Longitudinal clinical and radiographic evaluation of severely intruded permanent incisors in a pediatric population

Abstract

Intrusion is defined as the axial dislodgment of the tooth into its socket and is considered one of the most severe types of dental trauma. This longitudinal outcome study was undertaken to evaluate clinically and radiographically severely intruded permanent incisors in a population of children and adolescents. All cases were treated between September 2003 and February 2008 in a dental trauma service. Clinical and radiographic data were collected from 12 patients (eight males and four females) that represented 15 permanent maxillary incisors. Mean age at the time of injury was 8 years and 9 months (range 7-14 years and 8 months). Mean time elapsed to follow-up was 26.6 months (range 10-51 months). The analysis of data showed that tooth intrusion was twice as frequent in males. The maxillary central incisors were the most commonly intruded teeth (93.3%), and falling at home was the main etiologic factor (60%). More than half of the cases (53.3%) were multiple intrusions, 73.3% of the intruded teeth had incomplete root formation and 66.6% of the teeth suffered other injuries concomitant to intrusion. Immediate surgical repositioning was the treatment of choice in 66.7% of the cases, while watchful waiting for the tooth to return to its pre-injury position was adopted in 33.3% of the cases. The teeth that suffered additional injuries to the intrusive luxation presented a fivefold increased relative risk of developing pulp necrosis. The immature teeth had six times more chances of presenting pulp canal obliteration that the mature teeth and a lower risk of developing root resorption. The most frequent post-injury complications were pulp necrosis (73.3%), marginal bone loss (60%), inflammatory root resorption (40%), pulp canal obliteration (26.7%) and replacement root resorption (20%). From the results of this study, it was not possible to determine whether the type immediate treatment had any influence on the appearance of sequelae like pulp necrosis and root resorption after intrusive luxation, but the existence of additional injuries and the stage of root development influenced the clinical case outcome in a negative and positive manner, respectively.

Intrusive Dental Injuries in Children: Manifestations and Management

“…The intraoral examination revealed lacerations on lower lip mucosa and mobility of dento alveolar segment between permanent mandibular right lateral incisor (42) and left lateral incisor (32). Permanent maxillary left central (21) and lateral incisors (22) were intruded and lateral luxation of permanent maxillary right central (11) and lateral incisors (12) was evident clinically (Fig. 4C).…”

“…Composite and multifl ex wire splinting was done from right maxillary canine (13) to left maxillary fi rst premolar (24) except intruded left maxillary central (21) and lateral incisor (22). Interdental splinting was done from left mandibular lateral incisor (32) to right mandibular lateral incisor (42) followed by composite and multifl ex wire splinting from left mandibular fi rst premolar (34) to right mandibular fi rst premolar (44).…”

“…The intraoral examination revealed lacerations on lower lip mucosa. Permanent maxillary left central incisor (21) was severely intruded (more than 7 cm) maxillary left lateral incisor (22) was clinically missing and right maxillary central incisor (11) was luxated (Figs 5B and C). The radiographic examination revealed that the permanent maxillary left central incisor (21) was severely intruded with concomitant uncomplicated enamel fracture and the root formation was almost complete.…”

Conhecimento de mães sobre os procedimentos de emergência nos casos de avulsão dentária

“…É a lesão dentoalveolar que mais causa danos funcionais, estéticos e psicológicos ao paciente, constituindo-se em uma grave urgência odontológica 2 . Ocorre principalmente em crianças [3][4][5][6][7] , com prevalência estimada de 1% a 16% 8 .…”

Long-term Effects of Traumatic Injuries to Incisors and Periodontal Tissues during Childhood

“…Before root growth is completed, severely intruded teeth have six times the prevalence of root canal obliteration and a lower risk of root resorption. 15 years after the trauma event, 30% of the teeth have been lost [7,8,27,41].…”