Sequelae of trauma to primary maxillary incisors and complications in the primary dentition

Resident: Jason Hencler
Date: 8/14/09

Article title: Sequelae of trauma to primary maxillary incisors and complications in the primary dentition

Author(s): M. K. Borum, J. O. Andreasen
Journal: Endodontics and Dental traumatology
Volume #14; Page 31-44
Year: 1998

Major topic: Trauma and primary maxillary incisors

Type of Article: Clinical case study

Main Purpose: Investigate the immediate and long term consequences of trauma to the primary maxillary incisors.

Overview of method of research:
Study group was 287 children who sustained trauma to maxillary primary central and lateral incisors. Patients exhibited 545 traumatized maxillary primary incisors; 428 central and 117 lateral incisors. Parameters of the study included color changes, pulp necrosis (PN), pulp canal obliteration (PCO), gingival retraction, permanent displacement after luxation, pathological root resorption, and premature loss of the traumatized tooth. After initial trauma evaluation, follow-up visits were planned at 4wk, 8wk, and 1 yr as well as when the child was 6 and 10yo. All visits included radiographs and clinical exam.

Findings:
Color changes-Transient gray discoloration (TGD) was seen in 15.2% and 78% of the teeth later turned yellow. The relationship between TGD and later PCO as well as the relationship between TGD and the absence of PN are highly significant. Permanent gray discoloration (PGD) was seen in 18.1%. PCO was seen in 8.6% of the PGD teeth and 65.7% developed PN. Yellow discoloration was seen in 31% in which PCO was seen in 81.5%.
Pulp necrosis-Type of luxation seemed to be an important factor in the development of PN. Age at time of injury seemed to be a significant factor for developing PN, as younger children showed a lower frequency of PN than older children. Pulp Canal Obliteration-None of the teeth with PCO developed PN. The type of luxation also was an important factor in developing PCO. Frequency of PCO in older children was very low. Gingival retraction-The only variable found to be significant for the development of gingival retraction was the presence of gingival injury associated with the trauma. Pathological root resorption: Inflammatory root resorption was found to be associated with PN. Physiological root resorption-PN was significantly related to both accelerated and delayed physiological root resorption. No connection was found between PCO and changes in physiological resorption rates. Premature loss of traumatized Primary teeth-Of the 287 children, 167 experienced premature loss of 1 or more teeth.

Key points in the article discussion:
More than half of the traumatized teeth developed transient or permanent color changes. Transient color changes were associated with PCO while permanent color changes were associated with PN. Yellow discoloration was strongly associated with pulpal obliteraton. Although these findings are significant, color changes alone are not a reliable predictor of pulpal health. The age of the child at the time of injury seems to be very important in the development of PN. A very young child has a high vascular supply to the wide open and very short pulp along with resilient alveolar bone, the pulp is able to survive severe injury. Physiologic resorption in older children can be advanced to a point where the pulp becomes degenerated and vulnerable to even minor injuries. PCO in the primary dentition was highly associated with concussion, subluxation, and intrusion but less associated with lateral luxation. Conversely, PN is highly associated with lateral luxation. Gingival retraction was most often found after gingival trauma associated with tooth trauma. For laterally luxated teeth primary teeth, spontaneous repositioning with in the first days or weeks of trauma can be expected. A tooth that fails to realign within the first weeks of trauma is less likely to regain a healthy pulp, as ingrowth of new pulp tissue is blocked by clot formation between the most apical part of the original socket and the apical foramen of the tooth. Delayed physiologic root resorption may be associated with PN because resorption also takes place from the pulpal side of the root, which may be affected if the pulp is necrotic. PCO was not found to be associated with delayed resorption.

Summary of conclusions: Effects of premature loss of traumatized primary teeth on eruption and alignment of the permanent successors should be considered against the possible damage to the development of the successors by treatments aimed at preserving traumatized teeth. Increase in awareness and research on these problems has been essential in the development of treatment guidelines for the traumatized primary dentition.

Assessment of article: I did think this article was quite long with confusing statistics and tables. But once you’ve picked out the important points and read through the tables and pie charts, this article presented some very relevant information that could easily be useful in clinical situations when seeing patients with trauma.