitivity was related to the degree of luxation of the injured teeth. Apical inflammation, pulpal sclerosis, and obliteration were not related to the degree of luxation. The results suggest that long-term fixation of injured teeth has no negative effects on the long-term outcomes of subluxated and laterally luxated teeth.

Pulpal healing following acute dental trauma: clinical and radiographic review

Successful treatment of tooth luxations, crown fractures, and root fractures is often compromised by the emergency nature of the injury. Precise radiographic and clinical evaluation is required to facilitate healing and treatment selection. While traditional treatment protocols indicate that dental injuries implying pulpal ischemia require immediate endodontic therapy to avoid healing complications, the clinical investigations discussed herein suggest that a variety of etiologies for pulp survival/pulp necrosis exist. This article discusses the long-term prognosis of pulp necrosis following traumatic dental injuries, and clinical and radiographic criteria for its diagnosis.

A multidisciplinary approach to the treatment of an intruded maxillary permanent incisor complicated by the presence of two mesiodentes

Treatment of a traumatically intruded maxillary incisor with an immature apex remains controversial. Treatment options include observation, surgical repositioning, or orthodontic forced eruption. Likewise, the ideal timing of surgical removal of a mesiodens is highly controversial: immediate versus delayed intervention. The complications associated with untreated supernumerary teeth include: overretention of primary teeth, delayed eruption of permanent incisors, rotations, impaction, diastema, pulp necrosis and root resorption. Less common sequelae include enlarged follicular sacs, cystic degeneration and nasal eruption. This paper describes another risk factor associated with delayed removal of a mesiodens previously not mentioned in the dental literature, namely potential complications arising from a traumatic injury, in particular intrusion, of the maxillary permanent incisors.

[Complicated tooth replantation]

The materials and techniques for tooth replantation in presence of complications are discussed on the basis of recent advances in oral medicine and surgery and dentistry. The following complications are examined: mucous and cutaneous wounds, retention of teeth and foreign bodies, bony and radicular fractures with or without tissue loss, root drying, infection. Other problems are also discussed: replantation of deciduous teeth, endodontic therapy, stabilization of replanted teeth, application of orthodontic forces. Some technical principles are presented for a better management of various clinical situations. At last, interesting clinical cases are reported.

Intrusion injuries of primary incisors. Part I: Review and management

Intrusion injuries commonly occur in the primary dentition. They can be described as luxation injuries resulting from an axially directed impact, which drives the tooth deeper into the alveolar socket. The impact results in compression of and damage to the periodontal ligament as well as injury to the pulp of the intruded incisor. In addition to rendering treatment to the intruded primary tooth, the dentist must also be aware of the possibility of an injury to the developing permanent teeth germs located in close proximity to the roots of the injured primary teeth. This review will discuss the characteristics, implications, and management of intrusion injuries of primary incisors.

Complete intrusion of a maxillary right primary central incisor

This clinical article presents a rare presentation of complete intrusion of a maxillary right primary central incisor. Routine examination of a 29-month old female patient revealed an intrusion injury where the primary central incisor was displaced through the floor of the nasal cavity. The traumatic impaction was erroneously diagnosed as an avulsion injury by the attending emergency room physician and later discovered by the dental team during routine care. The injury was documented with radiographs. The intruded incisor was removed through the right naris utilizing general anesthesia to manage behavior and surgical access. This article emphasizes the importance of radiographs and demonstrates the need to involve the dental professional in initial assessment of dental trauma.

Transplantation of displaced and dilacerated anterior teeth

The therapy of dilacerated permanent anterior teeth usually involves surgically removing the tooth. Subsequently, orthodontic methods for closing the space or keeping it open are preferred until the patient reaches an age when definitive implantological or prosthetic treatments may be used. Anterior tooth transplantation should be considered as an alternative to surgically extracting the tooth. This study describes a period of investigation covering 3 years during which neither replacement resorption nor inflammatory resorption was diagnosed in the five transplanted teeth. The clinical tooth mobility was similar to that of the adjacent teeth. In spite of the vertical loss of bone shown radiographically no pathologically enlarged pockets or recessions have been found. It is not yet possible to make any comments on the prognosis for the long term.

Survival of avulsed permanent maxillary incisors in children following delayed replantation

The purpose of this study was to identify the variables that significantly influenced the survival of incisors replanted after extended extra-alveolar duration at The Hospital for Sick Children, Toronto, Canada, between June 1988 and December 1993. Survival analysis was used to identify variables that significantly influence the retention of replanted incisor teeth. Survival was defined as the time that elapsed between the replantation of an avulsed incisor and the time it was finally lost. Information on 9 variables was collected for 38 patients (25 males; 13 females) and 52 replanted permanent maxillary incisors. The mean extra-alveolar duration for the sample was 123 min. The mean follow-up interval was 942 days (range: 364-2126 days). Incisors replanted with open apices had a significantly decreased survival compared with teeth with mature apices (P = 0.04; relative risk 4.2). There was also a significant association between increased survival and obturation of the root canal with gutta-percha and sealer (P = 0.006; relative risk 10.0). A trend towards improved survival of replanted incisors was found for children older than 11 years old at the time of replantation (P = 0.09; relative risk 2.8). These results are consistent with previous studies and may assist clinicians and parents in the decision-making process associated with the management of avulsed teeth in children.

Delayed endodontic and orthodontic treatment of cross-bite occurring after luxation injury in permanent incisor teeth

A case is presented in which combined endodontic and orthodontic therapy was performed in traumatically injured teeth 12 months after an accident. Calcium hydroxide treatment was used to halt any possible resorption during orthodontic treatment. The teeth were repositioned in a desirable manner without any complication by orthodontic treatment. Root canal obturation was accomplished after the completion of active orthodontic treatment. Recall examination 12 months after completion of root canal treatment showed clinical and radiographic evidence of healing.

Subluxation injuries of maxillary primary anterior teeth: epidemiology and prognosis of 207 traumatized teeth

This study investigated the epidemiology, sequelae, and prognosis of subluxation injuries to the maxillary primary anterior dentition. Data were collected from dental records at the Montreal Children's Hospital, Montreal, Canada, of patients sustaining trauma between 1982 and 1993. The study group consisted of 207 teeth in 134 patients, 81 males and 53 females. The age of the patients ranged from 0.8 years to 7.5 years, with a mean of 3.5 years. The highest incidence of trauma was in males between the ages of 3 and 4 years, and in females between 1 and 3 years. The highest incidence of trauma (66.2%) involved the primary central incisors. The most common cause of trauma (52%) was simple falls indoors. Occlusal or periapical radiographs were the radiographic view of choice unless an anterior nasal spine fracture was suspected, in which case a lateral projection was exposed. Approximately 64% of the study teeth had a mobility ranging from 0.6 to 1.5 mm. Treatment varied from no treatment (80% of teeth) to extraction. Post-traumatic evaluations were distributed into six common time intervals used by dentists for follow up. The results indicated that patient discomfort and occlusal interference were not common. Discoloration and pulpal calcification increased with time. Mobility decreased with time, with the majority of teeth returning to a normal physiologic range. External resorption may have been present, but was rare. Treatment or antibiotics were rarely needed at follow-up visits. Overall, these teeth responded positively, and there was a low morbidity associated with subluxation injuries.

[The reimplantation of teeth avulsed by trauma]

The paper underlines the importance of the reimplantation of teeth following injury in young subjects. The positive results achieved within the short term encourage the extension of this method even to those cases with a poor prognosis (unsuitable means of conservation, long interval between injury and reimplantation). The tooth with in any case serve to retain the space until a prosthetic replacement is inserted when growth has ended.