Impact of avulsion of the primary incisors on the occurrence of sequelae in the permanent teeth: A retrospective cohort study

Abstract

Objectives:The purpose of this retrospective cohort study was to investigate the occurrence of sequelae in the permanent teeth after avulsion of their primary antecessors and to evaluate the factors associated with this occurrence. Methods:We screened 2922 records of patients with photographic and radiographic images who attended a reference centre for dental trauma in the primary teeth from 1998 to 2019. Among them, 240 were eligible records of children who had suffered avulsion of the primary incisors and were followed up until complete eruption of the permanent successors. Multilevel Poisson regression analyses were conducted between the explanatory variables related to children and avulsed teeth; outcome variables were occurrences of any type of sequelae in the permanent teeth, opacities, hypoplasia and malformation. Relative risks (RRs) and respective 95% confidence intervals (95% CIs) were calculated.Results: Among the 240 children's records, 194 fulfilled the inclusion criteria. Finally, we found 266 primary avulsed teeth and 115 (43.2%) permanent teeth presenting with sequelae. Avulsion occurring when children were older than 4 years (RR = 0.48; 95% CI = 0.24-0.95) had lower risks for developing sequelae than children aged 0-2 years of age. Additionally, when avulsion occurred in the lower dental arch (RR = 1.45; 95% CI = 1.06-1.99) and when three or more teeth were affected (RR = 1.57; 95% CI = 1.02-2.41), the occurrence of sequelae in the permanent teeth was more probable than if avulsion occurred in the upper arch and affected only a single tooth. Age older than 3 years was a protective factor for the occurrence of hypoplasia and age older than 4 years protective for the occurrence of opacities. Conclusions:The risk of sequelae in the permanent teeth after avulsion of their antecessor is higher when the trauma occurs in young children (<2 years) and in patients with avulsions of greater magnitude, such as when it affects the lower jaw, and more teeth are involved.

Traumatic dental injuries in the primary lower incisors

“…Upper teeth are more commonly affected in dental trauma; therefore, we believe that when the primary lower teeth suffer avulsion, it was caused by trauma of higher magnitude and intensity. Additionally, the literature shows that severe TDI in the primary teeth, such as avulsion, can strongly be associated with the development of sequelae in the permanent successor 25–27 . Our study demonstrated that severe TDI presents an almost fourfold higher risk of occurrence of sequelae in the permanent teeth, which reinforces the results of a previous study that showed that avulsion that in the lower teeth presented a higher risk of sequelae than avulsion in the upper teeth 25 .…”

“…Additionally, the literature shows that severe TDI in the primary teeth, such as avulsion, can strongly be associated with the development of sequelae in the permanent successor. [25][26][27] Our study demonstrated that severe TDI presents an almost fourfold higher risk of occurrence of sequelae in the permanent teeth, which reinforces the results of a previous study that showed that avulsion that in the lower teeth presented a higher risk of sequelae than avulsion in the upper teeth. 25 Repercussions in primary dentition can also occur; for example, premature tooth loss, which was significantly noted in our study.…”

“…The literature reports that the severity of the sequelae depends on the type of dental injury, the child's age and the stage of development of the permanent successor at the moment of the injury. 5,11,25 The most severe sequelae observed in our study were the arrest of root formation, root dilaceration, and crown dilaceration. Our findings are consistent with the literature since the most common sequelae were enamel hypoplasia and enamel discoloration, which were mainly observed in 0-to 2-and 3-to 4-year-old children.…”

Perspective Chapter: Teeth Avulsion

“…Furthermore, movement of the tooth during avulsion and the proximity between the primary tooth and the germ of its developing successor may interfere with its further growth and maturation leading to the occurrence of enamel defects and tooth malformations. The risk of sequelae in the permanent successor after avulsion of primary teeth is higher when the injury occurs in young children (<2 years), when the trauma is of greater magnitude such as when more teeth are involved and lower jaw is affected [70,71].…”

An update on management of avulsed teeth

“…Teeth with mature root development were significantly more affected by ankylosis than teeth with immature root development [32] . When the trauma occurs in children under 2 years of age, when it affects the lower jaw, or when several teeth are involved, the risk of sequelae in the permanent teeth after avulsion of their predecessor is greater [33] . Traumatic injuries to primary teeth are a risk factor for the development of sequelae in permanent successors, so children who suffer trauma to their primary teeth should be monitored until the eruption of the permanent teeth for early diagnosis and treatment of possible sequelae [34,35] .…”