Luxation injuries of primary anterior teeth—prognosis and related correlates

Department of Pediatric Dentistry
Lutheran Medical Center

Resident’s Name: Craig Elice Date: 10/21/09
Article title: Luxation injuries of primary anterior teeth—prognosis and related correlates
Author(s): Soporowski NJ, Allred EN, Needleman HL
Journal: Pediatric Dentistry
Volume (number): 16(2)
Month, Year: March/April 1994
Major topic: Report of types of injuries to primary teeth, affects of treatment, and sequelae
Minor topic(s: None
Type of Article: Retrospective longitudinal research article
Main Purpose: The study reported the prognosis of sample of luxation injuries to primary anterior teeth and evaluated what variables may be associated with the prognosis.
Overview of method of research: 307 luxation injuries of primary anterior teeth in 222 children were found in a chart review in a private practice. Demographic information including age, gender, etiology of the accident, description of the injury, occlusion were recorded. Luxation injuries were categorized into intrusion, extrusions, lateral luxations, and avulsions.
Findings: 91.2% of the injuries occurred in the maxillary arch, and central incisors were affected 80.2%, while the lateral incisors were affected 19.2% of the time. Males sustained injuries more frequently with a 1.7:1 ratio of males to females. The average age of injury was 3.8 years of age. Younger children sustained more intrusions while older children sustained more extrusions and avulsions. Repositioning the teeth or no treatment was a more frequent treatment in the young, while extractions were more common in older children. Falls accounted for the majority of luxation injuries (71,6%) followed by bike accidents (11.5%), sports related accidents (3.7%), and miscellaneous. Bike accidents were more likely to result in extrusions and avulsions as well as extraoral injuries, and sports accidents resulted in lateral luxations. 57% of all luxation injuries were lateral luxations followed by avulsions (19.2%), intrusions(15.3%), and extrusions(8.5%). Root fractures were associated with lateral luxations. Occlusion like increased overjet or a distal step occlusion did significantly increase the risk of injury. However, overjet was increased in intrusions as compared to avulsions. About 55% of the injuries developed no sequelae after being followed for an average of 4.3 years. 26.3% became necrotic, 10.5% developed calcific degeneration, and 7.9% became ankylosed. No sequelae was associated with the type of injury. Treatment rendered was associated with sequelae of all luxation groups, lateral luxations, and intrusions. According to age groups, the oldest group >5 years of age, showed the least sequelae, with the youngest group next, and the 2-3 year age group being the worst. No significance was shown between the type of injury, sequelae, or treatment rendered on the outcome of the permanent successor. Hypoplasia was reported most commonly with intrusion injuries in 17.4% of the sample compared with 7.4% for lateral luxations, and 5.7% for avulsions.
Discussion: The authors suggest some explanations for timing and type of injuries. The average of injury was 3.8 years which is a time when children become more active. The type of injury could be related to the length of the root of the tooth. Older children were more likely to sustain avulsions, extrusions, and lateral luxations due possibly to less root structure due to physiologic resorption, and also to the increased participation in organized activities. Younger children had more intrusions possibly due to increased likelihood of falling. The age of injury and best sequelae could also be related to timing of root closure. In the younger age group the root apex is open, and in the oldest age group the root apex is open because of physiologic resorption. Interestingly repositioning of lateral luxations was associated with an increased risk of developing pulpal necrosis, while repositioning of intusions were less likely to become necrotic
Key points/Summary : Males sustained more injuries 1.7:1. Lateral luxations were the most common injury to the primary dentition.. Younger children sustained more intrusive injuries, and had larger overjets when compared to children who sustained other injuries. Root fractures were associated with lateral luxations. No post-trauma sequelae occurred in 56.8% of luxated primary incisors. Treatment rendered mainly repositioning a laterally luxated incisor was assocated with increased prevalence of pulpal necrosis, while intrusion showed decreased prevalence of sequelae. Children ,2 and >5 years of age had the best sequelae survival rate. Hypoplastic defects on permanent successors were noted in 7.7% of the cases
Assessment of article: Good article quantifying success rates. Helpful when discussing injuries with patients and parents..