Abstract
Introduction
Crown fractures are a common type of traumatic dental injury. Various factors may
affect the outcome of crown fractures. This study aimed to evaluate the treatment
outcomes of immature teeth with a crown fracture.
Methods
This retrospective cohort study included patients who presented to a dental trauma
center from 2008–2018 with a history of a crown fracture of immature teeth and at
least 6 months of follow-up. Outcomes of primary endodontic or restorative interventions
as well as reinterventions were evaluated. Kaplan-Meier curves were used to compare
the unadjusted differences in survival time. Logistic and Cox regression analyses
were performed to identify potential predictors for complication and survival time,
respectively.
Results
The success rates of the primary interventions for 99 teeth (72 patients) after a
median follow-up of 22 months were as follows: cervical pulpotomy (90.4%), partial
pulpotomy (85.2%), mineral trioxide aggregate apical barrier (80.0%), root canal treatment
(66.6%), and only restoration (47.2%). Teeth that received vital pulp therapy were
less prone to complications (adjusted hazard ratio = 0.21; 95% confidence interval,
0.09–0.53; P < .05), whereas those with concomitant luxation injuries were more susceptible to
complications (adjusted odds ratio = 2.90; 95% confidence interval, 1.01–8.29; P < .05).
Conclusions
Crown fractures had a relatively high favorable prognosis. Vital pulp therapy (partial
or cervical pulpotomy) had the highest success rate, whereas cases that received only
restoration had the lowest success rate. Teeth with concomitant luxation injuries
had more odds and hazards of complications.
Key Words
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References
- International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: general introduction.Dent Traumatol. 2020; 36: 309-313
- On dental trauma in children and adolescents. Incidence, risk, treatment, time and costs.Swed Dent J Suppl. 2000; 140: 1-52
- Therapeutic and economic implications of traumatic dental injuries in Denmark: an estimate based on 7549 patients treated at a major trauma centre.Int J Paediatr Dent. 2001; 11: 249-258
- Dental injuries among children and adolescents aged 1–15 years attending to public hospital in Temuco, Chile.Dent Traumatol. 2010; 26: 254-261
- A retrospective evaluation of crown-fractured permanent teeth treated in a pediatric dentistry clinic.Dent Traumatol. 2007; 23: 211-217
- International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations.Dent Traumatol. 2020; 36: 314-330
- What can cause the pulps of immature, permanent teeth with open apices to become necrotic and what treatment options are available for these teeth.Aust Endod J. 2014; 40: 95-100
- Traumatic dental injuries: etiology, prevalence and possible outcomes.Stomatologija. 2014; 16: 7-14
- Prevalence of dental trauma in 5-6- and 12-14-year-old boys in Riyadh, Saudi Arabia.Dent Traumatol. 2001; 17: 153-158
- Treatment outcomes after uncomplicated and complicated crown fractures in permanent teeth.Clin Oral Investig. 2021; 25: 133-143
- Pulp prognosis following conservative pulp treatment in teeth with complicated crown fractures-a retrospective study.Dent Traumatol. 2017; 33: 255-260
- Type of treatment, prognosis, and estimation of time spent to manage dental trauma in late presentation cases at a dental teaching hospital: a longitudinal and retrospective study.Dent Traumatol. 2004; 20: 1-5
- Importance of events per independent variable in proportional hazards regression analysis. II. Accuracy and precision of regression estimates.J Clin Epidemiol. 1995; 48: 1503-1510
- The recommended guidelines of the American Association of Endodontists for the treatment of traumatic dental injuries.2013 (Available at:) (Accessed August 4, 2021)
- Partial pulpotomy for immature permanent teeth, its present and future.Pediatr Dent. 2002; 24: 29-32
- Mineral trioxide aggregate as a pulpotomy medicament: an evidence-based assessment.Eur Arch Paediatr Dent. 2008; 9: 58-73
- Management of crown-related fractures in children: an update review.Dent Traumatol. 2014; 30: 88-99
- Crown fractures in the permanent dentition: pulpal and restorative considerations.Dent Traumatol. 2002; 18: 103-115
- Traumatic dental injuries in a cohort of 16-year-olds in northern Sweden.Endod Dent Traumatol. 1997; 13: 276-280
- Traumatic crown fractures in permanent incisors with immature roots: a follow-up study.Endod Dent Traumatol. 1995; 11: 294-296
- Follow-up study of permanent incisors with enamel-dentin fractures after acute trauma.Scand J Dent Res. 1981; 89: 355-365
- Combination injuries 1. The risk of pulp necrosis in permanent teeth with concussion injuries and concomitant crown fractures.Dent Traumatol. 2012; 28: 364-370
- Combination injuries 2. The risk of pulp necrosis in permanent teeth with subluxation injuries and concomitant crown fractures.Dent Traumatol. 2012; 28: 371-378
- Combination injuries 3. The risk of pulp necrosis in permanent teeth with extrusion or lateral luxation and concomitant crown fractures without pulp exposure.Dent Traumatol. 2012; 28: 379-385
- Analysis of pulp prognosis in 603 permanent teeth with uncomplicated crown fracture with or without luxation.Dent Traumatol. 2014; 30: 333-337
- A retrospective study of traumatic dental injuries.Dent Traumatol. 2014; 30: 154-161
- 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: 191-199
- Clinical and radiographic evaluation of vital pulp therapy in open apex teeth with MTA and ZOE.N Y State Dent J. 2012; 78: 34-38
- Using mineral trioxide aggregate as a pulp-capping material.J Am Dent Assoc. 1996; 127: 1491-1494
- Mineral trioxide aggregate: a comprehensive literature review–part I: chemical, physical, and antibacterial properties.J Endod. 2010; 36: 16-27
- Long-term success of nonvital, immature permanent incisors treated with a mineral trioxide aggregate plug and adhesive restorations: a case series from a private endodontic practice.J Endod. 2017; 43: 1370-1377
- Pattern of traumatic dental injuries in the permanent dentition among children, adolescents, and adults.Dent Traumatol. 2012; 28: 358-363
- Pharmacoeconomic evaluation in the real world. Effectiveness versus efficacy studies.Pharmacoeconomics. 1999; 15: 423-434
- Responses of the pulp, periradicular and soft tissues following trauma to the permanent teeth.Aust Dent J. 2016; 61: 39-58
- Undetected microscopic pulp exposures in deep class II cavities.J Calif Dent Assoc. 2009; 37: 26-30
- Contradictions in the treatment of traumatic dental injuries and ways to proceed in dental trauma research.Dent Traumatol. 2010; 26: 16-22
Article info
Publication history
Published online: August 31, 2021
Identification
Copyright
© 2021 American Association of Endodontists.
