Aetiology, treatment patterns and long-term outcomes of tooth avulsion in children and adolescents

Abstract

Objective: Tooth avulsion constituting an emergency for children and adolescents necessitates management approaches ensuring the survival of avulsed teeth. The aim of this study was to determine the causes of tooth avulsion and to examine some factors affecting the clinical & radiographic assessment of their prognosis after replantation. Methodology: The study sample was created by using archival records of patients who were referred to the Suleyman Demirel University, Faculty of Dentistry, Department of Pedodontics, with complaint of traumatic injuries, between December 1999 and 2008. The information about age, gender, time and cause of the injury, number of affected teeth, the root maturation level (mature/immature), vitality of the affected teeth, condition of supporting tissues, extra-oral time of avulsed teeth, storage media, time of replantation, type and duration of splinting, and healing process was obtained from the patients’ records. Results: The sample consisted of 66 traumatized children who had a total of 93 avulsed anterior permanent teeth. The age of these patients ranged from 6 to 16 years and the 9- and 10-year-old group had the highest incidence (n=25). The most frequent causes were falls (n=24; 36.4%). Thirty-three out of a total of 93 avulsed teeth (35.5%) were replanted. Of the 33 replanted teeth, 3 (9.1%) were stored in milk and 25 were stored in dry media (n=25; 75.8%). Fifteen teeth (45.5%) were replanted within 30 minutes after the injury. After clinical and radiographic evaluation a total of 12 replanted teeth (36.4%) were considered as failed. Ten of the replanted teeth had to be extracted due to progressive root resorption. Statistical analysis showed no significant relationship between the successes of replanted teeth with extra-oral period, storage media, root formation stage, and additional traumas to the supporting tissues (p>0.05). Conclusion: In this study, during the 9-year period, it was determined that 5.87% of all traumatic dental consisted of avulsion injuries. Thirty-three avulsed teeth in 26 patients were replanted, and 12 replanted teeth were revealed as failures. A high rate of success can be obtained when the avulsed teeth are kept under wet conditions and brought to a dental clinic as soon as possible.

Changes in the aetiological factors of dental trauma in children over time: An 18‐year retrospective study

“…Falls are considered the most important aetiological factor for dental trauma during the primary and permanent dentition periods . The other factors resulting in dental injuries are collisions, sport, traffic accidents and violence . The majority of the dental trauma incidents in young children occur at home, in parks and at kindergarten, whereas adolescents are more commonly subject to dental trauma during sports activities, traffic accidents and violent incidents outside the home …”

“…5,[8][9][10][11] The other factors resulting in dental injuries are collisions, sport, traffic accidents and violence. [12][13][14][15] The majority of the dental trauma incidents in young children occur at home, in parks and at kindergarten, whereas adolescents are more commonly subject to dental trauma during sports activities, traffic accidents and violent incidents outside the home. 12,16,17 The time elapsed from when the dental trauma occurs to when the patient arrives at the dental clinic and receives emergency intervention is one of the most important factors in the prognosis of the affected tooth/teeth.…”

16‐Year follow‐up of an avulsed maxillary central incisor after replantation following 10‐h storage: An unusual case

“…Histologically, replanted teeth exhibit four main patterns of periodontal healing: normal periodontal ligament healing, healing with surface resorption, healing with ankylosis, and healing with inflammatory resorption . In cases of delayed replantation, ankylosis, that characterized by fusion of the alveolar bone and cementum, is generally inevitable because of the absence of viable PDL cells and also there is an underestimated risk of inflammatory . It seems that the prevention or delaying of ankylosis relies procedures such as treatment of root surface, root‐canal therapy, and systemic antibiotic regimen .…”

“…2 In cases of delayed replantation, ankylosis, that characterized by fusion of the alveolar bone and cementum, is generally inevitable because of the absence of viable PDL cells and also there is an underestimated risk of inflammatory. 2,20,37,38 It seems that the prevention or delaying of ankylosis relies procedures such as treatment of root surface, root-canal therapy, and systemic antibiotic regimen. 23 In this case, there was no ankylosis sign in radiograph or clinic 16 years after treatment.…”

Knowledge of Australian primary education providers towards dental avulsion injuries: a cross‐sectional study

“…The International Association of Dental Traumatology (IADT) identifies avulsion as one of the most serious dental injuries due to its implications for tooth loss and sequelae following treatment . Despite only accounting for 0.5–16% of all traumatic dental injuries (TDIs), avulsed teeth are considered the TDI with the poorest long‐term survival rates – with up to 64.5% of teeth lost at the point of injury . A meta‐analysis found that the median age at which a permanent tooth experienced a TDI was 13.8 years, implicating school‐aged children as a high‐risk group for TDIs and avulsion.…”