Clinical outcomes of 79 traumatically intruded permanent teeth in Chinese children and adolescents: A retrospective study

Abstract

Background/Aim Data on the clinical outcomes of traumatically intruded, young, permanent teeth in Chinese children and adolescents are absent. The aim of this study was to examine the probability of spontaneous re‐eruption of injured teeth, to investigate the incidence of pulp necrosis with infection of the root canal system and replacement root resorption and to analyse possible factors related to healing complications after injury. Materials and Methods Clinical data from 6‐ to 18‐year‐old patients who sustained intrusive luxation from 2007 to 2016 were reviewed. Teeth were treated by awaiting re‐eruption, orthodontic repositioning or surgical repositioning. The incidences of spontaneous re‐eruption, pulp necrosis with infection, replacement resorption and marginal bone loss were calculated, and factors related to these complications were analysed using Cox regression and Kaplan‐Meier analyses. Results Data from 79 teeth in 58 patients (mean age 9.19 ± 2.34 years) were examined over follow‐up periods from 7 to 87 months (median 18 months). Of the 50 teeth awaiting re‐eruption, the incidences of complete re‐eruption and partial re‐eruption were 40.0% and 34.0%, respectively. Teeth intruded <3 mm had a higher complete re‐eruption rate (57.1%) than those with a 3‐7 mm of intrusion (18.2%) (hazard ratio [HR] = 4.15). Of the 52 teeth observed for more than 12 months, pulp necrosis with infection, replacement resorption and marginal bone loss occurred in 57.4%, 15.4% and 61.5% of the teeth, respectively. Teeth with 3‐7 mm (60.9%, HR = 2.97) or >7 mm (100%, HR = 6.44) of intrusion and teeth with uncomplicated crown fracture (85.7%, HR = 5.19) were more likely to develop pulp necrosis with infection. Teeth that received orthodontic or surgical repositioning showed higher incidences of replacement resorption (23.1%, HR = 5.72; 25.0%, HR = 11.68, respectively). Conclusions Spontaneous re‐eruption of intruded teeth was significantly related to intrusion depth. Intrusion depth and crown fracture had strong relationships with pulp necrosis with infection, whereas the choice of treatment influenced the development of replacement resorption.

Photographic assessment of simulated dental luxation injuries

“…Pulp necrosis is the most commonly found complication following extrusion, 16 intrusion, 2 and lateral luxation 17 . Mature incisors with a closed apical foramen have a higher risk of pulp necrosis, 18, 19 with rates of up to 100% for intrusion 1 . If pulp necrosis is diagnosed or seems inevitable, the indication for endodontic treatment is given 20 .…”

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

“…It was found that OE may lead to better results in 90.3% of the teeth 8 . However, it is important to note that extrusion may also result in calcific metamorphosis, which is caused by the deposition of tertiary dentin on the dentinal walls, 17 and be related to more cases of replacement root resorption 18 . Following orthodontic treatment, there is an increased risk for root resorption even in intact teeth 19,20 that may be induced by the pressure in the periodontal ligament 21 .…”

“…8 However, it is important to note that extrusion may also result in calcific metamorphosis, which is caused by the deposition of tertiary dentin on the dentinal walls, 17 and be related to more cases of replacement root resorption. 18 Following orthodontic treatment, there is an increased risk for root resorption even in intact teeth 19,20 that may be induced by the pressure in the periodontal ligament. 21 According to a recently published meta-analysis, there is a higher incidence of root resorption in vital teeth as compared to roottreated teeth.…”

Fragment rehydration, splinting, and autotransplantation: A journey to better treatment for traumatized teeth

“…1,26 Orthodontic repositioning of traumatically intruded teeth might result in clinical complications such as root resorption and pulp necrosis. 31 In this issue, a retrospective study of the effects of extrusion of traumatically intruded teeth was conducted. Shalish et al compared adverse effects after orthodontic extrusion of traumatically intruded teeth to the treatment of non-traumatized teeth.…”

“…The current IADT guidelines recommend spontaneous eruption, orthodontic extrusion, and surgical repositioning as three treatment options for repositioning intruded teeth 1,26 . Orthodontic repositioning of traumatically intruded teeth might result in clinical complications such as root resorption and pulp necrosis 31 . In this issue, a retrospective study of the effects of extrusion of traumatically intruded teeth was conducted.…”