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1.
Abstract Trauma to the supporting tissues of the teeth are among the most common dental injuries, leading to such complications as pulp canal obliteration, necrosis and root resorption. The aim of this investigation was to study the outcome for young permanent teeth subjected to luxation injuries. From 108 dental records 171 teeth with injuries to the supporting tissue were selected. The material comprised 130 subluxated, 15 extruded, 9 intruded, 15 exarticulated and 6 laterally luxated teeth in children aged 6–19 years. Apart from luxation, 59 teeth (35%) had additional crown and root fractures. 65% of the teeth recovered without complications. 78% of the subluxated teeth and 24% of the luxated teeth showed uneventful posttraumatic healing. Concomitant uncomplicated crown fractures or root fractures without displacement of the coronal fragment did not interfere with the healing. Of 60 teeth with healing complications, 52 (87%) were subsequently recorded as healed, the remaining 8 were extracted or had progressive root resorption. Loss of pulp vitality and external root resorptions were the most often recorded complications (28% and 17% of the total material respectively). Pulp canal obliteration was noted in 3% of the cases. Extent of injury and degree of tooth maturity were found to be related to healing compliations.  相似文献   

2.
目的:研究乳牙外伤侧方移位后随访6个月的临床转归.方法 :收集2018 年3月-2019年3 月间就诊于上海交通大学医学院附属第九人民医院儿童口腔科、诊断为乳牙侧方移位、治疗方法为观察随访的患儿,经筛选后选取45 例、57颗患牙的临床资料进行回顾,分析患牙复位情况、牙髓转归,采用SPSS 23.0软件包对数据进行统计学...  相似文献   

3.
Abstract – The aim of this study was to investigate pre‐injury factors, causes of dental injuries and healing complications after traumatic injuries to permanent teeth. The analysed sample comprised 889 permanent teeth of 384 patients, who were treated in the Dentistry Department in Faculty Hospital in Pilsen. Enamel‐dentin fractures [233 teeth (26.2%)] and lateral luxations [207 teeth (23.3%)] were the most frequent injuries. The age of the patients at the time of injury varied between 7 and 65 years. Predominantly, children were affected [587 injured teeth (66.0%)]. The most frequent causes of injuries in patients older than 11 years were various sport activities, predominantly bicycling. Pulp necrosis was observed in 239 teeth (26.9%). It was the most frequent post‐traumatic complication in all types of dental traumas. Teeth with a completed root formation demonstrated a higher prevalence of pulp necrosis than teeth with an incomplete root formation in all types of luxation injuries. External root resorption was observed in 144 teeth. The rate of inflammatory resorption differed between the various types of luxation injuries (extrusive luxation 5.6%, lateral luxation 11.6%, intrusive luxation 33.3%). Following avulsion and replantation, active inflammatory resorptions were diagnosed in 13 (26.5%) of 49 replanted teeth and ankylosis/replacement resorptions were observed in 21 (42.9%) of 49 replanted teeth. After avulsion, primarily, immature teeth were affected by these complications. Within the observation period of 5 years, 39 teeth (4.4%) had to be removed (16 teeth with root fractures, 19 avulsed and replanted teeth, 3 luxated teeth, 1 tooth with crown‐root fracture).  相似文献   

4.
年轻恒牙脱出性损伤后牙髓预后及相关因素分析   总被引:2,自引:0,他引:2  
目的 评估年轻恒牙脱出性损伤后牙髓组织的预后,分析可能影响预后的相关因素.方法 对2000年1月至2006年12月于北京大学口腔医学院·口腔医院儿童口腔科就诊且资料完整、观察期≥6个月的157例(238颗牙)年轻恒牙外伤病历进行回顾性研究,记录患者性别及年龄、外伤类型、外伤牙位、牙根发育情况、外伤后就诊时间、是否接受急诊处理以及牙髓组织预后类型.应用Logistic回归模型分析与牙髓预后相关的因素.结果 符合纳入标准的外伤病历共157份,外伤牙238颗,其中38颗(16.0%)出现牙髓坏死,5颗(2.1%)出现髓腔钙化,牙髓存活195颗(81.9%).挫入移位牙髓坏死发生率最高(66.7%).牙根发育情况和外伤类型与牙髓组织预后具有显著相关性(P<0.05).结论 牙齿脱出性损伤中,挫人移位最易发生牙髓坏死.牙根发育情况和外伤类型与脱出性损伤牙齿的牙髓预后具有相关性.  相似文献   

5.
415颗未露髓冠折牙预后的回顾性研究   总被引:1,自引:1,他引:0       下载免费PDF全文
目的分析未露髓冠折牙的预后及影响预后的相关因素。方法对2000-2006年于北京大学口腔医院儿童口腔科注册的系统病历中,观察期大于等于6个月的未露髓恒牙冠折病历进行回顾性研究,记录患者的性别、年龄、外伤类型、是否伴有牙周组织损伤、外伤牙位、牙根发育情况、外伤后就诊时间、是否接受急诊处理以及牙髓组织预后等内容。应用Logistic回归分析与简单冠折和冠折伴牙周组织损伤牙髓组织预后相关的因素。结果符合纳入标准的病历307份,涉及外伤牙415颗。冠折伴牙周组织损伤牙齿的牙髓坏死率为34.0%,简单冠折牙齿的牙髓坏死率为22.7%,二者间的差异具有统计学意义(P<0.05)。患者年龄和外伤类型与简单冠折牙髓组织预后具有显著相关性,牙根发育和外伤类型与冠折伴牙周组织损伤牙髓组织预后具有显著相关性。结论是否伴有牙周组织损伤与冠折牙齿的预后具有显著相关性。  相似文献   

6.
Despite the many journal articles and reviews that have been published regarding the treatment of trauma to teeth, the endodontic management of these injuries is often still not fully understood. The purpose of this review is to establish clear and up-to-date guidelines for practitioners who are faced with treating dental injuries on a day-to-day basis, based on an assessment of current available scientific information relating to the endodontic management of these injuries.
Treatment is discussed under the headings: infractions, uncomplicated crown fractures, complicated crown fractures, crown-root fractures, root fractures, luxation injuries, avulsion, root resorption, pulp canal obliteration and open-apex teeth. Emphasis is placed on the treatment of traumatized immature teeth where maintenance of pulp blood supply is important to encourage continued development of the root system. Only the treatment of traumatized permanent anterior teeth is reviewed.
Information contained in this article is based on a review of the literature on dental trauma which involved a MEDLINE search using the key words "dental trauma" and the individual topics listed above. The guidelines produced by the International Association of Dental Traumatology, the American Academy of Pediatric Dentistry and the American Association of Endodontists were also reviewed and the recommendations contained in this paper are in concert with the major recommendations of these bodies.  相似文献   

7.
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.  相似文献   

8.
Abstract A material of 637 concussed, subluxated, extruded, laterally luxated and intruded permanent incisors was analyzed with respect to factors influencing the development of pulp canal obliteration (PCO) after injury. A total of 96 (15%) developed partial PCO; 9 of these (1% of the total material) went on to develop total PCO. Only 2 teeth exhibited yellow discoloration of the clinical crown and 1 showed grey discoloration. Sensibility to electrometric pulp testing of the teeth with PCO was not significantly different from sensibility of contralateral homologues at the final examination (except for after lateral luxation, where the teeth with PCO had a significantly lower perception threshold). PCO was significantly more frequent among teeth with incomplete root formation than in teeth where root formation was completed. Extrusion, lateral luxation and intrusion showed more frequent occurrence of PCO than did concussion and subluxation. Moreover, the use of orthodontic band/resin splints significantly increased the occurrence of PCO, presumably due to the additional trauma of forceful placement and cementation of orthodontic bands in contrast to the relatively passive placement of an acid-etch/resin splint. Based on previous and present clinical and radiographic findings concerning pulp response to luxation injuries, it is suggested that PCO is a sequel to revascularization and/or reinnervation of a damaged pulp after injury.  相似文献   

9.
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.  相似文献   

10.
Findings are reported for a study into the prognosis of permanent incisor teeth luxated or subluxated by trauma. The main complications were pulp death, pulp calcification and external root resorption. The findings supported the concept of concussion of the dental pulp following trauma since 57 per cent of the teeth that initially did not respond to pulp testing later gave positive responses. Luxated teeth showed significantly more complications than subluxated teeth. Teeth of children over the age of nine years were more likely to suffer pulp death than those of younger children. Although most of the luxated and severely subluxated teeth were splinted these teeth were still more likely to suffer complications than the less damaged and therefore non-splinted teeth.  相似文献   

11.
Pulpal healing patterns were studied in a clinical material of 637 luxated and 95 root-fractured permanent incisors followed routinely for up to 11 years. It was found that pulpal healing patterns could generally be divided into 3 groups according to the degree of injury sustained by the pulp: little, moderate or severe. Thus after luxation injuries, pulp survival could be without radiographic change (PS), with pulp canal obliteration (PCO) or nonhealing (pulp necrosis (PN]. After root fracture, similar healing patterns could be observed: healing by hard tissue union of fragments (HT), by connective tissue union of fragments (CT) or by nonunion due to interposition of granulation tissue between fragments (GT) resulting from PN of the coronal fragment. In both trauma situations, healing or nonhealing could be determined by type of luxation injury, stage of root development and type of fixation used (forceful application of orthodontic bands vs. passively applied acid-etch fixation). Pulpal healing complications (PN or GT) were based on clinical findings (coronal discoloration, loss of pulpal sensibility) and radiographic findings (resorption processes of the lamina dura at the root apex or at the level of the root fracture). However, in both injury groups the same changes could also be seen to be intermediate steps in the pulpal healing process. Based on findings from these studies, hypotheses for the mechanics of pulpal healing are proposed as well as guidelines for acute and later treatment of dental luxations, root fractures and the diagnosis of healing complications.  相似文献   

12.
Abstract Pulpal healing patterns were studied in a clinical material of 637 luxated and 95 root-fractured permanent incisors followed routinely for up to 11 years. It was found that pulpal healing patterns could generally be divided into 3 groups according to the degree of injury sustained by the pulp: little, moderate or severe. Thus after luxation injuries, pulp survival could be without radiographic change (PS), with pulp canal obliteration (PCO) or nonhealing (pulp necrosis (PN)). After root fracture, similar healing patterns could be observed: healing by hard tissue union of fragments (HT), by connective tissue union of fragments (CT) or by nonunion due to interposition of granulation tissue between fragments (GT) resulting from PN of the coronal fragment. In both trauma situations, healing or nonhealing could be determined by type of luxation injury, stage of root development and type of fixation used (forceful application of orthodontic bands vs. passively applied acid-etch fixation). Pulpal healing complications (PN or GT) were based on clinical findings (coronal discoloration, loss of pulpal sensibility) and radiographic findings (resorption processes of the lamina dura at the root apex or at the level of the root fracture). However, in both injury groups the same changes could also be seen to be intermediate steps in the pulpal healing process. Based on findings from these studies, hypotheses for the mechanics of pulpal healing are proposed as well as guidelines for acute and later treatment of dental luxations, root fractures and the diagnosis of healing complications.  相似文献   

13.
Abstract – Aim: To evaluate the pulp and periodontal healing of laterally luxated permanent teeth. Material and methods: Patients presenting with lateral luxation of permanent teeth during 2001–2002 were enrolled in this clinical study. Laterally luxated teeth were repositioned and splinted with a TTS/composite resin splint for 4 weeks. Immediate (prophylactic) root‐canal treatment was performed in severely luxated teeth with radiographically closed apices. All patients received tetracycline for 10 days. Re‐examinations were performed after 1, 2, 3, 6, 12 and 48 months. Results: All 47 laterally luxated permanent teeth that could be followed over the entire study period survived. In 10 teeth (21.3%), a prophylactic root‐canal treatment was performed within 2 weeks following injury. The remaining 37 teeth showed the following characteristics at the 4‐year re‐examination: 19 teeth (51.4%) had pulp survival (no clinical or radiographic signs or symptoms), nine teeth (24.3%) presented with pulp canal calcification, and pulp necrosis was seen in another nine teeth (24.3%), within the first year after trauma. None of the teeth with a radiographically open apex at the time of lateral luxation showed complications. External root resorption was only seen in one tooth. Conclusions: Laterally luxated permanent teeth with incomplete root formation have a good prognosis, with all teeth surviving in this study. The most frequent complication was pulp necrosis that was only seen in teeth with closed apices.  相似文献   

14.
Abstract— This paper is a review of the clinical findings from my thesis "Pulp survival and hard tissue formation subsequent to dental trauma". Traumatic injuries in children and adolescents are a common problem, and the prevalence of such injuries has increased over the last 10–20 years. The purpose of the present investigations was to evaluate the long-term results following uncomplicated crown fractures and luxations involving subsequent pulp canal obliteration. A total of 241 patients with 545 injured teeth were available for clinical examination, of whom 102 answered a questionnaire and were interviewed before oral examination. In addition, 82 permanent incisors presenting with pulp canal obliteration were followed for a period of 7 to 22 years (mean 16 years). The findings showed little pulpal response to crown fracture and subsequent restorative procedures as long as there was no concomitant periodontal injury (15-year follow-up). Approximately every fourth resin composite filling was rated as unacceptable at clinical examination. The interview showed that half of the individuals were dissatisfied with the color and/or anatomic form of the composite restoration. Pulp canal obliteration was found in all luxation categories, and 69% of the teeth demonstrated yellow crown discoloration. According to the survival curve the 20-year pulp survival rate diagnosed radiographically was 84%. Although the risk of pulp necrosis increased with time, routine endodontic intervention of teeth with ongoing pulp canal obliteration of the root canal did not seem justified.  相似文献   

15.
Objectives. The aim of the present study was to investigate pulp healing responses following crown fracture with and without pulp exposure as well as with and without associated luxation injury and in relation to stage of root development. Patient material and methods. The long‐term prognosis was examined for 455 permanent teeth with crown fractures, 352 (246 with associated luxation injury) without pulpal involvement and 103 (69 with associated luxation injury) with pulp exposures. Initial treatment for all patients was provided by on‐call oral surgeons at the emergency service, University Hospital (Rigshospitalet), Copenhagen. In fractures without pulpal involvement, dentin was covered by a hard‐setting calcium hydroxide cement (Dycal®), marginal enamel acid‐etched (phosphoric acid gel), then covered with a temporary crown and bridge material. In the case of pulp exposure, pulp capping or partial pulpotomy was performed. Thereafter treatment was identical to the first group. Patients were then referred to their own dentist for resin composite restoration. Results. Patients were monitored for normal pulp healing or healing complications for up to 17 years after injury (x = 2·3 years, range 0·2–17·0 years, SD + 2·7). Pulp healing was registered and classified into pulp survival with no radiographic change (PS), pulp canal obliteration (PCO) and pulp necrosis (PN). Healing was related to the following clinical factors: stage of root development at the time of injury, associated damage to the periodontium at time of injury (luxation) and time interval from injury until initial treatment. Crown fractures with or without pulp exposure and no concomitant luxation injury showed PS in 99%, PCO in 1% and PN in 0%. Crown fractures with concomitant luxation showed PS in 70%, PCO in 5% and PN in 25%. An associated damage to the periodontal ligament significantly increased the likelihood of pulp necrosis from 0% to 28% (P < 0·001) in teeth with only enamel and dentin exposure and from 0% to 14% (P < 0·001) in teeth with pulp exposure. Conclusions. In the case of concomitant luxation injuries, the stage of root development played an important role in the risk of pulp necrosis after crown fracture. However, the primary factor related to pulp healing events after crown fracture appears to be compromised pulp circulation due to concomitant luxation injuries.  相似文献   

16.
Abstract – Intrusion is defined as the axial dislodgment of the tooth into its socket and is considered one of the most severe types of dental trauma. This longitudinal outcome study was undertaken to evaluate clinically and radiographically severely intruded permanent incisors in a population of children and adolescents. All cases were treated between September 2003 and February 2008 in a dental trauma service. Clinical and radiographic data were collected from 12 patients (eight males and four females) that represented 15 permanent maxillary incisors. Mean age at the time of injury was 8 years and 9 months (range 7–14 years and 8 months). Mean time elapsed to follow‐up was 26.6 months (range 10–51 months). The analysis of data showed that tooth intrusion was twice as frequent in males. The maxillary central incisors were the most commonly intruded teeth (93.3%), and falling at home was the main etiologic factor (60%). More than half of the cases (53.3%) were multiple intrusions, 73.3% of the intruded teeth had incomplete root formation and 66.6% of the teeth suffered other injuries concomitant to intrusion. Immediate surgical repositioning was the treatment of choice in 66.7% of the cases, while watchful waiting for the tooth to return to its pre‐injury position was adopted in 33.3% of the cases. The teeth that suffered additional injuries to the intrusive luxation presented a fivefold increased relative risk of developing pulp necrosis. The immature teeth had six times more chances of presenting pulp canal obliteration that the mature teeth and a lower risk of developing root resorption. The most frequent post‐injury complications were pulp necrosis (73.3%), marginal bone loss (60%), inflammatory root resorption (40%), pulp canal obliteration (26.7%) and replacement root resorption (20%). From the results of this study, it was not possible to determine whether the type immediate treatment had any influence on the appearance of sequelae like pulp necrosis and root resorption after intrusive luxation, but the existence of additional injuries and the stage of root development influenced the clinical case outcome in a negative and positive manner, respectively.  相似文献   

17.
年轻恒牙挫入性损伤是预后最差的牙外伤类型之一,常导致牙齿缺失,影响患儿的美观及健康.治疗方案通常包括观察再萌出、正畸牵引复位和外科复位3种;临床上应根据患牙的牙根发育情况及挫入程度,参考患儿及家长意愿,选择单独或结合使用上述3种治疗方案进行治疗.治疗后的主要并发症包括牙髓坏死、牙根吸收、牙槽骨边缘性吸收、根管闭塞等.尽...  相似文献   

18.
BackgroundDental trauma injuries are frequent in children and adolescents and can result in a sequela of future complications. Lateral luxation injuries are diagnosed when a tooth becomes displaced in a position other than axial and is often associated with alveolar bone fracture. Although the tooth is not immediately lost, pulp canal obliteration or pulpal necrosis can occur. The objective of this systematic review was to gather existing data on lateral luxation injuries to mature teeth to evaluate their overall prognosis and reported complications.Types of Studies ReviewedThe authors conducted a systematic search of the literature using MEDLINE, PubMed, Embase, and Cochrane databases in February 2019. They hand searched reference lists to identify additional literature. The authors included prospective and retrospective observational studies in the search. They screened a total of 291 articles, downloaded 28 articles, and included 4 articles in the study.ResultsThe most frequent complication reported for mature teeth with lateral luxation was pulpal necrosis (44.2%). Less frequent findings included surface resorption (14.0%), inflammatory resorption (8.5%), pulp canal obliteration (8.1%), and replacement resorption (0.9%). The included studies were cohort studies, which resulted in great heterogeneity, and the authors could not attempt a meta-analysis.Conclusions and Practical ImplicationsA large number of permanent teeth that experience lateral luxation are at risk of developing pulpal necrosis and other complications. Careful follow-up is required for these patients to treat complications as early as possible. Furthermore, the authors of this systematic review emphasize the importance of consistent reporting of dental trauma outcomes.  相似文献   

19.
Abstract— Two hundred and eighty-seven children with a total of 545 traumatized primary upper incisors were followed using standardized procedures until the age of 10. Extraction was the only treatment offered when intervention was necessary. The immediate as well as the long-term consequences of trauma were studied on the basis of this material. Consequences in the primary dentition comprised: color changes (53%), pulp necrosis (25%), pulp canal obliteration (36%), gingival retraction (6%), permanent displacement after luxation (5–22%), pathological root resorption (1–10%) as well as disturbances in physiological root resorption (4%) and, lastly, premature tooth loss (46%). In a multivariate analysis of the development of pulp necrosis in primary teeth after trauma, the following decisive factors were found: age of the patient at the time of injury, degree of displacement of the tooth as well as the degree of loosening and presence of crown fracture. The factors found to influence development of pulp canal obliteration were: displacement of the tooth at time of injury as well as detectable physiologic root resorption at time of trauma. The presence of crown fracture seemed to decrease the risk of obliteration. The need for scientifically based treatment strategies for managing and reducing complications after trauma in the primary dentition is stressed.  相似文献   

20.

Background/Aims

Lateral luxation injuries are a type of traumatic dental injury in which the tooth becomes displaced in the palatal/lingual or labial direction. This injury is common among children and can result in pulp canal obliteration or pulp necrosis. The objective of this systematic review was to gather existing data on lateral luxation injuries to immature teeth to evaluate their overall prognosis.

Methods

A systematic search was conducted using Medline, Pubmed, Scopus, Lilacs, EMBASE and Cochrane databases in October 2017. Reference lists were also hand‐searched to identify additional literature. Prospective and retrospective observational studies were included. A total of 502 articles were screened and six articles were included in the study.

Results

Pulp canal obliteration was the most frequent complication of immature teeth with lateral luxation (31.3%). This was followed by pulp necrosis (17.5%), inflammatory resorption (5.7%), and surface resorption (3.2%). Due to the heterogeneity of the studies, a meta‐analysis was not attempted. There was great variation in the reported outcomes among the studies.

Conclusion

Accurate prognosis evaluation of traumatic dental injuries is difficult due to the nature of current studies being retrospective or prospective cohort studies. Lateral luxation is a common traumatic dental injury and has life‐long concerns for a patient. It is important for future studies to report on the same outcomes to increase the quality of evidence regarding prognosis and treatment interventions, not only for lateral luxation injuries, but for all traumatic dental injuries.  相似文献   

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