Dept.

of
Pedodontics
&
JOURNAL
CLUB
Preventive
GUIDED BY :
Dentistry
Dr MANISH GOEL

PRESENTED BY :
Dr Rupinder Deep Kaur
PG 1st Yr

Dr POOJA AHLUWALIA
Dr KAPIL DEV GUPTA
1

Healing complications of
traumatized permanent teeth in
pediatric patients: a longitudinal
study
(International Journal of Paediatric Dentistry 2014; 24:3806)

AUTHORS
1.
2.
3.
4.

THAIS R. C. SOARES
RONIR R. LUIZ
PATRICIA A. RISSO
LUCIANNE C. MAIA

School of Dentistry, Federal University of Rio de

Janeiro, Rio de

INTRODUCTION

Introduction

Traumatic Dental Injuries involve different

types of injuries which depend on strength
and axis of impact.
Affect soft and hard dental tissue and its
supporting structures
TDI can result in tooth loss and bone loss
with occlusal interference
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Introduction

Healing complications depend on factors

Type of affected tissue
Root development
Bacterial contamination

Pulp necrosis is the most common

complication, late diagnosis of which can
result in apical periodontitis and root
resorption

Introduction

The present study aimed to describe the

health complications associated with the
traumatized permanent teeth over a 12
month period and access the relationship
between these complications and TDI

MATERIAL & METHOD

Materials & Method

Retrospective study by evaluating

1022 patients
Age group: 0 -15 years
Subjects treated according to Helsinki
Declaration

Materials & Method

CLINICAL EXAMINATION

Parameters registered on trauma charts:

Affected tissue and tooth

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Materials & Method

CLINICAL EXAMINATION

Clinical information recorded for each

tooth:
Color of clinical crown

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Materials & Method

RADIOGRAPHIC AND PHOTOGRAPHIC EXAMINATION

Horizontal & Axial intraoral

photographs at time of treatment
3 periapical radiographs, occlusal, and
panoramic

12

Materials & Method

DIAGNOSIS OF HEALING COMPLICATION

Based on clinical and radiographic

characteristic
HC recorded at time of first diagnosis
All teeth were considered with
necrotic pulp except for those with
other complications at first diagnosis

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Materials & Method

DATA COLLECTION

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Materials & Method

EVALUATION

To evaluate the relationship between

severity of TDI and occurrence of HC
the injuries were grouped according to
affected tissue (Dental, support and
dental support) excluding avulsion
Avulsion was considered
independently as it is taken as a more
severe injury with doubtful prognosis

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RESULTS

16

Results
From total 352 records of patients, 294 were selected

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Results

18

Results

19

Results

20

Results

21

Results

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DISCUSSION

23

Discussion

Most Enamel & Dentin # without pulp exposure

common
injuries

This differs from the previous studies conducted by

Hecova H. et al, Cavalcanti AL et al, and Bendo CB et al
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Discussion

Avulsion is the most severe injury

In present study patients all avulsed tooth
showed HC at the end of 12 months.
This statement contradicts the one given
by Anderson et al. which states that pulp
regeneration can be observed in avulsed
teeth with incomplete RD when there is no
diagnosis of HC at 3 and 6 months
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Discussion

They have a observed that pulp necrosis

was the most frequent HC that too
associated with dislocated tooth.
There are in accordance with the previous
studies conducted by Hecova H,
Andreasen FM, Nikoui M, Humphrey JM
and Michanowicz JP

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Discussion

Also a positive finding matching the

previous studies is that during the 3 month
period, teeth with affected dental tissue
associated with trauma to the supporting
tissues showed more HC than the teeth that
had only dental hard tissue.

27

Discussion

Another common finding of the present study

and other previous studies is that the majority
of TDIs associated with inflammatory
resorption are supporting tissues and avulsion.
Inflammatory resorption is most prevalent after
3 months mainly in luxated and avulsed teeth.
Pulp obliteration was observed in cases of
trauma in supporting tissues.
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Discussion

Teeth with complete RD appeared to be more

prone to have HCs for other kind og affected
tissue
In case of teeth with affected support tissues and
avulsion, it was possible to identify a statistical
difference between RD and HC after 3 months.
These are in agreement with the previously
conducted studies
29

Discussion

Teeth with complete development have lower

risk of scarring
Other factors besides the type of affected tisssue
and rhizogenesis may be related to the
development of HC.

30

CONCLUSION

31

Conclusion

The present study found that HCs are more common

in teeth that have suffered trauma in supporting tissues
and avulsion.
That too especially in teeth with complete RD.
HC occurred more frequently within the first 3 months
and necrotic pulp is the most common complication

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CRITICAL
EVALUATION

33

PROS
The topic of the study is relevant as traumatic
injuries are most commonly encountered in the
dental clinic and a pedodontist should have a
through knowledge of the treatment and
complications.

34

CONS
They should have included all type of cases in
the study as it was a referral centre and all types
of cases were not available.
They have not considered the extraoral storage
medium period, and splint conditions, as they
interfere with the development of HCs
The collection data from first attendance was
based on the history given by the parents as first
treatment was given by DSTC which again
causes a bias in the study

35

CONS
Moreover the study is a retrospective type in
which much of the information is based on the
history which at times cannot be reliable.

36

INFERENCE OF THE STUDY

A similar kind of prospective study should be
carried out considering the first attendance and
the other factors such as storage media, and
splint conditions should also be taken into
consideration.

37

 Humphrey JM et al. (2003) had undertaken a study to

identify the variables that significantly influenced the
tooth survival as well as pulpal and periodontal outcomes
for intruded permanent maxillary incisors of children and
adolescents
A total of 26 patients were taken that represented 31
permanent maxillary incisors.
The concluded that the severity of intrusion increases the
mechanical resistance that must be overcome to
reposition an incisor and encourages the development of
RRR because of compression injury. Delayed
repositioning leaves the root in intimate contact with the
alveolar bone. This facilitates RRR and ankylosis
38

 Hecova H et al. conducted a study to investigate preinjury factors, causes of dental injuries and healing
complications after traumatic injuries to permanent teeth
They analyzed 889 permanent teeth of 384 patients among
which enamel-dentin fractures and lateral luxations were
most common.
They concluded that the rate of pulp necrosis is high
following traumatic tooth injuries. Teeth with dislocation
injuries additionally sustain a considerable risk for
periodontal healing complications. Thus, regular controls
are necessary for an early detection of complications.
Avulsion has by far the lowest healing rate and higher loss
rate. Early replantation, transport media and extirpation of
necrotic pulp as important factors for healing results.
39

REFERENCES

40

 A retrospective study of 889 injured permanent

teeth. Dent Traumatol 2010; 26: 466475.
Andreasen FM, Vestergaard PB. Prognosis of
luxated permanent teeth the development of
pulp necrosis. Endod Dent Traumatol 1985; 1:
207220.
Nikoui M, Kenny DJ, Barrett EJ. Clinical
outcomes for permanent incisor luxations in a
pediatric population. III. Lateral luxations. Dent
Traumatol 2003; 19: 280285.
41

 Humphrey JM, Kenny DJ, Barrett EJ. Clinical

outcomes for permanent incisor luxations in a
pediatric population. I. Intrusions. Dent
Traumatol 2003; 19: 266273.
Michanowicz JP, Al Kandari A, Daniel JG.
Management of fractured and displaced ermanent
teeth. In: Al Kandari A, Daniel JG. (eds). Current
Concepts in Endodontics. Kuwait: Al Alfain
Printing and Publishing Co. 1997: 255272.

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