Prognostic markers of post‐traumatic dental external root resorption in children—a pilot study

Abstract

Background External inflammatory root resorption (EIRR) is a frequent complication of traumatic dental injuries (TDI). The aim of this cohort study was to identify novel non‐invasive markers of post‐traumatic EIRR by assessing the changes in the pulp's blood flow and the composition of gingival sulcus fluid (GCF) in children after dental trauma. Material and methods Thirty‐two children were enrolled and assessed within 48 h of a TDI to their permanent incisors and during an additional three visits over a 6‐months follow up period. During each visit, a radiograph and laser Doppler flow (LDF) measurements of the pulp blood flow were performed on the injured tooth, and the GCF was sampled. The permanent first molar tooth of the same subject served as a control for the LDF measurements and the GCF sampling. Concentrations of IL‐1α in the GCF were measured using enzyme‐linked immunosorbent assays. Radiographs were used to confirm EIRR. Results EIRR occurred in fourteen (43.8%) teeth in 32 patients. The teeth with EIRR showed diminished LDF readings when compared with controls at all visits. The LDF readings of the injured teeth continued to decrease at follow up visits. In the EIRR group, levels of IL‐1α in the GCF of teeth with EIRR were increased and significantly higher than those of the control teeth at the visit when EIRR was diagnosed. The IL‐1α levels were significantly higher in the EIRR group when compared to the injured teeth of patients without EIRR at the last follow‐up visit. Conclusions The occurrence of EIRR after mechanical trauma of permanent teeth with complete root development is accompanied by a significant reduction in the blood flow of the tooth's pulp. It is accompanied by an increase in concentrations of IL‐1α in the GCF of EIRR affected teeth. The results of this pilot study identified the use of IL‐1α in GCF and LDF as non‐invasive markers of EIRR.

Inflammatory mediators for predicting the risk of trauma‐induced root resorption: A systematic review

“… 16 In another study, Maga et al investigated IL‐1α and found significantly higher levels in the injured teeth with EIRR at the second, third and fourth visits. The same was seen when the levels were compared between the injured teeth with EIRR and those without ERRR 17 . Diminished values were recorded with LDF in injured teeth with EIRR compared with the control teeth at all visits.…”

“…Diminished values were recorded with LDF in injured teeth with EIRR compared with the control teeth at all visits. A lower level was seen in injured teeth without EIRR than in the control teeth at the first two visits and a higher level in the control teeth than in the injured teeth at the third and fourth visits 17 . The sensitivity for EIRR was 0.72, and specificity was 0.28 17 .…”

“…A lower level was seen in injured teeth without EIRR than in the control teeth at the first two visits and a higher level in the control teeth than in the injured teeth at the third and fourth visits 17 . The sensitivity for EIRR was 0.72, and specificity was 0.28 17 . The three studies which evaluated the single nucleotide polymorphisms (SNP) in the epithelial cells from mucosa found no significant association with resorption (Table 6).…”

“… 18,19 The details of standardization, classification or the index of root resorption and sampling have been detailed in Table 3. Among the studies utilizing the gingival crevicular fluid, Kumar et al 16 included patients with four types of injuries while Gregorczyk‐Maga et al (2021) 17 evaluated patients with mature permanent incisors that had uncomplicated crown fractures with subluxation (Table 4). The type of injury was not mentioned in a previous study done by the same authors 18 .…”

Present status and future directions: Endodontic management of traumatic injuries to permanent teeth

“…Even though EIR is primarily a radiologic diagnosis, a clinical diagnostic approach seems conceivable. Two recent studies identified IL‐1α in the gingival sulcus fluid of affected teeth as a potential biomarker for EIR (Gregorczyk‐Maga et al, 2019, 2021). Further research is needed to evaluate the clinical usefulness of biomarker‐based diagnostic tests for this specific type of root resorption.…”