Evaluation of Clinical and Radiographic Findings among Patients with Traumatic Dental Injuries Seeking Delayed Treatment

Abstract

Background. Time elapsed between trauma and treatment greatly influences the prognosis of traumatic dental injuries (TDIs). The aim of this study was to analyze clinical and radiographic findings related to complications of TDIs among patients seeking delayed treatment of such injuries. Materials and Methods. 123 permanent teeth with a history of previous TDIs were included in the study. Clinical findings analyzed were the type of fracture, type and number of injured teeth, crown discoloration, and pulpal status of the injured tooth (pulpal diagnosis). The radiographic findings analyzed included pulp canal obliteration (PCO), root resorption (RR), and periapical radiolucency (PR). Statistical analysis included descriptive analysis. Results. Tooth discoloration was the most common presenting complaint (53.65%), while fall (48.78%) was the most frequent cause of trauma. The range of time duration between trauma and presentation for treatment was 5 months to 30 years (average time 12.82 years). Pulp necrosis (PN) was the most common complication (90.24%). Almost half of the teeth with PN had fracture injury and discoloration along with a high frequency of PR (78.37%). Even teeth with a normal appearance were found to have a high incidence of PN (76.92%) and PR (53.84%). The crown discoloration was the second most frequent finding (48.78%). Many teeth (41.66%) with vital pulp were also discolored. Most of the teeth (79.31%) with yellowish discoloration and all teeth with brownish discoloration were nonvital. A high frequency of PN (90%) and PR (78.33%) was found in teeth with discoloration. PR was the most common radiographic finding (69.10%), while PCO and RR were observed in 17.88% and 21.13% of teeth, respectively. Conclusion. The findings of this study support the fact that delayed treatment of TDIs leads to increased complications. PN was the most common complication followed by tooth discoloration, RR, and PCO among patients seeking delayed treatment after TDIs.

Dental trauma: assessment and acute management of fractures

“…When undertaking an examination following dental trauma, a systematic approach is prudent to reduce the risk of any missed or wrong diagnoses which may negatively impact patient outcomes. 4 A thorough extra-oral and intra-oral hard and soft tissue exam looking for evidence of fractures (e.g. step deformities, mobile segments or embedded tooth fragments) should be undertaken.…”

Treatment priorities and arrival time of traumatic dental injuries—An 8‐year retrospective study

“…However, when these resources are unavailable, dentists in private practice assume responsibility for providing after‐hours care. Delayed care for TDIs has been associated with poor prognoses for the affected teeth 8–11 . A study by Vukovic et al 8 compared TDIs to permanent teeth that occurred after‐hours to those during office hours, revealing that 90% of after‐hours injuries experienced a median delay in treatment of 48 h, while injuries during office hours had a median delay of 2.3 h. After‐hours injuries were more likely to result in complications, such as pulpitis, pulp necrosis, internal resorption, or extraction due to pulpal or periodontal complications 12–15 .…”

“…Delayed care for TDIs has been associated with poor prognoses for the affected teeth. [8][9][10][11] A study by Vukovic et al 8 compared TDIs to permanent teeth that occurred after-hours to those during office hours, revealing that 90% of after-hours injuries experienced a median delay in treatment of 48 h, while injuries during office hours had a median delay of 2.3 h. After-hours injuries were more likely to result in complications, such as pulpitis, pulp necrosis, internal resorption, or extraction due to pulpal or periodontal complications. [12][13][14][15] Some studies have reported that certain dentists may neglect providing treatment for TDIs in young children.…”

Endodontic Management of Calcific Metamorphosis in Maxillary Central Incisor: A Case Report

“…Diagnosis is usually confirmed by radiographic examination which shows complete or partial obliteration of the canal. 2,3 This condition is not pathologic in nature and does not require treatment until and unless radiographic and clinical signs of periapical pathology develop. So it is necessary to observe these teeth both clinically and radiographically before initiating an endodontic treatment.…”