Dental Traumatology 2014; doi: 10.1111/edt.12149

Does trauma in the primary dentition cause sequelae in permanent successors? A systematic review Michele Machado Lenzi1, Adılis Kalina Alexandria1, Daniele Masterson T. P. Ferreira2, Lucianne Cople Maia1 1 Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro; 2Central Library, Health Science Center, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

Key words: tooth injury; primary tooth; permanent tooth; prevalence Correspondence to: Michele Lenzi, Disciplina de Odontopediatria da FO-UFRJ, Caixa ria – CCS, Postal: 68066, Cidade Universita CEP: 21941-971, Rio de Janeiro, RJ, Brazil Tel./Fax: +55 21 25622098 e-mail: [email protected] Accepted 10 October, 2014

Abstract – This systematic review sought scientific evidence (in the literature) that trauma in the primary incisors cause sequelae in permanent successors. Also this work verified whether there was a relation between the presence and type of sequelae in permanent teeth with the child’s age at the time of injury and type of trauma. Electronic databases, including the PubMed, Scopus, The Cochrane Library, LILACS, and Web of Science were used to search for original articles up to June 2013. Prospective and retrospective studies that assessed the association of trauma in deciduous incisors and developmental disturbances in permanent successors were selected. Two authors independently reviewed and extracted the data from the included studies. A methodological quality assessment evaluation of the selected studies was performed. The search retrieved 258 citations. Initially, 19 studies fulfilled the selection criteria; however, one (1) was excluded, leaving 18 for the final selection. Despite some limitations in the study designs were observed, especially the lack of a control group in most studies, the evidence found suggests that individuals with trauma in their primary incisors have more developmental disorders in the permanent successors than individuals without a previous trauma. Furthermore, the younger the child is at the time of injury, the more frequent and more severe are the sequelae to the permanent successor incisors. More severe traumas such as intrusion and avulsion are associated to more serious developmental disorders. These results should be analyzed carefully because very few studies evaluated had a control group.

Trauma in the primary incisors is common, and its prevalence has been studied in several countries, showing a prevalence ranging from 11.0% to 47.0% (1, 2). After trauma to primary incisors, it is essential to consider the possible risks of sequelae in successor teeth. The developmental disturbances of the permanent teeth related to trauma to their predecessors have a prevalence that ranges from 20% to 74% (3–10). This high prevalence is related to the close anatomical relationship between the apices of the primary teeth and their developing permanent successors (10, 11). The distance between the apex of the primary central incisor and the incisal edge of the permanent central incisor ranges from 2.97 mm at age 3 to 1.97 mm at age 6 (12). The sequelae in permanent teeth after traumatic injury in primary incisors are related to the type of injury, the age of the child at the time of injury, as well as the association with fractures of the alveolar bone (5, 10, 13). The intrusion and avulsion of primary incisors were the types of injury that most commonly caused sequelae in successors (2–4, 6, 7, 10, 14, 15). Discoloration of enamel, enamel hypoplasia, crown dilacerations, root dilacerations, and eruption distur© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

bances are some of the sequelae described in the literature (3, 11, 16–19). Although there are studies in the literature on this subject, there is still doubt whether other factors beyond a trauma could have led to these consequences. This systematic review aims to examine the scientific evidence that trauma in the primary incisors is associated with sequelae in permanent successors and to investigate the association between the presence and type of sequelae in permanent teeth with the child’s age at the time of injury and type of trauma. Methods

This systematic review was performed according to PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines (http://www. prisma-statement.org) and was registered at Prospero under the number CRD42013004470. Search strategy

The following electronic databases were searched up to and including June 2013: PubMed, Scopus, The 1

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Cochrane Library, LILACS, and Web of Science. To find additional studies, a hand search was done on the reference lists of the retrieved studies. The search strategy included appropriate changes in the keywords and followed the syntax rules of each database. Mesh terms, keywords, and other free terms related to tooth injuries, primary dentition, permanent dentition, and sequelae were used with Boolean operators (OR, AND) to combine searches. The terms used were ‘tooth injuries’, ‘dental lesions’, ‘dental injuries’, ‘dental trauma’, traumatic injury*, ‘trauma dentoalveolar’, ‘tooth avulsion’, exarticulation, ‘tooth dislocation’, ‘tooth luxation’, ‘tooth movement’, ‘intrusive luxation’, ‘dental intrusion’, ‘extrusive luxation’, ‘tooth extrusion’, ‘lateral luxation’, ‘tooth subluxation’, concussion, ‘tooth fractures’, ‘primary dentition’, ‘deciduous dentition’, ‘deciduous tooth’, predecessors, ‘primary teeth’, ‘primary tooth’, ‘tooth abnormalities’, dental anomal*, ‘tooth malformation’, ‘tooth discoloration’, ‘dental enamel hypoplasia’, ‘enamel hypoplasia’, ‘crown dilaceration’, ‘root dilaceration’, odontoma, ‘compound odontoma’, ‘tooth unerupted’, ‘tooth impacted’, ‘tooth eruption ectopic’, complications, sequelae, ‘permanent dentition’, ‘adult dentition’, ‘secondary dentition’, successors, ‘permanent tooth’, ‘permanent teeth’. Articles appearing in more than one database search were considered only once. Two examiners (MML and AKA) independently performed the search process under the guidance of a librarian (DMTPF). Any differences between the two examiners were solved by a third investigator (LCM). Inclusion criteria

Figure 1 outlines the population, intervention/exposure, comparison, and outcome—PICO/PECO format (20). Prospective and retrospective-controlled or not studies conducted on children with dental trauma in primary dentition that were followed through until their permanent teeth had erupted were included in this review. Traumatized primary teeth were compared to non-traumatized ones (controls) and followed up until complete successor eruption. In case of the absence of a control group, the study should present a full follow

up of the traumatized primary teeth until the complete eruption of the successor. Textbooks, dissertations, case reports, case series, review articles, animal studies, editorials or opinions, and studies with insufficient data (age of children, type of trauma, prevalence of sequelae) were excluded. There were no language restrictions. Quality assessment of studies and data extraction

First, the titles and abstracts were analyzed to apply the criteria for inclusion and exclusion. Then, the selected studies were evaluated and judged by their full texts. The quality assessment and risk of bias of included papers was applied following Fowkes and Fulton (21) for appraising research in the medical area. The checklist included questions on study design, study sample, control group, quality of measurements and outcomes, completeness, and distorting influences. When checking the criteria for each paper, we assigned problems for each criterion as major (++) or minor (+) in terms of their expected effect on the results, and a decision was made as to whether the methods were adequate to produce useful information or not. The positive and negative aspects of the studies were weighted and implicitly judged. Inadequate study designs were considered a major problem (++). Assessing the quality was noted as a minor problem (+) when the paper had a sample of convenience; when the criteria for inclusion/exclusion was not defined adequately; when the sample size calculations or a representative sampling of the population was not included. Risk of bias was considered a major problem (++) when assessing the quality of papers that did not have a control group. Problems in the quality of measurements and outcomes, completeness, and distorting influences when applicable were considered a minor problem (+). Some aspects of the study design may have a greater influence than others. For example, the absence of a control group would probably be more important than the characteristics of the sample. Points where the question was not applicable were marked ‘NA’. To make a judgment and to determine the value of the study, we also posed three questions

Inclusion Criteria P (participants)

Children

E (exposition)

Dental trauma in primary teeth

C (comparison)

Non-traumatized primary teeth (control group). In the case of the absence of a control group, the study should present a full follow-up of the traumatized primary teeth until the complete eruption of the successor.

O (outcomes)

Primary outcome: The presence of sequela in a permanent tooth. Secondary outcomes: Types of sequelae in permanent teeth, child's age at time of injury and type of injury.

Fig. 1. Inclusion criteria based on the PECO format following Maia and Antonio (20).

© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

Does trauma in the primary dentition cause sequelae in successors?

(2–8, 10, 14, 16–18, 22–28) were assessed. Among these studies, one study (17) evaluated a sample of cases reported in a previous article and literature cases and was excluded. A total of 18 articles were screened for the final analysis. Table 1 shows the quality assessment of the included studies. The summary details and characteristics of the final selected studies are recorded in Table 2. Of the 18 studies included, duration of the study ranged from 5 to 10 years. Regarding the type of trauma observed, eight studies (2–4, 10, 14, 23, 26, 27) included children with dislocations and fractures, three studies (5, 7, 16) were performed in patients who had only sustained dislocations, five studies (18, 22, 24, 25, 28) included only patients with intrusions and two studies (6, 8) avulsions. Dental injuries were assessed according to criteria of Andreasen and Andreasen (11) in all studies reviewed. The sample size ranged from 30 to 487 children and from 44 to 620 traumatized primary teeth. The age of patients ranged from 0 to 10 years old. All studies included both genders. In relation to the presence of sequelae in permanent successors, the results showed that the prevalence ranged from 20.2% (7) to 74.1% (6) and in all studies, dental enamel defects were the most prevalent sequelae. Five articles (4, 5, 7, 8, 23) found a statistically significant association between

about bias (‘Are the results erroneously biased in a certain direction?’), confounding (‘Are there any serious confusing or other distorting influences?’), and chance (‘Is it likely that the results occurred by chance?’). Here, the answer to each question could be ‘YES’ or ‘NO’. If the answers to the three questions were ‘No’, then the paper could be considered sound. Data extraction was performed by two researchers (MML; AKAF) and was based on methods, participants, type of injury, prevalence of sequelae, most frequent sequelae, time of follow up, and statistical analysis. Any differences between the two examiners were solved by a third investigator (LCM). Results

A total of 258 titles/abstracts were identified or retrieved by database search and one by hand search. Most were found in PubMed (n = 107), followed by Scopus (n = 82), Web of Science (n = 49), Cochrane library (n = 16), and Lilacs (n = 4). Figure 2 summarizes the study selection process. Of these, 94 were duplicated; therefore, counted only once. All unique titles and abstracts (n = 165) were analyzed according to the inclusion and exclusion criteria, and 146 were excluded. The full texts of the remaining 19 studies

Identification

258 Records identified through database searching and 1 through a hand search

165 Records after duplicates removed

165 Records screened

146 Records excluded

Screening

Case report (n = 79) Review article (n = 19) No follow up of permanent teeth (n = 18) Only permanent treatment (n = 6) Animal Study (n = 3)

Included

Eligibility

Insufficient information (n = 8)

Fig. 2. Flow diagram of literature search according PRISMA statement.

3

19 of full-text articles assessed for eligibility

18 Studies included in the qualitative synthesis

© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

1 Full-text articles excluded: - Sample consisting of cases Reported in a previous article and literature cases

Objective Common design Prevalence Cross-sectional Prognosis Cohort Treatment Controlled trial Cause Cohort, case–control, cross-sectional Source of sample Sampling method Sample size Entry criteria/exclusions Non-respondents Definition of controls Source of controls Matching/randomization Comparable characteristics Validity Reproducibility Blindness Quality control Compliance Drop outs Deaths Missing data Extraneous treatments Contamination Changes over time Confounding factors Distortion reduced by analysis Bias: Are the results erroneously biased in a certain direction? Confounding: Are there any serious confusing or other distorting influences? Chance: Is it likely that the results occurred by chance?

Study design appropriate to objectives?

Summary questions

Distorting influences?

Completeness?

Quality of measurements and outcomes?

Control group acceptable?

Study sample representative?

Ckecklist

Guideline 0 – – – + 0 0 0 0 0 0 0 0 0 0 NA 0 0 NA NA 0 NA NA 0 0 0 NO

NO

NO

+ 0 + 0 0 ++ ++ ++ ++ 0 0 NA 0 0 NA NA 0 NA NA 0 0 0 YES

NO

NO

Andreasen & Ravn (3)

0 – – –

Altun et al. (25)

Table 1. Checklist for appraising a medical article following Fowkes and Fulton (21)

NO

NO

+ 0 0 0 0 0 0 0 0 0 0 NA 0 0 NA NA 0 NA NA 0 0 0 NO

0 – – –

Andreasen & Ravn (5)

NO

NO

+ 0 0 0 0 ++ ++ ++ ++ 0 0 NA 0 0 NA NA 0 NA NA 0 0 0 YES

0 – – –

Assuncß~ao et al. (7)

NO

NO

+ 0 0 0 0 ++ ++ ++ ++ 0 0 NA 0 0 NA NA 0 NA NA 0 0 0 YES

0 – – –

Ben Bassat et al. (16)

NO

NO

+ 0 0 0 0 ++ ++ ++ ++ 0 0 NA 0 0 NA NA 0 NA NA 0 0 0 YES

0 – – –

Carvalho et al. (18)

NO

NO

+ 0 + 0 0 ++ ++ ++ ++ 0 0 NA 0 0 NA NA 0 NA NA 0 0 0 YES

– 0 – –

Christophersen et al. (8)

NO

NO

+ 0 + 0 0 ++ ++ ++ ++ 0 0 NA 0 0 NA NA 0 NA NA 0 0 0 YES

0 – – –

De Amorim et al. (4)

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© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

Objective Common design Prevalence Cross-sectional Prognosis Cohort Treatment Controlled trial Cause Cohort, case–control, cross-sectional Source of sample Sampling method Sample size Entry criteria/exclusions Non-respondents Definition of controls Source of controls Matching/randomization Comparable characteristics Validity Reproducibility Blindness Quality control Compliance Drop outs Deaths Missing data Extraneous treatments Contamination Changes over time Confounding factors Distortion reduced by analysis Bias: Are the results erroneously biased in a certain direction? Confounding: Are there any serious confusing or other distorting influences? Chance: Is it likely that the results occurred by chance?

Study design appropriate to objectives?

© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

++, major problem; +, minor problem; 0, no problem; NA, not applicable.

Summary questions

Distorting influences?

Completeness?

Quality of measurements and outcomes?

Control group acceptable?

Study sample representative?

Ckecklist

Guideline

Table 1. Continued

0 – – – + 0 + 0 0 ++ ++ ++ ++ 0 0 NA 0 0 NA NA 0 NA NA + 0 0 YES

NO

NO

+ 0 0 0 0 ++ ++ ++ ++ 0 0 NA 0 0 NA NA + NA NA + 0 0 YES

NO

NO

Innes (24)

0 – – –

Jacomo & Campos (2)

NO

NO

+ 0 0 0 0 ++ ++ ++ ++ 0 0 NA 0 0 NA NA 0 NA NA + 0 0 YES

0 – – –

Ishikawa et al. (26)

NO

NO

+ 0 0 0 0 ++ ++ ++ ++ 0 0 NA 0 0 NA NA 0 NA NA 0 0 0 YES

0 – – –

Ravn (6)

NO

NO

+ 0 0 0 0 ++ ++ ++ ++ 0 0 NA 0 0 NA NA 0 NA NA 0 0 0 YES

0 – – –

Ravn (28)

NO

NO

+ 0 0 0 0 0 0 0 0 0 0 NA 0 0 NA NA 0 NA NA + 0 0 NO

0 – – –

Scerri et al. (23)

NO

NO

+ 0 0 0 0 ++ ++ ++ ++ 0 0 NA 0 0 NA NA 0 NA NA + 0 0 YES

0 – – –

Sennhenn-Kirchner & Jacobs (14)

NO

NO

+ 0 0 0 0 ++ ++ ++ ++ 0 0 NA 0 0 NA NA 0 NA NA + 0 0 YES

0 – – –

Sleiter & Von Arx (27)

NO

NO

+ 0 0 0 0 ++ ++ ++ ++ 0 0 NA 0 0 NA NA 0 NA NA + 0 0 YES

0 – – –

Spinas et al. (22)

NO

NO

+ 0 0 0 0 ++ ++ ++ ++ 0 0 NA 0 0 NA NA 0 NA NA 0 0 0 YES

0 – – –

von Arx (10)

Does trauma in the primary dentition cause sequelae in successors? 5

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the age of the child at the time of the trauma and the prevalence of sequelae in permanent dentition. Three articles (5, 7, 23) found an association between the type of injury and prevalence of sequelae. The association between type of injury and type of defects was found in three studies (5, 23, 28). For the quality assessment, the articles were classified according to the risk of bias, confounding, and chance. Susceptibility to bias was observed in 15 of the 18 studies analyzed (Table 1). Discussion

The literature suggests that traumatic dental injuries that occur during odontogenesis can cause changes in the primary incisors and their successors (3, 5, 6, 17, 28). The aim of this systematic review was to find evidence in the literature that trauma in deciduous dentition causes alterations in the developing permanent teeth and to show that there is an association between the presence and type of sequelae in permanent teeth with the child’s age at time of injury and type of trauma. Epidemiological studies of dental injuries provide important data concerning the prevalence and associated factors of such injuries. Epidemiological data can provide a basis for the development of preventive and clinical procedures (11). There are tools that are designed and developed specifically to assess the quality of evidence from epidemiological studies (29). The critical appraisal of the methods and results of these studies was conducted using a detailed checklist with an additional summary judgment (21) After reviewing all articles identified in the search, we determined that 18 papers met the inclusion criteria. The problems found in these articles were mainly due to an inadequate description of the efforts to address potential sources of bias, such as sample size, source of sample, control group, and missing data. These problems influenced the quality of the evidence found, and further studies should be carried out paying greater attention to these methodological factors. The design of the selected studies did not include sample size calculations or a representative sampling of the population. Most studies were conducted in dental schools (4–7, 23, 28) or dental trauma centers (2, 10, 14, 18, 27), and samples of convenience were obtained in these cases. Assessing the quality was noted as a minor problem (+) when the paper had a sample of convenience. None of the articles reviewed explained how the sample size was determined, possibly suggesting a lack of representativeness of sample, and as a consequence a compromised external validity. However, a statement in the methods section that the sample size was chosen in order to have sufficient power to detect a meaningful result would be adequate evidence that steps had been taken to ensure an appropriate sample size (21). The most-striking finding when this systematic review was conducted was the high number of papers that lacked a control group. Only four articles (3, 5, 16, 23) reported control groups. A control group is

important to verify whether other etiologic factors are associated with teeth malformations besides dental trauma in primary teeth. There are other possible causes for malformation of permanent teeth, such as molar-incisor hypoplasia, imperfect amelogenesis, and fluorosis (23). We detected few studies with a control group, and this was a major limitation of the assessed papers. Risk of bias was considered a major problem when assessing the quality of papers that did not have a control group. Andreasen and Ravn (5) found in their study a high frequency of developmental disturbances recorded in the non-trauma group. That high frequency indicated that non-traumatic factors were involved in the etiology of the observed changes. On the other hand, Scerri et al. (23) found 52.2% of the cases in the study group with sequelae in permanent successors while only 10% of disturbances were found in the control group. The criteria for inclusion and exclusion of studies differed in some approaches. Most of the papers included only traumatic injuries of the periodontal tissue (5, 7, 16), other studies only included intrusion (18, 22, 24, 25, 28) or avulsion (6, 8). The literature shows that the severity of the sequelae depends on the child’s age at the time of the injury, the type and extent of the injury, and the stage of development of the successor at the moment of trauma (6, 10, 11, 13, 23). For some authors (1–3, 6, 7, 10, 12, 23, 25) regardless of the stage of development of the successor, the types of trauma that cause the most sequelae are luxations, mainly intrusion and avulsion. Andreasen & Ravn (5), Assuncß~ ao et al. (7) and Scerri et al. (23) found a significant association between the type of trauma and the prevalence of sequelae. In the Andreasen & Ravn (5) and Assuncß~ ao et al. (7) studies, intrusion luxation and avulsion were the types of trauma that were more associated with the presence of alterations in the permanent teeth. Scerri et al. (23) found the highest prevalence of malformations following subluxation of primary incisors. An association between the type of injury and type of defects was also found. For Ravn (28), the more serious disturbances such as enamel hypoplasia, crown, or root malformation are more common in cases of avulsion. A possible explanation for this may be found in the anatomic relationship of the primary tooth to the permanent tooth germ. The root curvature of the primary tooth provokes a slight rotary movement during avulsion, which can injure the bud of the permanent successor tooth (5, 28). Scerri et al. (23) and Andreasen & Ravn (5) found a statistically significant result between intrusion and enamel discoloration with enamel hypoplasia. When the sequelae of the successors were analyzed in relation to the child’s age at the time of the trauma, the results of the studies showed that the developmental disturbances tended to be more severe and had a higher ratio when traumatic injuries occurred at a younger age (4, 6, 8, 14, 16, 18, 23, 26). Five articles (4, 5, 7, 8, 23) found a statistically significant association between the age of the child at the time of the trauma and the prevalence of sequelae in permanent © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

Christophersen et al. (8) Denmark/2005/ Retrospective De Amorim et al. (4) Brazil/2011/ Retrospective

Ben Bassat et al. (16) Israel/1985/ Retrospective Carvalho et al. (18) Brazil/2010/ Retrospective

Assuncß~ao et al. (7) Brazil/2009/ Retrospective

Andreasen & Ravn (5) Denmark/1971/ Retrospective

Dental Trauma Center of the Pediatric Dentistry Clinic of Rio de Janeiro State University Danish Municipal Dental Health Services in Lyngby-Taarbaek, Hilleroed and Taarnby Private Pediatric Dental Clinic in Goi^ania, Brazil

Not mentioned

Baby Clinic Londrina State University, Brazil

n = 148 children n = 241 traumatized teeth

n = 35 children n = 44 traumatized teeth

n = 307 children n = 221 traumatized teeth

n = 36 children n = 76 traumatized teeth

Luxations and fractures

Avulsion

Intrusion

Luxations

Enamel discoloration, enamel hypoplasia

Enamel discoloration, enamel hypoplasia

Enamel discoloration, enamel hypoplasia

Enamel discoloration, enamel hypoplasia

Enamel discoloration, enamel hypoplasia, crown dilaceration

Enamel discoloration, Enamel hypoplasia

Luxations

Trauma group: n = 103 children n = 213 traumatized teeth Control group: Contralateral permanent successors (n = 26 children n = 33 teeth) n = 389 children n = 620 traumatized teeth Luxations

Enamel hypoplasia

Luxations and fractures

Main material: 487 children (147–30% with history of trauma) Control Material: 111 children (17–15.3% with history of trauma)

Main material: 5 public schools in Conpenhagen where children had been under regular dental care. Control Material: 5 public schools in Conpenhagen where children were not being treated for dental care regularly Dental Department, University Hospital, Conpenhagen

Andreasen & Ravn (3) Denmark/1973/ Retrospective

Most frequent sequelae on permanent successors Enamel hypoplasia

n = 78 children n = 138 traumatized teeth

Hospital pediatric dentistry clinic

Altun et al. (25) Turkey/2009/ Prospective

Injury types on primary teeth Intrusion

Sample size

Participants

Source of sample

Author/Country/Year/ Study design

Table 2. Characteristics of the sample and data collection of the included studies

22.4% (n = 54)

30% (n = 10)

68.8% (n = 84)

25% (n = 27)

20.2% (n = 126)

Trauma group 41.3% (n = 88)

Main material: 57.8%(trauma group) 45.3% (non-trauma group)

53.6% (n = 74)

Sequelae prevalence





8



10

Chi-squared test and multiple logistic regression/ Significant association between age and frequency of sequelae (P = 0.03)

Correlation between age and sequelae (P = 0.04)

Chi-squared tests/ Correlation between age and sequelae (P = 0.140)

Multivariate analysis described by Larsen and Chi-squared tests/ Correlation between age and frequency of sequelae (P = 0.001), type of injury (P = 0.002) Proportion and Chi-squared test/ Association between age and sequelae (P = 0.000325). Association between type of trauma and sequelae (P = 0.000001) Not mentioned

10



Chi-squared tests/ Correlation between age and frequency of sequelae P = 0.442 Fisher’s test. The difference in frequency of enamel changes in the trauma and non-trauma group was found to be significant (P < 0.01)

Statistical analysis/P value

7

Duration of the study (years)

Does trauma in the primary dentition cause sequelae in successors? 7

Dental Trauma Center of the Pediatric Dentistry Clinic of Rio de Janeiro state University

Paediatric clinic

Paediatric clinic in Japan

Institute of Pedodontics

Jacomo & Campos (2) Brazil/2009/ Retrospective

Innes (24) Scotland/ 2009/Retrospective

Ishikawa et al. (26) Japan/1990/ Retrospective

Ravn (6) Denmark/ 1975/Retrospective Ravn (28) Denmark/ 1976/Retrospective

Dental Departament, St Lukes Hospital, Guardamangia and School Dental Clinic, Floriana

Department of Oral Surgery in the Center for Oral and Maxillofacial Diseases of the University of Goetting Department of Oral and Maxillofacial Surgery, Switzerland Dentoalveolar trauma study Centre of the University of Cagliari Dental Department Department of Oral and Maxillofacial Surgery, Kantosspital, Lucerne, Switzerland

Scerri et al. (23) Republic of Malta/ 2010/Retrospective

Sennhenn-Kirchner & Jacobs (14) Germany/2006/ Retrospective Sleiter & Von Arx (27) Switzerland/ 2002/Retrospective Spinas et al. (22) Italy/2006/ Retrospective von Arx (10) Switzerland/1995/ Retrospective

Department of Pedodontics

Source of sample

Participants

Author/Country/Year/ Study design

Table 2. Continued

n = 307 children n = 753 traumatized teeth

Luxations and fractures

n = 30 children n = 74 traumatized teeth

n = 114 children n = 255 traumatized teeth

Luxations and fractures

Intrusions

Enamel discoloration, enamel hypoplasia

Luxation and fractures

n = 85 children n = 130 traumatized teeth

Enamel discoloration

Luxations and fractures

Study group: n = 32 children n = 67 traumatized teeth Control group: n = 20 children n = 67 teeth n = 106 children n = 200 traumatized teeth

Enamel hypoplasia and/ or enamel defects

Enamel hypoplasia

Enamel discoloration

Enamel discoloration

Avulsion

Luxations and fractures

Enamel hypoplasia, dilacerations, ectopic eruption Crown malformation and calcification and discoloration in the enamel and hypoplasia Enamel hypoplasia

Enamel discoloration, enamel hypoplasia

Most frequent sequelae on permanent successors

Intrusions

n = 77 children n = 85 traumatized teeth n = 78 children n = 100 traumatized teeth

n = 66 children n = 126 traumatized teeth

Intrusions

Luxations and fractures

Sample size

n = 78 children n = 138 traumatized teeth

Injury types on primary teeth

23% (n = 33)

25% (n = 32)

32.4% (n = 24)

25% (n = 20)

Study group: 52.2% (n = 35) Control group: 10% (n = 8)

10

15

5

5



10

54% (n = 54)



57.1% (n = 72)



7

54.4% (n = 74)

74.1% (n = 63)

8

Duration of the study (years)

51.1% (n = 89)

Sequelae prevalence

Not mentioned

Not mentioned

Not mentioned

Not mentioned

Association between type of trauma and sequelae (P < 0.001) Chi-squared test/ Association between type of trauma and sequelae (P < 0.01)

Not mentioned

Chi-squared tests/ Correlation between age and frequency of sequelae (P < 1.00) Chi-squared tests not find any correlation between age and frequency of sequelae Not mentioned

Statistical analysis/P value

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© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

Does trauma in the primary dentition cause sequelae in successors? dentition. For Amorim et al. (4), age was the only variable significantly associated with developmental sequelae to permanent incisors: the younger the child, the greater the prevalence and severity of the developmental sequelae. Christophersen et al. (8) and Andresen & Ravn (5) found the same result. Assuncß~ ao et al. (7) showed higher susceptibility of children

Does trauma in the primary dentition cause sequelae in permanent successors? A systematic review.

This systematic review sought scientific evidence (in the literature) that trauma in the primary incisors cause sequelae in permanent successors. Also...
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