Long-term prognosis of 66 permanent anterior teeth with root fracture.

A longitudinal clinical and radiographic follow-up study was made of all permanent teeth with root fractures referred to the Oslo University Department of Pedodontics between 1953 and 1972 (n = 66). The material included 51 patients aged 6-21 years. The mean observation period was 5.2 years, ranging from 1 to 19 years. The present report documents background data and the long-term results. Two teeth with exarticulation of the coronal fragments (3%) were immediately extracted. Repair of the fracture area occurred in 51 teeth (77%). Pulp necrosis was found in 13 teeth (20%), nine of which were successfully treated endodontically; only four teeth had to be extracted. Several factors were found to influence the prognosis, most notably the degree of dislocation of the coronal fragment. The localization of the fracture influenced repair only slightly. Despite somewhat increased mobility in some cases, the longevity of teeth with fractures even in the coronal third of the root was not significantly shortened. It is concluded that when optimally treated by repositioning, fixation and relief of occlusion, anterior teeth with root fracture have a favorable prognosis. Even when pulp necrosis occurs, the long-term prognosis is good.     

Long-term prognosisof 66 permanent anterior teethwith root fracture

abstract — A longitudinal clinical and radiographic follow-up study was made of all permanent teeth with root fractures referred to the Oslo University Department of Pedodontics between 1953 and 1972 ( n = 66). The material included 51 patients aged 6–21 years. The mean observation period was 5.2 years, ranging from 1 to 19 years. The present report documents background data and the long-term results. Two teeth with exarticulation of the coronal fragment (3%) were immediately extracted. Repair of the fracture area occurred in 51 teeth (77%). Pulp necrosis was found in 13 teeth (20%), nine of which were successfully treated endodontically; only four teeth had to be extracted. Several factors were found to influence the prognosis, most notably the degree of dislocation of the coronal fragment. The localiátion of the fracture influenced repair only slightly. Despite somewhat increased mobility in some cases, the longevity of teeth with fractures even in the coronal third of the root was not significantly shortened. It is concluded that when optimally treated by repositioning, fixation and relief of occlusion, anterior teeth with root fracture have a favorable prognosis. Even when pulp necrosis occurs, the long-term prognosis is good.     

Repair characteristics of root fractures in permanent anterior teeth

abstract — A follow-up study was made of repaired root fractures in 51 permanent anterior teeth, with a mean observation period of 6 years. The material was subdivided into three repair types (Figs. 1–3): Type 1—invisible or hardly discernible fracture line (15 teeth), Type 2—fragments separated by a narrow radiolucent line and peripheral rounding of the fracture edges (33 teeth), and Type 3—fragments separated by a distinct bony bridge (3 teeth). The majority of repaired teeth gave a normal or slightly decreased response to electric pulp tests and the mobility was physiologic or slightly increased. Reduced transparency or slight yellowish discoloration was observed in 14 teeth. The most conspicuous radiographic finding was pulp obliteration which occurred in 86%. Two different patterns were observed: (1) partial obliteration located in the apical fragments and the fracture area, and extending 0.5–4 mm into the coronal fragment, and (2) progressive obliteration of the entire pulp cavity ending with almost total obliteration. Pulp necrosis did not develop as a sequel to progressive obliteration in any case. Several different characteristics of the fracture influenced the repair pattern, the most important being the degree of fragment dislocation and mobility, stage of root development and localization of the fracture. Correlation between type of repair and various treatment procedures was observed only with regard to reduction.     

Prognosis of permanent teeth involved in jaw fractures A clinical and radiographic follow-up study

Abstract— The paper deals with the prognosis of teeth positioned in fracture lines. The clinical and radiographic findings are based on 68 patients with 84 fractures involving 110 permanent teeth. The observation period varies from 1 to 7 years. By means of a multivariate analysis it has been found that pulp necrosis was present in 25% of the involved teeth and was significantly related to the course of the fracture line in regard to the apical area and the time interval from injury to permanent fixation. Loss of marginal bone support was registered in 12 % of the involved teeth and found significantly related to tooth location and to dislocation of fragments after reduction. Pulp obliteration was recorded in only 5 % of the involved teeth. Root resorption was not found at follow-up.     

Root fractures in permanent anterior teeth with incomplete root formation

abstract – A follow-up study was made of seven teeth with incomplete root formation observed in a group of 66 permanent anterior teeth with root fracture. Three fractures were overlooked on the initial radiographs, two other teeth were suspected of being fractured, and an accurate diagnosis was made in two cases only. All teeth exhibited markedly increased mobility at the initial examination, and slight dislocation of the coronal fragment was found in two teeth. Following reduction (two teeth) and fixation (all teeth), the observation period ranged from 1 ¹/2 to 19 years. Retained pulp vitality, repair in the fracture area and, most important, approximately normal root development with closure of the apical foramen were observed in all teeth. Even the occurrence of re-fracture in two seemingly repaired teeth did not jeopardize the long-term result.     

Use of a removable splint in the treatment of subluxated, luxated and root fractured anterior permanent teeth in children

Aim: The aim of this study was to evaluate the prognosis of subluxated, luxated and root fractured teeth in children treated by removable splints, designed to stabilize mobile anterior teeth and eliminate occlusal trauma due to malocclusion. Material and methods: A total of 227 traumatized anterior teeth (91 subluxated, 105 luxated and 31 root fractured teeth) treated with a removable splint were observed for 3 years. The traumatized teeth were from 79 children aged between 6–12 years (mean 8 years 5 months). If a traumatized tooth was extremely mobile, a fixed splint was first made before the impression was taken for the removable splint. Two weeks after completion of the removable splint treatment, an impression was taken again to evaluate the occlusal relationship of pre‐ versus post‐treatment of removable splint. Results: The treatment period with a removable splint averaged 3 weeks in subluxated teeth, 3–5 weeks in luxated teeth, 4–6 weeks in apical third root fracture injuries, and more than 5 weeks in middle third root fracture injuries. All the subluxated teeth and 74.1% of the luxated teeth maintained their pulp vitality during the 3‐year follow‐up period. Two of 21 (9.5%) apical third root fracture teeth and three of five (60%) middle third root fracture teeth had pulp necrosis in the coronal fragments. Internal resorption was not found in any of the traumatized teeth. External replacement resorption was not found in subluxated and luxated teeth. All the root fractured teeth displayed transient external resorption around the fracture lines. The surface resorption appeared to be self‐limiting and not to threaten the retention of the tooth. Inflammatory resorption was observed in teeth with pulp necrosis, but in all cases this was reversed with endodontic treatment. Eight of 23 (39%) apical third root fractured teeth displayed replacement resorption in their apical fragments, but the resorption was not serious enough to extract the tooth. No obvious alteration in the occlusal relationship was found comparing pre‐ and post‐treatment casts. The removable splints appeared to positively affect healing after traumatic injuries, as evidenced by the low number of complications at the 3‐year follow‐up period.     

Healing of 400 intra-alveolar root fractures. 1. Effect of pre-injury and injury factors such as sex, age, stage of root development, fracture type, location of fracture and severity of dislocation

Abstract – This retrospective study consisted of 400 root‐fractured, splinted or non‐splinted incisors in young individuals aged 7–17 years (mean = 11.5 ± 2.7 SD) who were treated in the period 1959–1995 at the Department of Pediatric Dentistry, Eastman Dental Institute, Stockholm. Four hundred of these root fractures were diagnosed at the time of injury; and 344 teeth were splinted with either cap‐splints, orthodontic appliances, bonded metal wires, proximal bonding with composite resin or bonding with a Kevlar^® or glass fiber splint. In 56 teeth, no splinting was carried out for various reasons. In the present study, only pre‐injury and injury factors were analyzed. In a second study, treatment variables will be analyzed. The average observation period was 3.1 years ± 2.6 SD. The clinical and radiographic findings showed that 120 teeth out of 400 teeth (30%) had healed by hard tissue fusion of the fragments. Interposition of periodontal ligament (PDL) and bone between fragments was found in 22 teeth (5%), whereas interposition of PDL alone was found in 170 teeth (43%). Finally, non‐healing, with pulp necrosis and inflammatory changes between fragments, was seen in 88 teeth (22%). In a univariate and multivariate stratified analysis, a series of clinical factors were analyzed for their relation to the healing outcome with respect to pulp healing vs. pulp necrosis and type of healing (hard tissue vs. interposition of bone and/or PDL or pulp necrosis). Young age, immature root formation and positive pulp sensibility at the time of injury were found to be significantly and positively related to both pulpal healing and hard tissue repair of the fracture. The same applied to concussion or subluxation (i.e. no displacement) of the coronal fragment compared to extrusion or lateral luxation (i.e. displacement). Furthermore, no mobility vs. mobility of the coronal fragment. Healing was progressively worsened with increased millimeter diastasis between fragments. Sex was a significant factor, as girls showed more frequent hard tissue healing than boys. This relationship could possibly be explained by the fact that girls experienced trauma at an earlier age (i.e. with more immature root formation) and their traumas were of a less severe nature. Thus, the pre‐injury or injury factors which had the greatest influence upon healing (i.e. whether hard tissue fusion or pulp necrosis) were: age, stage of root development (i.e. the size of the pulpal lumen at the fracture site) and mobility of the coronal fragment, dislocation of the coronal fragment and diastasis between fragments (i.e. rupture or stretching of the pulp at the fracture site).     

Treatment of traumatized permanent incisors with crown and root fractures: a case report

Abstract – A case report of the treatment of permanent incisors with crown and root fractures is presented. A radiolucent lesion at the fracture lines was treated with calcium hydroxide in the coronal fragments for 18 months. Clinically, the teeth became firm and the radiographic results after 2 years showed healing of the lesion and hard tissue filling in the space at the fracture lines.     

Root fractures in permanent anterior teeth with incomplete root formation.

A follow-up study was made of seven teeth with incomplete root formation observed in a group of 66 permanent teeth with root fracture. Three fractures were overlooked on the initial radiographs, two other teeth were suspected of being fractured, and an accurate diagnosis was made in two cases only. All teeth exhibited markedly increased mobility at the initial examination, and slight dislocation of the coronal fragment was found in two teeth. Following reduction (two teeth) and fixation (all teeth), the observation period ranged from 1 1/2 to 19 years. Retained pulp vitality, repair in the fracture area and, most important, approximately normal root development with closure of the apical foramen were observed in all teeth. Even the occurrence of re-fracture in two semmingly repaired teeth did not jeopardize the long-term result.     

Criteria for diagnosis of pulp necrosis in traumatized permanent incisors

Records and radiographs of 108 patients (6–18 years) with 134 root canal treated incisors were examined. Subluxation was the most common type of injury, followed by intrusive, extrusive or lingual luxation, exarticiulation and uncomplicated crown fracture. Negative response to electric stimulation was noted in 107 teeth from the first examination. In 23 teeth an initial positive response changed to negative within 3 weeks to 9 months, whereas persistent positive reactions were recorded in four teeth. The diagnosis of necrosis was based on the following observations: negative vitality and radiographic changes (76 teeth), negative vitality and discoloration (45 teeth), negative vitality only (nine teeth), positive vitality and radiographic changes (four teeth). External inflammatory root resorption confirmed the diagnosis of necrosis in all replanted teeth and in 13 of 16 intruded teeth. Discoloration and periapical lesions were the most important diagnostic factors following subluxation, extrusive and lingual luxation. Necrosis was disclosed within 4 months in 117 teeth (87%). Diagnoses based on negative vitality and discoloration were made within 6 days to 3 months in all but one case. All external root resorptions and 37 of the 49 periapical lesions were observed within 3 weeks to 4 months of the injury.     

Tooth mobility changes subsequent to root fractures: a longitudinal clinical study of 44 permanent teeth

Abstract – The purpose of this study was to analyze tooth mobility changes in root‐fractured permanent teeth and relate this to type of interfragment healing (hard tissue healing (HT), interfragment healing with periodontal ligament (PDL) and nonhealing with interposition of granulation tissue (GT) because of pulp necrosis in the coronal fragment. Furthermore, the effect of age, location of the fracture on the root, and observation period on mobility values was analyzed. Mobility values were measured for 44 of 95 previous reported root‐fractured permanent incisors. Mobility changes were measured with a Mühlemanns periodontometer and noninjured incisors served as controls. The mobility values represented the labial‐lingual excursion of the root measured in μm when the tooth received a frontal and a palatal impact of 100 g force. In 18 cases of hard tissue healing (HT), a slightly increased mobility was seen after 3 months and 1 year, and a normalization of mobility value was usually found after 5 and 10 years. In 17 cases of PDL healing, generally a higher mobility was found in comparison with root fractures healing with hard tissue, and a consistent decrease in mobility value was found in the course of the 10 year observation period. A tendency for reduced mobility over time was found, a relation that could possibly be explained by the known general decrease in tooth mobility with increasing age. Finally, nine cases of nonhealing with initial interposition of granulation tissue (GT) because of pulp necrosis in the coronal fragment resulted in increasing mobility values possibly related to a lateral breakdown of the PDL in relation to the fracture line. In control teeth, a lowering of mobility was found over the course of a 10‐year observation period. In conclusion, mobility changes appeared to reflect the radiographic healing stages and known age effects upon tooth mobility.     

The risk of healing complications in primary teeth with root fractures: A retrospective cohort study

Background/Aim

Primary teeth are frequently affected by traumatic dental injuries. Root fractures are rare and have a reported incidence of 2% in the primary dentition. Hence, there is limited evidence on this topic. This study aims to evaluate the risk of healing complications in primary teeth with root fracture and to identify possible sequelae in the permanent dentition following root fracture in the primary dentition.

Materials and methods

A retrospective analysis of a cohort of 53 patients with 74 root fractured primary teeth. The standard follow-up program included clinical and radiographic examination after 4 weeks, 8 weeks, 6 months, and 1 year after the trauma and when the patient was 6 years of age. The following complications were registered: pulp necrosis (PN), pulp canal obliteration (PCO), ankylosis with replacement root resorption (ARR), infection-related root resorption (IRR), premature tooth loss (PTL), and repair-related resorption (RRR). Statistics: The Kaplan–Meier and Aalen-Johansen estimators were employed. The level of significance was 5%.

Results

A total of 74 teeth were included. 42 teeth were extracted at the initial examination. Risks estimated after 3 years: PTL 45.9% [95% CI: 28.8–63.0], PCO 12.9% [95% CI: 2.3–23.4], PN 14.9% [95% CI: 3.9–25.9], RRR 2.6% [95% CI: 0.0–7.5]. No teeth showed ARR or IRR. All complications were diagnosed within the first year. Most common sequelae in the permanent dentition was demarcated opacities, with an estimated risk of 20% [95% CI: 8.2–41.3].

Conclusions

There is a low risk of healing complications following a root fracture in the primary dentition. Root fractures often result in early extraction of the coronal fragment. The remaining apical fragment will undergo a physiological resorption. Aside from opacities, there is a low risk of sequelae in the permanent dentition.     

Fractures of the alveolar process of the jaw A clinical and radiographic follow-up study

Abstract— A study is reported on the prognosis of fractures confined to the alveolar process. The clinical and radiographic findings concern 29 patients with alveolar fractures, involving 71 permanent teeth. The observation period varied from 1 to 12 years (mean 6.5 years). A multivariate analysis was used to study the relationship between postoperative complications, such as pulp necrosis, pulp obliteration, and 18 clinical factors. Pulp necrosis was observed in 75% of the involved teeth and was found to be significantly related to the time interval from injury to permanent fixation. Pulp obliteration was recorded in 15% of the involved teeth and was found to be related to the observation period and time interval from injury to permanent fixation. Loss of marginal supporting bone was registered in 13% and progressive root resorption in 11% of the involved teeth.     

Transient discoloration of the coronal fragment in intra-alveolar root fractures

Abstract – Background: Root fractures are a relatively rare type of injury with frequencies of 0.5–7% of traumatized permanent teeth. It is well known that teeth with intra‐alveolar root fractures have a good prognosis. The pulp remains vital in about 80% of these teeth. If pulp necrosis develops, this normally only occurs in the coronal fragment. Although several studies on intra‐alveolar root fractures have been published during the last decades, none have mentioned that transient discoloration can occur. The aim of our study was to study the frequency and prognosis for intra‐alveolar root fractures with discoloration. Material and methods: The material consisted of 42 permanent incisors from 21 boys and 18 girls aged 7–19 years (mean = 12.7, median 12.0). In two girls and one boy, two incisors exhibited concurrent intra‐alveolar root fractured. The follow‐up period ranged from 1 to 9 years. The colour changes were determined at each control by transillumination of the clinical crown from the facial and palatal surfaces. Electrometric sensibility was evaluated and compared to the values of adjacent teeth using an electric pulp tester. At the final clinical and radiographic control, the type of healing was registered. Results: Discoloration was found in nine teeth. The root development was completed in all these teeth. The discoloration disappeared within 4 weeks to 6 months in eight teeth. The sensibility, which was lost at the injury, followed the changes in discoloration, and all teeth had regained normal sensibility when the discoloration had disappeared. Only one tooth, which showed a greyish hue, developed pulp necrosis. Conclusion: Transient discoloration in intra‐alveolar fractures is relatively common and is indicative of a good prognosis for healing.     

Intrusive luxation of permanent incisors in Norwegians aged 6–17 years: a retrospective study of treatment and outcome

Abstract – Background/Aim: External replacement resorption (ankylosis‐related) is a severe complication leading eventually to tooth loss. Little information exists regarding the influence of variables such as degree of intrusion or treatment method on the development of replacement resolution in intruded permanent incisors. The aim of this study was to report the most frequently involved age group, the preferred type of treatment, and the type and frequency of healing complications. Special attention was paid to the effect of treatment on the occurrence of replacement resorption. Material and Methods: Fifty‐one intruded permanent incisors were studied in 20 boys and 19 girls aged 6 to 17 years. Only three patients were over 12 years of age. Complete intrusion had occurred in 21 teeth, and 31 teeth were classified as immature. Re‐eruption was awaited for 37 teeth. The remaining teeth were repositioned orthodontically (7 teeth) or surgically (7 teeth). Results: Re‐eruption occurred in 35 out of 37 teeth over a period of 3–12 months. After a mean observation period of 4 years ranging from 1–12 years, retained pulp vitality was recorded in 22 teeth (43%). Pulp necrosis had developed in 57%, inflammatory resorption in 26% and replacement resorption in 12%. Whereas all inflammatory resorptions were arrested after long‐term calcium hydroxide treatment, replacement resorption always led to complete root resorption. In the analysis all orthodontic and surgical repositioned teeth were combined into an active treatment group. The non‐active treatment group consisted of teeth allowed to re‐erupt. The distribution of replacement resorption was significantly lower in teeth allowed to re‐erupt than in teeth repositioned actively. Conclusions: The best treatment of intruded incisors in 6–12 year‐old children is to await re‐eruption. Should endodontic treatment be required before re‐eruption has occurred, a gingivectomy can be performed to gain access to the root canal.     

MTA pulpotomy of human permanent molars with irreversible pulpitis

The histological success of mineral trioxide aggregate (MTA) pulpotomy for treatment of irreversible pulpitis in human teeth as an alternative treatment was investigated in this study. Fourteen molars which had to be extracted were selected from patients 16–28 years old. The selection criteria include carious pulp exposure with a history of lingering pain. After isolation, caries removal and pulp exposure, MTA was used in pulpotomy treatment. Patients were evaluated for pain after 24 h. Two patients were lost from this study. Twelve teeth were extracted after 2 months and were assessed histologically. Recall examinations confirmed that none of the patients experienced pain after pulpotomy. Histological observation revealed that all samples had dentin bridge formation completely and that the pulps were vital and free of inflammation. Although the results favour the use of MTA as a pulpotomy material, more studies with larger samples and a longer recall period are suggested to justify the use of MTA for treatment of irreversible pulpitis in human permanent teeth.     

Intrusive luxation of 60 permanent incisors: a retrospective study of treatment and outcome

Abstract – Background/Aim: Intrusive luxation in the permanent dentition is an uncommon injury but it is considered one of the most severe types of dental trauma because of the risk for damage to the periodontal ligament, pulp and alveolar bone. Management of intrusive luxation in the permanent dentition is controversial. The purpose of this study was to evaluate pulp survival and periodontal healing in intrusive luxated permanent teeth in relation to treatment alternatives, degree of intrusion and root development. Material and Method: The material consisted of 60 intruded permanent teeth in 48 patients (32 boys and 16 girls) aged 6–16 years (mean 9.4, median 9.0). The observation time was 6–130 months (mean 47.8, median 40.0). The analysed treatments were spontaneous re‐eruption (17 teeth), orthodontic extrusion (12 teeth) and surgical reposition (31 teeth). The degree of intrusion was registered as mild (0–3 mm), moderate (4–6 mm) and severe (≥7 mm). Root development was categorized with respect to root formation and development of the apex into four stages; one‐quarter to three‐quarters root formation, full root formation with open apex, full root formation with half‐closed apex and full root formation with apex closed. Ankylosis‐related resorption with pulp necrosis was diagnosed in 20 teeth, ingrowth of bone apically in two teeth, pulp necrosis without ankylosis‐related resorption in 23 teeth and pulp revitalization occurred in 15 teeth. Results: Significant correlations to the treatment outcome were root development (P = 0.03) and degree of intrusion (P = 0.03). Conclusions: No firm conclusion could be drawn for the difference in outcome between orthodontic extrusion and surgical reposition. To conclude, evaluation of the prognosis for intruded teeth should be based on the stage of root development and degree of intrusion. In teeth with immature root development, no active treatment appears to result in fewer healing complications.     

局部应用多西环素对脱位恒牙愈合效果的影响

目的 评价使用多西环素和生理盐水处理脱位恒牙对牙髓及牙周愈合的影响。方法 将38例患者（男22例,女16例,年龄7~14岁）的44颗脱位恒牙随机分为2组。在复位植入牙槽窝前,A组21颗牙使用0.05 mg/mL多西环素溶液浸泡5 min,B组23颗牙使用生理盐水浸泡5 min。术后定期随访并观察牙根发育情况, 使用Mann-Whitney U检验评价2组愈合情况的差异。结果 2组脱位牙之间的基本特征无显著差异。A组18颗牙被诊断为牙髓坏死,3颗牙有炎症性吸收,13颗牙有骨性黏连,6颗被拔除。B组16颗牙被诊断为牙髓坏死,4颗牙有炎症性吸收,12颗牙有骨性黏连,7颗被拔除。2组间的主要临床随访结局差异无统计学意义。结论 与生理盐水相比,使用多西环素溶液处理脱位恒牙并未显示出明显的优势。     

Luxation of permanent teeth due to trauma A clinical and radiographic follow-up study of 189 injured teeth

Abstract— The present study is a clinical and radiographic follow-up investigation of 108 patients with 189 luxated permanent teeth. The observation period ranged from 1 to 12 years with a mean of 3.4 years. A multivariate analysis was applied to examine the relationship between 17 clinical factors and the following four dependent variables: pulp necrosis, pulp obliteration, progressive root resorption, and loss of marginal bone support. Pulp necrosis was found in 98 teeth (52%), and this complication was significantly related to the type of luxation and stage of root development. Pulp obliteration was registered in 42 teeth (22%) and found significantly related to the variables stage of root development, type of luxation, and crown fracture. Progressive external root resorption occurred in 21 teeth (11 %). The type of luxation, reduction, and the time interval from injury to treatment was found significantly related to this complication. Loss of marginal bone support was found in 18 instances (10%), and this complication was significantly related to type of luxation, time interval from injury to treatment, fracture of supporting bone, and number of injured teeth.     

Regenerative Endodontic Treatment for Necrotic Immature Permanent Teeth

This retrospective study included 23 necrotic immature permanent teeth treated for either short-term (treatment period <3 months) or long-term (treatment period >3 months) using conservative endodontic procedures with 2.5% NaOCl irrigations without instrumentation but with Ca(OH)₂ paste medication. For seven teeth treated short-term, the gutta-percha points were filled onto an artificial barrier of mineral trioxide aggregate (MTA). For 16 teeth treated long-term, the gutta-percha points, amalgam, or MTA were filled onto the Ca(OH)₂-induced hard tissue barrier in the root canal. We found that all apical lesions showed complete regression in 3 to 21 (mean, 8) months after initial treatment. All necrotic immature permanent teeth achieved a nearly normal root development 10 to 29 (mean, 16) months after initial treatment. We conclude that immature permanent teeth with pulp necrosis and apical pathosis can still achieve continued root development after proper short-term or long-term regenerative endodontic treatment procedures.