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Erschienen in: International Journal of Implant Dentistry 1/2023

Open Access 01.12.2023 | Research

Traumatic dental injuries over an 8-year period at a German dental center: a retrospective overview and cross-sectional analysis

verfasst von: Puria Parvini, Yanislava Lermen, Robert Sader, Frank Schwarz, Karina Obreja

Erschienen in: International Journal of Implant Dentistry | Ausgabe 1/2023

Abstract

Background/aim

The aim of this study was to analyze a population of patients who had suffered from traumatic dental injuries (TDIs) by using different patient-, trauma- and treatment-related parameters.

Material and methods

All dental records of patients ≥ 3 years old who had presented at the dental emergency service between Jan 1, 2009 and Dec 31, 2016 for the treatment of dental trauma were analyzed. A total of 2758 patients were invited for a recall examination at the Department for Dental Surgery and Implantology, ZZMK Carolinum, Goethe University Frankfurt, Germany; of these, 269 patients attended their recall appointments.

Results

The enrolled patient population consisted of 1718 males and 1040 females, with a mean age of 19.63 years (median 12.00 ± 17.354 years). A total of 4909 injured teeth were assessed, with a mean of 1.78 injured teeth per patient (median 2.00 ± 1.279). Males were found to be more frequently affected by TDIs compared to females (1.65:1). The majority of these injuries occurred in the first two decades of life (66.1%; n = 1824). The majority of the patients presented for initial treatment within 24 h of their accident (95.7%). The most frequent TDIs were isolated luxation injuries 49.4% (n = 2426) and isolated crown fractures 30% (n = 1472). Combination injuries were diagnosed in 20.6% of the cases (n = 1011).

Conclusions

Based on the findings of the present analysis, it can be concluded that males were more frequently affected by TDIs than females. Most patients had suffered from TDI before they had turned 10 years of age. Overall, the enamel–dentin fracture was found to be the most frequent injury, followed by concussions and lateral luxations.

Graphical Abstract

Hinweise

Publisher's Note

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Abkürzungen
DHT
Dental hard tissue
PDL
Periodontal ligament
TDIs
Traumatic dental injuries

Introduction

Traumatic dental injuries (TDI) are acute, mechanical injuries to the teeth and adjacent structures; TDIs account for 5% of all treatments carried out on permanent teeth [1]. With an estimated incidence of about 1 in 100 per year, and prevalences of 14.8% and 23.8% among the permanent and deciduous teeth, respectively, 15.2% of the current world population have, at one point in their lives, been affected by dental trauma [2, 3]. Gender and oral factors such as dental overjet with protrusion [4] and incomplete lip coverage influence [5] the prevalence of dental trauma. The growing popularity of certain sports also plays a role [6, 7] and, thus, nowadays, more than half of children and adolescents experience a dental injury before the age of 18 years. [8] The worst-case outcome of a TDI is permanent tooth loss, with all its substantial functional and psychological implications [8, 9]. Such a loss of teeth can pose particular challenges in children and adolescents where ongoing growth makes it more difficult to achieve esthetically and functionally acceptable outcomes.
When deciduous teeth are affected by traumatic injury, the benefits of preservation must be weighed against the risks to the permanent dentition. Consideration should be given to the type and extent of the damage and the progress of tooth germ development, as well as the patient's age given that there is a higher risk of permanent injury in younger children. A significant role is also attributable to the forcefulness and direction of the traumatic impact, with intrusion of the deciduous teeth arguably being the most violent example [10].
Before focusing on the teeth, the dental trauma patients need to be examined comprehensively to rule out any systemic effects of the accident such as brain injury, hemorrhage, or the fracture of bones [11]. A neurological examination of the major facial nerves is required and the mandible should be checked for mobility to exclude the possibility of jaw fracture. It is technically advisable to appraise and record on a trauma documentation form the exact course of the accident and the patient's medical and dental history.
Records from a standardized documentation form of this type, used by the dental emergency service at the authors' university center, provided the basis for designing a retrospective study of all patients who had presented with dental injuries over an 8-year period. Against a background of considerable evidence in the literature on the nature and demographic aspects of such injuries, but with less being available on their long-term implications and sequelae, it was decided to complement the retrospective analysis by inviting all patients to attend a follow-up examination for an additional cross-sectional analysis.
The aim of this study was to analyze a population of patients who had suffered from traumatic dental injuries (TDIs) by using different patient-, trauma- and treatment-related parameters.

Materials and methods

This study was conducted by collecting the medical records of 2,758 patients ≥ 3 years of age who had been admitted to the Department for Dental Surgery and Implantology, ZZMK Carolinum, Goethe University Frankfurt, Germany; in the period of January 01, 2009 to December 31, 2016. The data of all patients were collected and analyzed by two dentists (JL and KF).
The study protocol was in accordance with the Helsinki Declaration of 1975 (revised in August 2018) and approved by the Ethics Committee Goethe University Frankfurt, Germany University.
Subsequently, all 2758 patients were invited for a follow-up visit. Written informed consent was required from each patient, or his or her legal representative, based on the comprehensive information provided about the nature, scope, benefits and risks of the study.
Demographic data (gender, date of birth) were collected from the medical records and the different types of TDI, as well as the epidemiological variables, were obtained from the standardized emergency documentation forms used at the center.
The information collected for each patient included their medical/dental history, the nature of the accident, photographs, the findings obtained in extraoral and intraoral examinations, as well as injuries not within the scope of the oral and maxillofacial regions.
The following study variables were assessed: (1) the patient's age, (2) gender, (3) oral hygiene status, (4) tooth development status, (5) previous dental injuries, (6) number of (permanent or deciduous) teeth injured, (7) number of distinct injuries, (8) general signs and symptoms, (9) accident data (time, place, reason, course of events), (10) primary care received, (11) time passed from the accident to the dental examination, (12) tetanus vaccination status, (13) diagnosis including soft tissue and bone injuries, (14) mouth opening (mm) and/ or occlusal problems, (15) treatment protocol (conservative, endodontic, or surgical including extraction), and (16) radiographic findings (tooth root and/or bone fracture).
For avulsed teeth, the details were evaluated on (1) reimplantation (yes/no), (2) extraoral time (min) and (3) the storage medium.
Dento-alveolar injuries were classified according to the classification proposed by Andreasen (1994). In addition, an injury to the periodontal tissues with a simultaneous hard dental tissue injury to the same tooth was referred to as a combination injury. The classification of the traumatic injuries was followed according to Andreasen and Andreasen (1994) (Table 1).
Table 1
Classification of the traumatic injuries according to Andreasen and Andreasen (1994)
I. Injuries to the hard dental tissues and pulp
Enamel fracture
Enamel–dentine fracture
Complicated crown fracture
II. Injuries to the hard dental tissue, pulp and alveolar process
Crown–root fracture
Root fracture
Alveolar fracture
III. Injuries to the periodontal tissues
Concussion
Subluxation
Luxation injuries
Lateral luxation
Intrusion
Extrusion
Avulsions

Cross-sectional analysis

The patients who attended the follow-up examination (n = 269) provided the relevant information required to compile their comprehensive histories, detailing any initial and subsequent events and treatment steps. The series of radiographs and photographs on file helped to identify the sequelae of the original injuries and their treatment. All previously injured teeth that survived were tested using a Periotest device (Medizintechnik Gulden, Moldautal, Germany) and percussion for their mobility or ankylosis. A positive value is reflected for loose teeth. Conversely, a negative value is registered with ankylosed teeth.
All sites with tooth loss were clinically examined with respect to the sequence of events following the injury, including any effects on bone quantity and jaw growth, outcomes of the treatment provided by the tooth- or implant-supported restoration, orthodontic gap closure, or the transplantation of a deciduous or permanent tooth. Other clinical parameters included (1) tooth sensitivity, (2) probing depths on six aspects of the tooth, (3) discoloration, (4) growth inhibition, (5) patient compliance with recalls, and (6) identification of treatment requirements. Radiographs were obtained, whenever indicated, to identify periodontal or endodontic pathologies. The radiographs were evaluated for (1) apical periodontitis, (2) root fracture and/or root resorption, and (3) endodontic treatment received.
Any findings of endodontic or periodontal complications resulted in further treatment (Fig. 1). However, the patients were first provided with all necessary comprehensive information about these treatments. If any oral surgical need was identified the treatment was subsequently performed in the Department of Oral Surgery and Implantology.

Statistical analysis

All data were entered into a spreadsheet (Excel 2019, Microsoft, Redmond, WA) and descriptive analysis was undertaken with statistical software (SPSS Statistics, version 26; IBM, Armonk, NY).
Chi-square testing was used to analyze the categorical data. All tests were implemented as two-sided significance tests with differences considered significant at p < 0.05. A Kolmogorov–Smirnov test was used to check the metric variable for normal distribution, however, normal distribution was not confirmed (p < 0.05). Hence, non-parametric tests were employed for comparisons, the primary endpoint being four major sequelae (tooth loss, hard-tissue restoration, endodontic treatment, general sequelae) of the three injury types (PDL (periodontal ligament), DHT (dental hard tissue), PDL + DHT). A secondary endpoint concerned the likelihood of implant treatment following traumatic dental injuries. Periotest values were analyzed by a Kruskal–Wallis test, while all other comparisons were analyzed by Pearson’s Chi-squared tests.

Results

Retrospective analysis

The study comprised 1718 male (62.3%) and 1040 female (37.7%) patients with a male-to-female ratio of 1.65:1 (Table 2). The mean age of the included patients was 19.63 ± 17.35 years (median: 12 years; range: 3–83 years). Even though children < 3 years old were excluded due to compliance issues, under-10-year-olds were still the largest group, with older decades progressively decreasing in patient numbers (Fig. 2). Under-20-year-olds (n = 1824) accounted for 66.1% of the sample.
Table 2
Overview of the retrospective total sample of patients, the cross-sectional subsample, and their traumatic dental injuries
 
Retrospective
Cross-sectional
Patients injured
n
%
n
%
Female
1040
37.7
  
Male
1718
62.3
  
Total
2758
100
269
 
Age at injury/recall
Mean
SD
Mean
SD
Years
19.63
17.35
27.55
19.72
Teeth injured
n
%
n
%
Permanent teeth
4217
85.9
569
95.2
Deciduous teeth
692
14.1
29
4.8
Total
4909
100
598
4.8
PDL injuries
2426
49.4
258
45.3
DHT injuries
1472
30.0
152
26.7
PDL + DHT injuries
1011
20.6
159
27.9
Total
4909
100
569
100
DHT dental hard tissue, PDL periodontal ligament
Most of the injuries were found to have occurred in public sports or play facilities (24.8%), at home (21.9%), during bicycle falls (15.6%), on the street (11.4%) or by physical force (8.3%). Although most of the patients (n = 930) had presented with only one injured tooth, the extensiveness of the trauma ranged from injuries confined to the soft tissue in 330 patients to ten affected teeth in one individual (mean: 1.78 ± 1.28 injuries per patient) (Table 3).
Table 3
Overview of the accident environments, extensiveness of the dental trauma per patient and of the affected upper and lower permanent or deciduous teeth
Accident environments
n
%
Extensiveness of traumatic dental injuries
  
Patients
Sites
n
n
Public sports/play
685
24.8
Soft tissue only
330
0
 Home
604
21.9
One tooth
930
930
Bicycle
430
15.6
Two teeth
913
1826
 Street
314
11.4
Three teeth
339
1017
Violence
228
8.3
Four teeth
168
672
 School
164
5.9
Five teeth
37
185
 Play
135
4.9
Six teeth
20
120
 Work
80
2.9
Seven teeth
9
63
Fainting
68
2.5
Eight teeth
10
80
 Traffic
40
1.5
Nine teeth
1
9
Epilepsy
7
0.3
Ten teeth
1
10
Alcohol
2
0.1
   
 Intubation
1
0.0
   
Total
2758
(100)
Total
2758
4912
Maxilla
Mandible
Permanent teeth
Deciduous teeth
Permanent teeth
Deciduous teeth
Site
n
%
Site
n
%
Site
n
%
Site
n
%
11
1327
31.5
51
237
34.2
31
158
3.7
71
11
1.6
21
1377
32.7
61
218
31.5
41
157
3.7
81
13
1.9
12
381
9.0
52
76
11.0
32
88
2.1
72
15
2.2
22
447
10.6
62
77
11.1
42
89
2.1
82
12
1.7
13
65
1.5
53
16
2.3
33
13
0.3
73
4
0.6
23
51
1.2
63
9
1.3
43
18
0.4
83
1
0.1
14
7
0.2
54
1
0.1
34
3
0.1
74
0
0.0
24
8
0.2
64
1
0.1
44
2
0.0
84
1
0.1
15
5
0.1
55
0
0.0
35
0
0.0
75
0
0.0
25
5
0.1
65
0
0.0
45
2
0.0
85
0
0.0
16
2
0.0
36
3
0.1
26
4
0.1
46
1
0.0
17
2
0.0
37
2
0.0
27
0
0.0
47
0
0.0
Jaw ∑
3681
87.3
 
635
91.8
 
536
12.7
 
57
8.2
 + 
536
12.7
 
57
8.2
 
 ← 
 ← 
 
 ← 
 ← 
Total
4217
(100)
 
692
(100)
   
4909
∑ = total
The most frequently injured teeth, in both deciduous and permanent dentitions, were the upper central incisors (65.7% and 64.2%, respectively), followed by the maxillary lateral incisors (19.6% and 22.1%, respectively). Upper-jaw injuries clearly prevailed (87.9%), again based on permanent (87.3%) and deciduous (91.8%) teeth. Only 49 (46 permanent and 3 deciduous) posterior teeth were affected overall, accounting for a mere 1% of the total 4909 tooth sites.
The aforementioned mean of 1.78 ± 1.28 injuries per patient rises to 2.13 ± 1.65 if all injuries to either the periodontal ligament (PDL) or the dental hard tissue (DHT) are regarded as separate entities (Table 4). This is because 1011 (20 deciduous, 991 permanent) teeth were injured in both the PDL and DHT, accounting for 20.6% of all 4909 teeth as compared to either the DHT (1472; 30.0%) or PDL (2426; 49.4%) injuries alone. Hence, based on all the PDL injuries, the most frequent subtype of injury was concussion (31.4%), followed by lateral luxation (27.9%) and subluxation (23.5%), while for the DHT injuries, enamel–dentin injuries accounted for almost half (48.4%), followed by enamel (22.6%) and enamel–dentin–pulp injuries (11.6%).
Table 4
Number of injuries to the permanent and deciduous teeth, arranged according to injury types and subtypes
 
Number of injuries sustained by
Types of traumatic injury
Permanent teeth
Deciduous teeth
All injuries
(PDL, DHT, PDL + DHT)
n
n
%
n
n
%
n
n
%
PDL (including PDL + DHT)
2780
  
657
  
3437
  
 Concussion
 
983
35.4
 
95
14.5
 
1078
31.4
 Subluxation (mobility)
 
612
22.0
 
194
29.5
 
806
23.5
 Lateral luxation
 
762
27.4
 
196
29.8
 
958
27.9
 Extrusion
 
141
5.1
 
46
7.0
 
187
5.4
 Intrusion
 
76
2.7
 
34
5.2
 
110
3.2
Avulsion
 
206
7.4
 
92
14.0
 
298
8.7
   
100
  
100
  
100
DHT (including PDL + DHT)
2428
  
55
  
2483
  
 Enamel (infraction)
 
199
8.2
 
4
7.3
 
203
8.2
 Enamel (fracture)
 
537
22.1
 
23
41.8
 
560
22.6
 Enamel–dentin
 
1191
49.1
 
11
20.0
 
1202
48.4
 Enamel–dentin–pulp
 
282
11.6
 
5
9.1
 
287
11.6
 Crown–root
 
178
7.3
 
7
12.7
 
185
7.5
 Root
 
41
1.7
 
5
9.1
 
46
1.9
   
100
  
100
  
100
Total
5208
  
712
  
5920
  
Injuries to the periodontal ligament or dental hard tissue are counted separately in this table, even if any two of them affected the same tooth site
DHT dental hard tissue, PDL periodontal ligament
Regarding the permanent teeth, the main PDL injuries were concussion (35.4%), lateral luxation (27.4%) and subluxation (22.0%), while the main DHT injuries were enamel–dentin injury (49.1%), enamel fracture (22.1%) and enamel–dentin–pulp injury (11.6%). With respect to the deciduous teeth, the main PDL injuries were lateral luxation (29.8%) and subluxation (29.5%), while the main DHT injuries were enamel fracture (41.8%) and enamel–dentin injury (22.6%). Furthermore, the main subtypes of the combined PDL + DHT injuries were enamel–dentin injury plus concussion (29.3%) Table 5 shows the injuries (PDL, DHT, PDL + DHT) to the permanent and deciduous teeth, arranged according to injury types.
Table 5
Injuries to the permanent and deciduous teeth, arranged according to injury types
Types of traumatic injury
Permanent teeth
Deciduous teeth
All teeth
(PDL, DHT, PDL + DHT)
n
%
%
n
%
%
n
%
%
PDL injuries
1789
 
73.7
637
 
26.3
2426
 
100.0
 % based on injury types
 
42.4
  
92.1
  
49.4
 
DHT injuries
1437
 
97.6
35
 
2.4
1472
 
100.0
 % based on injury types
 
34.1
  
5.1
  
30.0
 
PDL + DHT injuries
991
 
98.0
20
 
2.0
1011
 
100.0
 % based on injury types
 
23.5
  
2.9
  
20.6
 
All injuries
4217
 
85.9
692
 
14.1
4909
 
100.0
Total %
 
100
  
100
  
100
 
DHT dental hard tissue, PDL periodontal ligament
*Injuries to deciduous versus permanent teeth: p < 0.001 (Pearson's Chi-squared test)
A Pearson’s Chi-squared test was performed, revealing that the difference in injury types between the permanent and deciduous teeth was statistically significant (p < 0.001). The Pearson's Chi-squared test also revealed significant differences with regard to the number of extractions performed after the injuries (Table 6); teeth had to be removed significantly more often after PDL injuries than after DHT or PDL + DHT injuries (p < 0.001), while injuries to the deciduous teeth were followed by extraction significantly more often than injuries to the permanent teeth (p < 0.001).
Table 6
Teeth extracted or not extracted after sustaining traumatic injury, arranged according to injury types
Types of traumatic injury
Not extracted
Extracted
Other†
All teeth
(PDL, DHT, PDL + DHT)
n
%
%
n
%
%
n
%
%
n
%
%
PDL injuries
2144
 
88.4
130
 
5.4
152
 
6.3
2426
 
100
 % based on injury types
 
46.7
  
80.7
  
98.7
  
49.4
 
DHT injuries
1444
 
98.1
27
 
1.8
1
 
0.1
1472
 
100
 % based on injury types
 
31.4
  
16.8
  
0.6
  
30.0
 
PDL + DHT injuries
1006
 
99.5
4
 
0.4
1
 
0.1
1011
 
100
 % based on injury types
 
21.9
  
2.5
  
0.6
  
20.6
 
All injuries
4594
 
93.6
161
 
3.3
154
 
3.1
4909
 
100
Total %
 
100
  
100
  
100
  
100
 
DHT dental hard tissue, PDL periodontal ligament
This category includes teeth that were not reimplanted (n = 141) or could not be found (n = 13) after the accident
More teeth with PDL than with DHT or PDL + DHT injuries extracted: p < 0.001 (Pearson's Chi-squared test)
More deciduous than permanent teeth extracted (data not shown): p < 0.001 (Pearson's Chi-squared test)

Cross-sectional analysis

A total of 269 (9.8%) patients with 598 previously injured (569 permanent and 29 deciduous) teeth attended the follow-up recall (Table 1).
Most of these patients (75.1%) were not found to require additional treatment. Of the remaining patients, the diagnosed indications were for endodontic treatment in 22 (8.2%) patients, for extraction in 21 (7.8%), conservative or prosthetic treatment in 12 (4.5%), orthodontic in five (1.9%), as well as apicoectomy in four (1.5%) and the treatment of ankylosis in three (1.1%) patients. In addition, orthodontic treatment was already ongoing in 30 (11.2%) of the patients at the time of the study and had been completed in a further 44 (16.4%). This treatment was also being planned for a further 31 (11.5%) patients, however, this option was not mentioned by the remaining 164 (61.0%) patients.
Previous injuries were recorded for the remaining 569 permanent teeth at the follow-up visits (Fig. 3). Roughly one-third of them (30.8%) had involved no events, 58 (10.2%) had been lost (almost half of these were PDL injuries) or they had been subjected to restorative (2.5%) or root-canal (26.7%) treatment, while miscellaneous, other sequelae accounted for the remainder (39; 6.85%). A Pearson’s Chi-squared test disclosed that the sequelae were significantly associated with differences in the injury type, i.e., PDL versus DHT versus PDL + DHT injuries (p < 0.001) (Tables 7, Table 8).
Table 7
Cross-sectional subsample of patients: sequelae of previous traumatic injuries to the permanent teeth
Restorative treatment provided
Types of traumatic injury
No sequelae
Tooth loss
Hard tissue
Endodontic
General sequelae
All teeth
(PDL, DHT, PDL + DHT)
n
%
%
n
%
%
n
%
%
n
%
%
n
%
%
n
%
%
PDL injuries
120
 
46.5
28
 
10.9
15
 
5.8
66
 
25.6
29
 
11.2
258
 
100
 % based on injury types
 
68.6
  
48.3
  
10.3
  
43.4
  
74.4
  
45.3
 
DHT injuries
22
 
14.5
19
 
12.5
76
 
50.0
32
 
21.1
3
 
2.0
152
 
100
 % based on injury types
 
12.6
  
32.8
  
52.4
  
21.1
  
7.7
  
26.7
 
PDL + DHT injuries
33
 
20.8
11
 
6.9
54
 
34.0
54
 
34.0
7
 
4.4
159
 
100
 % based on injury types
 
18.9
  
19.0
  
37.2
  
35.5
  
17.9
  
27.9
 
All injuries
175
 
30.8
58
 
10.2
145
 
25.5
152
 
26.7
39
 
6.9
569
 
100
Total %
 
100
  
100
  
100
  
100
  
100
  
100
 
DHT  dental hard tissue, PDL  periodontal ligament
Association between sequelae and injury types: p < 0.001 (Pearson's Chi-squared test)
Table 8
Cross-sectional subsample of patients: injury subtypes based on previous trauma to the permanent teeth in relation to both clinical and radiographic findings at follow-up and to the distribution of these subtypes within the combined PDL + DHT injuries
  
Status at follow-up
Endodontic treatment
  
Other findings (left) or
Types of traumatic injury
 
Lost
Nonsensitive
Previous
Indicated
Ankylosed
Discolored
requirements (right)
(PDL, DHT, PDL + DHT)
n
n
%
n
n
n
n
n
n
n
n
PDL injuries
258
          
Concussion
 
44
17.1
0
3
2
1
3
0
1
 
Subluxation (mobility)
 
49
19.0
1
9
6
9
2
2
7
2
Lateral luxation
 
94
36.4
8
34
25
6
4
14
19
 
Extrusion
 
19
7.4
3
8
5
1
1
5
3
 
Intrusion
 
17
6.6
1
7
3
3
0
2
14
1
Avulsion
 
35
13.6
14
20
11
3
6
7
8
1
   
100
27
81
52
23
16
30
52†
4†
DHT injuries
152
          
Enamel (infraction)
 
4
2.6
     
0
  
Enamel (fracture)
 
35
23.0
1
  
1
 
2
  
Enamel–dentin
 
67
44.1
 
12
9
1
 
4
2
4
Enamel–dentin–pulp
 
14
9.2
4
8
7
2
 
5
  
Crown–root
 
27
17.8
13
    
3
3
6
Root
 
5
3.3
2
    
0
2
 
   
100
  
16
   
7‡
10‡
PDL + DHT injuries
159
          
    
11
61
48
7
11
 
13§
Abbreviations in this row:
    
E(I)
E(F)
ED
EDP
CR
R
Total
E(I) = Enamel (infraction)
   
Concussion
7
19
36
3
2
1
68
E(F) = Enamel (fracture)
   
Subluxation
3
3
23
3
1
0
33
ED = Enamel–dentin
   
Lateral luxation
4
7
16
4
6
3
40
EDP = Enamel–dentin–pulp
   
Extrusion
3
0
1
0
0
0
4
CR = Crown–root
   
Intrusion
0
0
5
0
1
0
6
R = Root
   
Avulsion
0
5
3
0
0
0
8
Total
569
  
Total:
17
34
84
10
10
4
159
DHT  dental hard tissue, PDL  periodontal ligament
†Concussion: apical osteolysis (n = 1); subluxation: pulp canal obliteration (n = 7), prosthetic treatment (n = 2); lateral luxation: pulp canal obliteration (n = 11), apical osteolysis (n = 5), inflammatory replacement resorption (n = 2); extrusion: pulp canal obliteration (n = 2), apical osteolysis (n = 1); intrusion: apical osteolysis (n = 2), inflammatory resorption (n = 2), surface resorption (n = 10), extraction (n = 1); avulsion: inflammatory resorption (n = 4), pulp canal obliteration (n = 2), surface resorption (n = 2), removal (n = 7), prosthetic treatment (n = 1)
‡Enamel–dentin: pulp canal obliteration (n = 2), conservative treatment (n = 3), apicoectomy (n = 1); crown–root: surface resorption (n = 2), apical osteolysis (n = 1), extraction (n = 5), prosthetic treatment (n = 1); root: pulp canal obliteration (n = 2). §Apical osteolysis (n = 4), inflammatory (n = 2) or surface (n = 3) resorption, pulp canal obliteration (n = 4), apicoectomy (n = 1), extraction (n = 7), prosthetic treatment (n = 1)
While 536 previously injured teeth (89.6%) did not require treatment, an implant had been placed in 12 (2.0%) of the tooth sites and was being planned in another 15 (2.5%). A further 23 (3.8%) sites were restored by different means and 12 (2.0%) were left edentulous. A Pearson’s Chi-squared test revealed a strong, but not significant, tendency for implant treatment following TDI (p = 0.07) (Table 9).
Table 9
Cross-sectional subsample of patients: indications for implant treatment after previous injury to any affected teeth
 
Restoration
Indication for implant treatment
Non-implant measures taken
 
Types of traumatic injury
Not indicated
Implant placed
Implant planned
Restored
Left edentulous
All tooth sites
(PDL, DHT, PDL + DHT)
n
%
%
n
%
%
n
%
%
n
%
%
n
%
%
n
%
%
PDL injuries
259
 
90.6
5
 
1.7
6
 
2.1
6
 
2.1
10
 
3.5
286
 
100
 % based on injury types
 
48.3
  
41.7
  
40.0
  
26.1
  
83.3
  
47.8
 
DHT injuries
132
 
86.3
7
 
4.6
3
 
2.0
9
 
5.9
2
 
1.3
153
 
100
 % based on injury types
 
24.6
  
58.3
  
20.0
  
39.1
  
16.7
  
25.6
 
PDL + DHT injuries
145
 
91.2
0
 
0.0
6
 
3.8
8
 
5.0
0
 
0.0
159
 
100
 % based on injury types
 
27.1
  
0.0
  
40.0
  
34.8
  
0.0
  
26.6
 
All injuries
536
 
89.6
12
 
2.0
15
 
2.5
23
 
3.8
12
 
2.0
598
 
100
Total %
 
100
  
100
  
100
  
100
  
100
  
100
 
DHT  dental hard tissue, PDL periodontal ligament
Likelihood of implant treatment after traumatic dental injuries: p = 0.007 (Pearson's Chi-squared test)
Avulsions, due to their severity and extensive treatment requirements, were evaluated in detail. The total retrospective sample had included 298 avulsed teeth (Table 4); 44 of these (42 permanent and 2 deciduous) teeth or tooth sites could be followed up, 34 of them having been reimplanted while 10 were not.
Seventeen of the 44 teeth (38.6%) had been successfully preserved, while 9 (20.5%) were not considered for replantation, 5 sites (11.4%) had been managed by orthodontic gap closure, 4 (9.1%) by transplanting deciduous canines, 4 (9.1%) by fixed prostheses and 3 (6.8%) by implant treatment, while the remaining 2 (4.5%) were previously avulsed deciduous teeth. The mean Periotest values obtained for the previously injured teeth were 4.91 ± 4.53 (− 3 to + 29) based on the PDL injuries, 6.55 ± 7.25 based on the DHT and 5.34 ± 5.82 based on the PDL + DHT injuries. A Kruskal–Wallis test revealed a certain tendency, short of statistical significance, for the Periotest values to be associated with the injury types (p = 0.087).

Discussion

This study was based on a sample of several thousand TDIs (n = 4909) from 2758 patients. The distribution of these traumatic injuries was found to be similar to other studies [1, 3, 12]. Moreover, this retrospective and cross-sectional analysis of patients, presenting at a German center, first and foremost, revealed a considerable gender discrepancy. Males outnumbered female patients by a factor of 1.65 and this distribution held true even when based only on the deciduous teeth. Perhaps, unsurprisingly, TDIs are well known to vary with gender and age. With regard to gender distribution, Petti et al. reported in a meta-analysis a global prevalence ratio of 1.43 and also suggested a 34 to 52% higher likelihood for males to experience dental trauma [3]. In other studies, male predominance has been found to range from 1.5 to 2.5 times [1317] due to their statistically greater involvement in contact sports, fighting, occupational hazards and car accidents [12, 1720]. Eslamipour et al. reported the prevalence of dental trauma to the permanent incisors as being 24% in 9- to 14-year-old patients, where the prevalence in girls was 18.8% compared to the significantly higher rate of 29.9% in boys [2].
The present study shows a continuous age gradient, with the first decade of life predominating and a clear majority of all patients (66.1%) being under 20 years old when the accidents occurred. The injury types differed for the permanent vs. the deciduous teeth and, with regard to the likelihood of sequelae, this notably included the extraction of teeth. There was a strong tendency for TDIs to entail implant treatment, while follow-up examinations revealed an 89.8% rate of tooth survival and a 60.2% rate of sequelae.
Consistent with a Chilean study where luxation trauma accounted for 70.4% of injuries to the deciduous teeth [14], in the present study the PDLs were twelve times more numerous than the DHT injuries to this dentition (Table 3). It has been noted that minor periodontal injuries may be underreported by going clinically unnoticed or due to parents not seeking a dentist in the absence of distinct symptoms or bleeding [2125]. In a Turkish study, periodontal injuries were shown to account for 84.7% of injuries to the deciduous teeth, regardless of age or gender [26]. In the present study, 18.9% of the injured deciduous teeth were removed due to periodontal injuries. A series of retrospective cohort studies (follow-up ≥ 1 year) identified pulp necrosis, pulp canal obliteration, premature tooth loss and root resorption as the main sequelae of deciduous tooth trauma within 1 year [2729].
Unlike the injury types (PDL versus DHT), the injury subtypes did not differ very much among the permanent and deciduous teeth. Notable exceptions included concussions (35.4% vs. 14.5% of PDL injuries) and fractures confined to the enamel (22.1% vs. 41.8% of DHT injuries) as opposed to enamel–dentin injuries (49.1% vs. 20.0%). PDL injuries to the permanent teeth were mainly found to include concussion (35.4%), lateral luxation (27.4%) and subluxation (22.0%). Cases of avulsion accounted for 7.4%. Regarding all injuries (to both permanent and deciduous teeth), trauma to the enamel or enamel–dentin fractures without pulp involvement accounted for 60% (22.6% plus 48.4%, respectively) of the DHT injuries. Hence, the latter (48.4%) were by far the most frequent subtype of hard-tissue injuries overall. Reviews from around the world (Nigeria, India, Canada and Chile) concluded that dental trauma mainly occurred to the enamel (63.7 to 80%), followed by enamel–dentin fractures (15.9 to 17.2%) or as uncomplicated crown fractures (32.9%) and subluxation (31.7%) [14, 3032], whereas in a Brazilian study of all age groups, periodontal injuries were identified as the main type of dentoalveolar trauma [15, 33].
As the major findings of the present study concern sequelae, it is useful to provide a brief discussion of the mechanisms. Notable examples of complications following dental trauma would be pulp necrosis, apical periodontitis, clinical crown discoloration, fistula formation or inflammatory resorption. DHT injuries may facilitate bacterial colonization, inflammation and necrosis of the pulp [3437]. Pulp survival has been reported to be 95 to 98% for uncomplicated crown fractures but only 63 to 94% for complicated crown fractures, however, after timely and correct treatment, long-term vitality may realistically be expected [37, 38]. After root fractures, pulp survival has been found in 60 to 80% of cases [3942] and necrosis to be closely associated with the severity of the neurovascular supply disruption [43]. Therefore, while pulp necrosis is an unlikely scenario following isolated crown fractures if properly treated [44, 45], combined injuries (e.g., crown fracture plus subluxation) would weaken the pulp defense [33, 44] and increase the risk of necrosis by affecting not only the apical neurovascular bundle but also the periodontal fibers [4446]. PDL injuries, which accounted for the majority of cases in the present study, may cause various forms of root resorption. Pulp necrosis is significantly more likely to occur in dislocated teeth with fully developed roots [4749] and has been reported, depending on the severity of the trauma, to affect 17 to 100% of dislocated teeth [48, 50]. PDL injuries of the lateral-luxation, avulsion or intrusion type will often entail more serious complications such as external or replacement resorption, with lateral luxation resulting in soft-tissue damage and fracture of the vestibular bone lamella. Within the cross-sectional subsample reported here, only 175 of the 569 previously injured permanent teeth (30.8%) neither had sequelae nor required treatment. Conversely, 58 injured teeth (10.2%) were lost by the time of the follow-up examination; almost half of these losses (48.3%) occurred following PDL injuries. Informed on-site behavior and making the correct initial treatment decisions are essential to a favorable prognosis of traumatically injured teeth, which, as has been pointed out previously [43], will always depend on the type of trauma sustained, the length of time from the point of the accident to the emergency treatment, and the quality of the treatment.
The treatment of a TDI may be considered successful once healing of the pulp and periodontal soft tissue has been accomplished and the tooth is asymptomatic, exhibiting vitality, and appropriately positioned. In addition, the tooth should exhibit normal clinical and radiographic characteristics including an intact height of the alveolar bone as well as properly sealed root structures, with the root growth either completed or continuing. It is also a fact, however, that dental trauma can always entail sequelae which may vary in nature and severity; these often do not become manifest until months or, indeed, years after the event. Hence, early detection is the key to preventing long-term consequences; this can only be attained by conscientiously implementing and motivating patients to attend periodic recall visits in order to meticulously conduct all the required follow-up examinations.

Limitations

Valuable information on the prognosis of TDIs was collected during the analysis. However, certain limitations were present due to the study design. Compared to retrospective studies, prospective studies can often collect more profound data. However, collecting the necessary data in the context of the initial treatment is questionable from an ethical point of view and difficult to integrate into the treatment process.
The data evaluated were taken from patient records, trauma documentation forms, radiographs and photographs. The evaluated TDIs were primarily treated by 23 different dentists or oral surgeons. Some of these practitioners were at the beginning of their professional careers, while others had several years of experience. Consequently, the prognosis of the affected teeth would be related to the clinical experience and competence of the individual dentist as it was they who had made the primary therapeutic decision.
The different treatment concepts applied, which have changed over the years due to current recommendations, may mean that there is a limit to the validity of the results. The TDIs that occurred during the period of 8 years were reexamined. The longer, historically, that the TDI had occurred, the less likely the patient would present for a recall examination in this study. Some patients presented regularly for a follow-up examination so that the necessary treatments could be performed early. Other follow-up patients presented for the first time after their primary care or had intermediate checkups and treatments performed by their dentists.

Conclusion

Based on the findings of the present analysis, it can be concluded that males were more frequently affected by TDIs than females. Most patients had suffered from TDI before they had turned 10 years of age. Overall, the enamel–dentin fracture was found to be the most frequent injury, followed by concussions and lateral luxations.

Acknowledgements

The authors want to thank Ms Katja Fink for her contribution to the data collection.

Declarations

Ethics approval from the Ethics Committee Goethe University Frankfurt, Germany University.
Not applicable.

Competing interests

The authors declare that they have no competing interests.
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Literatur
1.
Zurück zum Zitat Glendor U. Epidemiology of traumatic dental injuries—a 12 year review of the literature. Dent Traumatol. 2008;24(6):603–11.PubMedCrossRef Glendor U. Epidemiology of traumatic dental injuries—a 12 year review of the literature. Dent Traumatol. 2008;24(6):603–11.PubMedCrossRef
2.
Zurück zum Zitat Eslamipour F, Iranmanesh P, Borzabadi-Farahani A. Cross-sectional study of dental trauma and associated factors among 9- to 14-year-old school children in Isfahan, Iran. Oral Health Prev Dent. 2016;14(5):451–7.PubMed Eslamipour F, Iranmanesh P, Borzabadi-Farahani A. Cross-sectional study of dental trauma and associated factors among 9- to 14-year-old school children in Isfahan, Iran. Oral Health Prev Dent. 2016;14(5):451–7.PubMed
3.
Zurück zum Zitat Petti S, Glendor U, Andersson L. World traumatic dental injury prevalence and incidence, a meta-analysis—one billion living people have had traumatic dental injuries. Dent Traumatol. 2018;34:71–86.PubMedCrossRef Petti S, Glendor U, Andersson L. World traumatic dental injury prevalence and incidence, a meta-analysis—one billion living people have had traumatic dental injuries. Dent Traumatol. 2018;34:71–86.PubMedCrossRef
4.
Zurück zum Zitat Andersson L. Epidemiology of traumatic dental injuries. Pediatr Dent. 2013;35:102–5.PubMed Andersson L. Epidemiology of traumatic dental injuries. Pediatr Dent. 2013;35:102–5.PubMed
5.
Zurück zum Zitat Richards D. One billion people have experienced a traumatic dental injury. Evid Based Dent. 2018;19:34–5.PubMedCrossRef Richards D. One billion people have experienced a traumatic dental injury. Evid Based Dent. 2018;19:34–5.PubMedCrossRef
6.
Zurück zum Zitat Fasciglione D, Persic R, Pohl Y, Filippi A. Dental injuries in inline skating—level of information and prevention. Dent Traumatol. 2007;23:143–8.PubMedCrossRef Fasciglione D, Persic R, Pohl Y, Filippi A. Dental injuries in inline skating—level of information and prevention. Dent Traumatol. 2007;23:143–8.PubMedCrossRef
7.
Zurück zum Zitat Lahti H, Sane J, Ylipaavalniemi P. Dental injuries in ice hockey games and training. Med Sci Sports Exerc. 2002;34:400–2.PubMedCrossRef Lahti H, Sane J, Ylipaavalniemi P. Dental injuries in ice hockey games and training. Med Sci Sports Exerc. 2002;34:400–2.PubMedCrossRef
8.
Zurück zum Zitat Lee JY, Divaris K. Hidden consequences of dental trauma: the social and psychological effects. Pediatr Dent. 2009;31:96–101.PubMed Lee JY, Divaris K. Hidden consequences of dental trauma: the social and psychological effects. Pediatr Dent. 2009;31:96–101.PubMed
9.
Zurück zum Zitat Cortes MI, Marcenes W, Sheiham A. Impact of traumatic injuries to the permanent teeth on the oral health-related quality of life in 12–14-year-old children. Community Dent Oral Epidemiol. 2002;30:193–8.PubMedCrossRef Cortes MI, Marcenes W, Sheiham A. Impact of traumatic injuries to the permanent teeth on the oral health-related quality of life in 12–14-year-old children. Community Dent Oral Epidemiol. 2002;30:193–8.PubMedCrossRef
10.
Zurück zum Zitat Spinas E, Melis A, Savasta A. Therapeutic approach to intrusive luxation injuries in primary dentition. A clinical follow-up study. Eur J Paediatr Dent. 2006;7:179–86.PubMed Spinas E, Melis A, Savasta A. Therapeutic approach to intrusive luxation injuries in primary dentition. A clinical follow-up study. Eur J Paediatr Dent. 2006;7:179–86.PubMed
11.
Zurück zum Zitat Krastl G, Filippi A, Weiger R. Initial management of dental trauma: musts, shoulds, and cans. Quintessence Int. 2020;51:763–74.PubMed Krastl G, Filippi A, Weiger R. Initial management of dental trauma: musts, shoulds, and cans. Quintessence Int. 2020;51:763–74.PubMed
12.
Zurück zum Zitat Azami-Aghdash S, Ebadifard Azar F, Pournaghi Azar F, Rezapour A, Moradi-Joo M, Moosavi A, GhertasiOskouei S. Prevalence, etiology, and types of dental trauma in children and adolescents: systematic review and meta-analysis. Med J Islam Repub Iran. 2015;29:234.PubMedPubMedCentral Azami-Aghdash S, Ebadifard Azar F, Pournaghi Azar F, Rezapour A, Moradi-Joo M, Moosavi A, GhertasiOskouei S. Prevalence, etiology, and types of dental trauma in children and adolescents: systematic review and meta-analysis. Med J Islam Repub Iran. 2015;29:234.PubMedPubMedCentral
13.
Zurück zum Zitat Lam R, Abbott P, Lloyd C, Lloyd C, Kruger E, Tennant M. Dental trauma in an Australian rural centre. Dent Traumatol. 2008;24:663–70.PubMedCrossRef Lam R, Abbott P, Lloyd C, Lloyd C, Kruger E, Tennant M. Dental trauma in an Australian rural centre. Dent Traumatol. 2008;24:663–70.PubMedCrossRef
14.
Zurück zum Zitat Díaz JA, Bustos L, Brandt AC, Fernández BE. Dental injuries among children and adolescents aged 1–15 years attending to public hospital in Temuco, Chile. Dent Traumatol. 2010;26:254–61.PubMedCrossRef Díaz JA, Bustos L, Brandt AC, Fernández BE. Dental injuries among children and adolescents aged 1–15 years attending to public hospital in Temuco, Chile. Dent Traumatol. 2010;26:254–61.PubMedCrossRef
15.
Zurück zum Zitat Navabazam A, Farahani SS. Prevalence of traumatic injuries to maxillary permanent teeth in 9- to 14-year-old school children in Yazd, Iran. Dent Traumatol. 2010;26:154–7.PubMedCrossRef Navabazam A, Farahani SS. Prevalence of traumatic injuries to maxillary permanent teeth in 9- to 14-year-old school children in Yazd, Iran. Dent Traumatol. 2010;26:154–7.PubMedCrossRef
16.
Zurück zum Zitat Noori AJ, Al-Obaidi WA. Traumatic dental injuries among primary school children in Sulaimani city, Iraq. Dent Traumatol. 2009;25:442–6.PubMedCrossRef Noori AJ, Al-Obaidi WA. Traumatic dental injuries among primary school children in Sulaimani city, Iraq. Dent Traumatol. 2009;25:442–6.PubMedCrossRef
17.
Zurück zum Zitat Naidoo S, Sheiham A, Tsakos G. Traumatic dental injuries of permanent incisors in 11- to 13-year-old South African schoolchildren. Dent Traumatol. 2009;25:224–8.PubMedCrossRef Naidoo S, Sheiham A, Tsakos G. Traumatic dental injuries of permanent incisors in 11- to 13-year-old South African schoolchildren. Dent Traumatol. 2009;25:224–8.PubMedCrossRef
18.
Zurück zum Zitat Eyuboglu O, Yilmaz Y, Zehir C, Sahin H. A 6-year investigation into types of dental trauma treated in a paediatric dentistry clinic in Eastern Anatolia region. Turkey Dent Traumatol. 2009;25:110–4.PubMedCrossRef Eyuboglu O, Yilmaz Y, Zehir C, Sahin H. A 6-year investigation into types of dental trauma treated in a paediatric dentistry clinic in Eastern Anatolia region. Turkey Dent Traumatol. 2009;25:110–4.PubMedCrossRef
19.
Zurück zum Zitat Altun C, Ozen B, Esenlik E, Guven G, Gürbüz T, Acikel C, Basak F, Akbulut E. Traumatic injuries to permanent teeth in Turkish children, Ankara. Dent Traumatol. 2009;25:309–13.PubMedCrossRef Altun C, Ozen B, Esenlik E, Guven G, Gürbüz T, Acikel C, Basak F, Akbulut E. Traumatic injuries to permanent teeth in Turkish children, Ankara. Dent Traumatol. 2009;25:309–13.PubMedCrossRef
20.
Zurück zum Zitat David J, Astrøm AN, Wang NJ. Factors associated with traumatic dental injuries among 12-year-old schoolchildren in South India. Dent Traumatol. 2009;25:500–5.PubMedCrossRef David J, Astrøm AN, Wang NJ. Factors associated with traumatic dental injuries among 12-year-old schoolchildren in South India. Dent Traumatol. 2009;25:500–5.PubMedCrossRef
21.
Zurück zum Zitat Andreasen JO, Andreasen FM, Skeie A, Hjørting-Hansen E, Schwartz O. Effect of treatment delay upon pulp and periodontal healing of traumatic dental injuries—a review article. Dent Traumatol. 2002;18:116–28.PubMedCrossRef Andreasen JO, Andreasen FM, Skeie A, Hjørting-Hansen E, Schwartz O. Effect of treatment delay upon pulp and periodontal healing of traumatic dental injuries—a review article. Dent Traumatol. 2002;18:116–28.PubMedCrossRef
22.
Zurück zum Zitat Saroglu I, Sönmez H. The prevalence of traumatic injuries treated in the pedodontic clinic of Ankara University, Turkey, during 18 months. Dent Traumatol. 2002;18:299–303.PubMedCrossRef Saroglu I, Sönmez H. The prevalence of traumatic injuries treated in the pedodontic clinic of Ankara University, Turkey, during 18 months. Dent Traumatol. 2002;18:299–303.PubMedCrossRef
23.
Zurück zum Zitat Wilson CF. Management of trauma to primary and developing teeth. Dent Clin N Am. 1995;39:133–67.PubMedCrossRef Wilson CF. Management of trauma to primary and developing teeth. Dent Clin N Am. 1995;39:133–67.PubMedCrossRef
24.
Zurück zum Zitat Cunha RF, Pugliesi DM, de Mello Vieira AE. Oral trauma in Brazilian patients aged 0–3 years. Dent Traumatol. 2001;17:210–2.PubMedCrossRef Cunha RF, Pugliesi DM, de Mello Vieira AE. Oral trauma in Brazilian patients aged 0–3 years. Dent Traumatol. 2001;17:210–2.PubMedCrossRef
25.
Zurück zum Zitat Kramer PF, Zembruski C, Ferreira SH, Feldens CA. Traumatic dental injuries in Brazilian preschool children. Dent Traumatol. 2003;19:299–303.PubMedCrossRef Kramer PF, Zembruski C, Ferreira SH, Feldens CA. Traumatic dental injuries in Brazilian preschool children. Dent Traumatol. 2003;19:299–303.PubMedCrossRef
26.
Zurück zum Zitat Avsar A, Topaloglu B. Traumatic tooth injuries to primary teeth of children aged 0–3 years. Dent Traumatol. 2009;25:323–7.PubMedCrossRef Avsar A, Topaloglu B. Traumatic tooth injuries to primary teeth of children aged 0–3 years. Dent Traumatol. 2009;25:323–7.PubMedCrossRef
27.
Zurück zum Zitat Lauridsen E, Blanche P, Amaloo C, Andreasen JO. The risk of healing complications in primary teeth with concussion or subluxation injury—a retrospective cohort study. Dent Traumatol. 2017;33:337–44.PubMedCrossRef Lauridsen E, Blanche P, Amaloo C, Andreasen JO. The risk of healing complications in primary teeth with concussion or subluxation injury—a retrospective cohort study. Dent Traumatol. 2017;33:337–44.PubMedCrossRef
28.
Zurück zum Zitat Lauridsen E, Blanche P, Yousaf N, Andreasen JO. The risk of healing complications in primary teeth with extrusive or lateral luxation—a retrospective cohort study. Dent Traumatol. 2017;33:307–16.PubMedCrossRef Lauridsen E, Blanche P, Yousaf N, Andreasen JO. The risk of healing complications in primary teeth with extrusive or lateral luxation—a retrospective cohort study. Dent Traumatol. 2017;33:307–16.PubMedCrossRef
29.
Zurück zum Zitat Lauridsen E, Blanche P, Yousaf N, Andreasen JO. The risk of healing complications in primary teeth with intrusive luxation: a retrospective cohort study. Dent Traumatol. 2017;33:329–36.PubMedCrossRef Lauridsen E, Blanche P, Yousaf N, Andreasen JO. The risk of healing complications in primary teeth with intrusive luxation: a retrospective cohort study. Dent Traumatol. 2017;33:329–36.PubMedCrossRef
30.
Zurück zum Zitat Taiwo OO, Jalo HP. Dental injuries in 12-year old Nigerian students. Dent Traumatol. 2011;27:230–4.PubMedCrossRef Taiwo OO, Jalo HP. Dental injuries in 12-year old Nigerian students. Dent Traumatol. 2011;27:230–4.PubMedCrossRef
31.
Zurück zum Zitat Gupta S, Kumar-Jindal S, Bansal M, Singla A. Prevalence of traumatic dental injuries and role of incisal overjet and inadequate lip coverage as risk factors among 4–15 years old government school children in Baddi-Barotiwala Area, Himachal Pradesh, India. Med Oral Patol Oral Cir Bucal. 2011;16:e960–5.PubMedCrossRef Gupta S, Kumar-Jindal S, Bansal M, Singla A. Prevalence of traumatic dental injuries and role of incisal overjet and inadequate lip coverage as risk factors among 4–15 years old government school children in Baddi-Barotiwala Area, Himachal Pradesh, India. Med Oral Patol Oral Cir Bucal. 2011;16:e960–5.PubMedCrossRef
32.
Zurück zum Zitat Fakhruddin KS, Lawrence HP, Kenny DJ, Locker D. Etiology and environment of dental injuries in 12- to 14-year-old Ontario schoolchildren. Dent Traumatol. 2008;24:305–8.PubMedCrossRef Fakhruddin KS, Lawrence HP, Kenny DJ, Locker D. Etiology and environment of dental injuries in 12- to 14-year-old Ontario schoolchildren. Dent Traumatol. 2008;24:305–8.PubMedCrossRef
33.
Zurück zum Zitat Gulinelli JL, Saito CT, Garcia-Júnior IR, Panzarini SR, Poi WR, Sonoda CK, Jardim EC, Faverani LP. Occurrence of tooth injuries in patients treated in hospital environment in the region of Araçatuba, Brazil during a 6-year period. Dent Traumatol. 2008;24:640–4.PubMedCrossRef Gulinelli JL, Saito CT, Garcia-Júnior IR, Panzarini SR, Poi WR, Sonoda CK, Jardim EC, Faverani LP. Occurrence of tooth injuries in patients treated in hospital environment in the region of Araçatuba, Brazil during a 6-year period. Dent Traumatol. 2008;24:640–4.PubMedCrossRef
34.
Zurück zum Zitat Mjör IA. Pulp-dentin biology in restorative dentistry. Part 5: clinical management and tissue changes associated with wear and trauma. Quintessence Int. 2001;32:771–88.PubMed Mjör IA. Pulp-dentin biology in restorative dentistry. Part 5: clinical management and tissue changes associated with wear and trauma. Quintessence Int. 2001;32:771–88.PubMed
35.
Zurück zum Zitat Mjör IA. Pulp-dentin biology in restorative dentistry. Part 7: the exposed pulp. Quintessence Int. 2002;33:113–35.PubMed Mjör IA. Pulp-dentin biology in restorative dentistry. Part 7: the exposed pulp. Quintessence Int. 2002;33:113–35.PubMed
36.
Zurück zum Zitat Love RM, Jenkinson HF. Invasion of dentinal tubules by oral bacteria. Crit Rev Oral Biol Med. 2002;13:171–83.PubMedCrossRef Love RM, Jenkinson HF. Invasion of dentinal tubules by oral bacteria. Crit Rev Oral Biol Med. 2002;13:171–83.PubMedCrossRef
37.
Zurück zum Zitat Lauridsen E, Hermann NV, Gerds TA, Ahrensburg SS, Kreiborg S, Andreasen JO. Combination injuries 1. The risk of pulp necrosis in permanent teeth with concussion injuries and concomitant crown fractures. Dent Traumatol. 2012;28:364–70.PubMedCrossRef Lauridsen E, Hermann NV, Gerds TA, Ahrensburg SS, Kreiborg S, Andreasen JO. Combination injuries 1. The risk of pulp necrosis in permanent teeth with concussion injuries and concomitant crown fractures. Dent Traumatol. 2012;28:364–70.PubMedCrossRef
38.
Zurück zum Zitat de Blanco LP. Treatment of crown fractures with pulp exposure. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996;82:564–8.PubMedCrossRef de Blanco LP. Treatment of crown fractures with pulp exposure. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996;82:564–8.PubMedCrossRef
39.
Zurück zum Zitat Cvek M, Andreasen JO, Borum MK. Healing of 208 intra-alveolar root fractures in patients aged 7–17 years. Dent Traumatol. 2001;17:53–62.PubMedCrossRef Cvek M, Andreasen JO, Borum MK. Healing of 208 intra-alveolar root fractures in patients aged 7–17 years. Dent Traumatol. 2001;17:53–62.PubMedCrossRef
40.
Zurück zum Zitat Andreasen JO, Andreasen FM, Mejàre I, Cvek M. 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. Dent Traumatol. 2004;20:192–202.PubMedCrossRef Andreasen JO, Andreasen FM, Mejàre I, Cvek M. 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. Dent Traumatol. 2004;20:192–202.PubMedCrossRef
41.
Zurück zum Zitat Andreasen JO, Andreasen FM, Mejàre I, Cvek M. Healing of 400 intra-alveolar root fractures. 2. Effect of treatment factors such as treatment delay, repositioning, splinting type and period and antibiotics. Dent Traumatol. 2004;20:203–11.PubMedCrossRef Andreasen JO, Andreasen FM, Mejàre I, Cvek M. Healing of 400 intra-alveolar root fractures. 2. Effect of treatment factors such as treatment delay, repositioning, splinting type and period and antibiotics. Dent Traumatol. 2004;20:203–11.PubMedCrossRef
42.
Zurück zum Zitat Cvek M, Mejàre I, Andreasen JO. Healing and prognosis of teeth with intraalveolar fractures involving the cervical part of the root. Dent Traumatol. 2002;18:57–65.PubMedCrossRef Cvek M, Mejàre I, Andreasen JO. Healing and prognosis of teeth with intraalveolar fractures involving the cervical part of the root. Dent Traumatol. 2002;18:57–65.PubMedCrossRef
43.
Zurück zum Zitat Zaleckiene V, Peciuliene V, Brukiene V, Drukteinis S. Traumatic dental injuries: etiology, prevalence and possible outcomes. Stomatologija. 2014;16:7–14.PubMed Zaleckiene V, Peciuliene V, Brukiene V, Drukteinis S. Traumatic dental injuries: etiology, prevalence and possible outcomes. Stomatologija. 2014;16:7–14.PubMed
44.
Zurück zum Zitat Robertson A. A retrospective evaluation of patients with uncomplicated crown fractures and luxation injuries. Endod Dent Traumatol. 1998;14:245–56.PubMedCrossRef Robertson A. A retrospective evaluation of patients with uncomplicated crown fractures and luxation injuries. Endod Dent Traumatol. 1998;14:245–56.PubMedCrossRef
45.
Zurück zum Zitat Robertson A, Andreasen FM, Andreasen JO, Norén JG. Long-term prognosis of crown-fractured permanent incisors. The effect of stage of root development and associated luxation injury. Int J Paediatr Dent. 2000;10:191–9.PubMedCrossRef Robertson A, Andreasen FM, Andreasen JO, Norén JG. Long-term prognosis of crown-fractured permanent incisors. The effect of stage of root development and associated luxation injury. Int J Paediatr Dent. 2000;10:191–9.PubMedCrossRef
46.
Zurück zum Zitat Viduskalne I, Care R. Analysis of the crown fractures and factors affecting pulp survival due to dental trauma. Stomatologija. 2010;12:109–15.PubMed Viduskalne I, Care R. Analysis of the crown fractures and factors affecting pulp survival due to dental trauma. Stomatologija. 2010;12:109–15.PubMed
47.
Zurück zum Zitat Lee R, Barrett EJ, Kenny DJ. Clinical outcomes for permanent incisor luxations in a pediatric population. II. Extrusions. Dent Traumatol. 2003;19:274–9.PubMedCrossRef Lee R, Barrett EJ, Kenny DJ. Clinical outcomes for permanent incisor luxations in a pediatric population. II. Extrusions. Dent Traumatol. 2003;19:274–9.PubMedCrossRef
48.
Zurück zum Zitat Nikoui M, Kenny DJ, Barrett EJ. Clinical outcomes for permanent incisor luxations in a pediatric population. III. Lateral luxations. Dent Traumatol. 2003;19:280–5.PubMedCrossRef Nikoui M, Kenny DJ, Barrett EJ. Clinical outcomes for permanent incisor luxations in a pediatric population. III. Lateral luxations. Dent Traumatol. 2003;19:280–5.PubMedCrossRef
49.
Zurück zum Zitat Ferrazzini Pozzi EC, von Arx T. Pulp and periodontal healing of laterally luxated permanent teeth: results after 4 years. Dent Traumatol. 2008;24:658–62.PubMedCrossRef Ferrazzini Pozzi EC, von Arx T. Pulp and periodontal healing of laterally luxated permanent teeth: results after 4 years. Dent Traumatol. 2008;24:658–62.PubMedCrossRef
50.
Zurück zum Zitat Humphrey JM, Kenny DJ, Barrett EJ. Clinical outcomes for permanent incisor luxations in a pediatric population. I. Intrusions. Dent Traumatol. 2003;19:266–73.PubMedCrossRef Humphrey JM, Kenny DJ, Barrett EJ. Clinical outcomes for permanent incisor luxations in a pediatric population. I. Intrusions. Dent Traumatol. 2003;19:266–73.PubMedCrossRef
Metadaten
Titel
Traumatic dental injuries over an 8-year period at a German dental center: a retrospective overview and cross-sectional analysis
verfasst von
Puria Parvini
Yanislava Lermen
Robert Sader
Frank Schwarz
Karina Obreja
Publikationsdatum
01.12.2023
Verlag
Springer Berlin Heidelberg
Erschienen in
International Journal of Implant Dentistry / Ausgabe 1/2023
Elektronische ISSN: 2198-4034
DOI
https://doi.org/10.1186/s40729-023-00506-x

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