European Journal of Orthodontics 13 (1991) 372-377

I 1991 European Orthodontics Society

The influence of orthodontic treatment on previously traumatized permanent incisors liana Brin\ Yocheved Ben-Bassat*, liana Heling**, and Avraham Engelberg* Departments of "Orthodontics and ""Endodontics, Hebrew University Hadassah School of Dental Medicine, Jerusalem, and ""Private practice, Beer-Sheva, Israel

Introduction

A significant percentage of candidates for orthodontic treatment suffer trauma to their permanent incisors prior to orthodontic intervention (Jarvinen, 1979). The orthodontic treatment that follows further increases their susceptibility to damage (Andreasen, 1981), although its extent depends on a myriad of factors such as the type of injury sustained, type of tooth movement accomplished and the developmental stage of the dentition at the time of trauma, duration of treatment, etc. Studies on the influence of orthodontic treatment on previously traumatized teeth indicate mainly an increased tendency towards root resorption when compared with 'intact' orthodontic patients. This tendency was found to be positively correlated with the severity of the traumatic event (Malmgren et ai, 1982). However, only a few attempts have been made to analyse separately the effect of factors related to trauma and those related to orthodontic treatment. Such an analysis could be helpful in forecasting the prognosis of traumatized teeth in individual

patients subjected to various modes of orthodontic force application. The present study was designed to elucidate clinically and radiographically the pathological sequelae occurring after one type of simple orthodontic movement of traumatized teeth and to compare them with those following trauma or orthodontic treatment alone. Subjects and methods

One-hundred-and-thirty-nine children (Table 1) with a mean age of 13.7 years were clinically and radiographically examined and divided into four groups. Group T: The 'trauma' group included 56 children, with 104 injured incisors, who were followed up in the Department of Pedodontics of the Hebrew University-Hadassah School of Dental Medicine. Twenty children in this group underwent recurrent trauma. Group O: The 'orthodontic' group included 29 children who presented with a Class I malocclusion and were treated for their overjet (the

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SUMMARY The reaction of previously traumatized teeth to orthodontic force application was investigated. Four groups of children were examined: group T comprised 56 children who encountered trauma to their maxillary incisors; group 0 comprised 29 orthodontic patients with intact incisors; group TO comprised 28 previously traumatized orthodontic patients; and group C served as the control group (n=26). Orthodontic treatment was restricted to tipping movement executed only by means of removable appliances. Groups T, 0, and TO were followed up longitudinally by means of clinical and radiographic examinations. In most of the cases the reported trauma occurred to teeth with completed roots and affected the crown only. Group TO presented the highest, though relatively moderate, prevalence of root resorption (27.8 per cent) and was followed by groups 0 and T (6.7 and 7.8 per cent, respectively) while in the control group no resorption was observed. Electrical pulp testing revealed the highest prevalence of loss of tooth vitality in group TO (7.3 per cent) in which the highest prevalence of pulp obliteration was also found. It can be concluded that the combination of trauma with orthodontic tipping renders the teeth more susceptible to complications, especially to root resorption and loss of vitality.

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ORTHODONTIC TREATMENT OF TRAUMATIZED TEETH

Table 1 Distribution of the sample according to age (in years).

Type of group

No. of children

Trauma (T) Ortho (0) Trauma+ Ortho (TO) Control (C)

56 29 28 26

Age at trauma No. of injured teeth

Age at start of ortho. treatment

Age at present examination

Mean + SD

Mean + SD

Mean + SD

104

9.1 + 1.7 11.3 + 2.1

54

10.3±2.6

9.6 ±1.6

Group C: An 'intact' control group included 26 children who were neither injured nor orthodontically treated. They were selected in a random fashion from a school class of comparable age to that of the other groups. The present examination was performed at least half a year after completion of the retention period in the O and TO groups. The time that elapsed from the trauma to the latest examination was about 3 years in most of the children. For most children in groups T, O, and TO, longitudinal data were available on the history of the injury and/or the orthodontic treatment. The information was drawn from the patients' files, radiographs, and study models. At the latest examination all participants were clinically examined (including electrical pulp testing for groups T, O, and TO) and radiographically screened by means of periapical views of the maxillary incisors. These were closely inspected by means of a magnifying glass over an illuminated viewing box. The following parameters were recorded from the radiographic

examination: arrest of root formation, pulp obliteration, and root resorption. The latter was assessed according to the method suggested by Malmgren et al. (1982) as: Grade 1: irregular root, slight resorption; Grade 2: resorption of less than 2 mm of the root length when compared with the intact antimere; Grade 3: resorption of more than 2 mm, but less than one-third of the root length; Grade 4: resorption of more than one-third of the root length. In groups T and TO together, 16 endodontically treated teeth were found. Such teeth may react differently to orthodontic forces with regard to resorption (Spurrier et al., 1990) and in view of the small number in this study, teeth with root canal therapy were eliminated. Most of the comparisons were made on the 'tooth level' (dependent variable), and so only means and standard deviations were used. The Chi square test was applied for evaluation of the results on the 'case level'. P

The influence of orthodontic treatment on previously traumatized permanent incisors.

The reaction of previously traumatized teeth to orthodontic force application was investigated. Four groups of children were examined: group T compris...
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