Evaluation of cases of concussion and subluxation in the permanent dentition: a retrospective study

Abstract Objectives This study evaluated the evolution of cases of concussion and subluxation through a retrospective study of 20 years. Material and Methods Were examined clinical and radiographic records of 1,309 patients who underwent treatment of dentoalveolar trauma in the discipline of Integrated Clinic of the School of Dentistry of Araçatuba, UNESP, of which we selected 137 whose patients had concussion and subluxation injuries, with average age of 23.3 (SD – 10.96). The variables collected were: gender, age, history of previous and actual trauma, treatments performed, the presence of necrotic pulp, and time elapsed until the same trauma. The concussion and subluxation groups were subjected to statistical analyses using the SPSS 16.0 version software (α=0.05), Chi-square, and t-tests. Results Of the 301 teeth involved, 49 (16.3%) suffered concussion and 252 (83.7%), subluxation, being the upper anterior teeth the most affected (75.1%) for both conditions. Subluxation and concussion traumas were more prevalent in men aged 10 to 20 years, most caused by cycling accidents (36.2%). There was a concomitant presence of crown fracture in 21% of cases of concussion and 34.7% of subluxation. Pulp necrosis was detected in 16.3% (concussion) and 27.1% (subluxation) (p=0.12), and most occurred within 6 months after the trauma (p=0.29). The pulp necrosis shows a positive correlation with motorcycle accidents (p=0.01), direct impact (p≤0.0001), crown fracture with pulp exposure (p≤0.0001), darkening of the crown (p=0.004) and spontaneous pain (p≤0.0001); and negative correlation with indirect impact (p≤0.0001). Conclusions Although concussion and subluxation traumas are considered of minor degrees, they must be monitored, since the possibility of pulp necrosis exists, and its early treatment favors a good prognosis.

摘要 研究目的 本研究通过一项为期20年的回顾性研究，评估牙震荡（concussion）与牙半脱位（subluxation）病例的病情演变情况。材料与方法 本研究回顾了巴西圣保罗州立大学（UNESP）阿拉沙图巴牙科学院综合临床科室收治的1309例牙牙槽外伤患者的临床及影像学病历，最终筛选出137例确诊为牙震荡或牙半脱位的患者，其平均年龄为23.3岁（标准差SD=10.96）。本研究收集的变量包括：性别、年龄、既往创伤史与本次创伤史、实施的治疗方案、牙髓坏死情况，以及创伤发生至就诊的间隔时长。采用SPSS 16.0统计软件（检验水准α=0.05），通过卡方检验与t检验对牙震荡组与牙半脱位组进行统计学分析。结果 本研究共纳入301颗患牙，其中49颗（16.3%）为牙震荡，252颗（83.7%）为牙半脱位；两类损伤均以上颌前牙受累最为常见，占比达75.1%。牙半脱位与牙震荡损伤在10~20岁男性群体中更为多发，最常见的致伤原因为自行车事故（36.2%）。21%的牙震荡病例与34.7%的牙半脱位病例合并冠折。牙髓坏死发生率在牙震荡组为16.3%，牙半脱位组为27.1%（p=0.12），且多数坏死发生于创伤后6个月内（p=0.29）。牙髓坏死与摩托车事故（p=0.01）、直接撞击（p≤0.0001）、伴牙髓暴露的冠折（p≤0.0001）、牙冠变色（p=0.004）及自发痛（p≤0.0001）呈正相关；与间接撞击（p≤0.0001）呈负相关。结论 尽管牙震荡与牙半脱位被认为是轻度损伤，但仍需对其进行随访监测，因为存在发生牙髓坏死的可能，且早期治疗有助于获得良好预后。