Associated factors to occurrence of pulp necrosis in traumatized primary incisors / Fatores relacionados à ocorrência de necrose pulpar em incisivos decíduos traumatizados

AUTOR(ES)
DATA DE PUBLICAÇÃO

2010

RESUMO

The purpose of this historical cohort study was to assess dental trauma in primary upper incisors and factors associated with the occurrence of pulp necrosis in traumatized primary upper central incisors. Data was collected by a single examiner through the analysis of photographs, radiographs, and information contained in the clinical files of patients who attended the Center for Research and Treatment of Dental Trauma in Primary Teeth of the School of Dentistry of the University of São Paulo between the years of 1998 and 2009. The inclusion criteria used was that the clinical file had to have photographs and radiographs which could confirm the presence of exfoliating primary incisors, erupting or erupted permanent upper central incisors. Five hundred and one clinical files were assessed to analyze dental trauma data, the majority of the patients was male and presented with a history of dental trauma that had occurred before they were 3 years old. Twenty three percent of the children had occlusal alterations which might have predisposed them to dental trauma. Dental trauma as a consequence of falling down (from their own height) on the floor was the main etiological factor found; central incisors were the most commonly affected teeth, periodontal trauma was the most prevalent and 57% of the patients sought treatment at the Center for Dental Trauma in Primary Teeth at least 30 days after the trauma had occurred. For the pulp necrosis study, 727 traumatized primary upper central incisors were assessed. The signs considered as indicators of necrosis were: presence of alteration in gingival tissue (fistula or abscess) and presence of periapical lesion. The incidence of pulp necrosis was of 22.6%; 10% of the total of teeth in the sample had suffered necrosis within an interval of 6 months after trauma, corresponding to 45% of the total of necrosed teeth. Poisson multivariate regression analysis indicated the following risk factors for pulp necrosis: reported pain (RR = 1.73; 1.22 2.45), dental hard tissue trauma involving dentin (RR = 1.74; 1.15 2.62), dental hard tissue trauma causing pulp exposure (RR = 4.55; 2.80 7.40), bone trauma (RR = 2.56; 1.08 6.08), brown color alteration (RR= 1.82; 1.27 2.61), grey color alteration (RR= 2.24; 1.48 3.41), external root resorption with apical infection (RR = 4.89; 3.36 7.18), external root resorption with apical infection and lateral and/or cervical (RR = 5.05; 3.53 7.22), and external root resorption with lateral and/or cervical infection (RR = 5.66; 3.59 8.90). The presence of pulp calcification (RR = 0.45; 0.28 0.73) and external root resorption with bone formation (RR =0.62; 0.47 0.83) were protective factors against pulp necrosis. It was concluded that bone trauma occurring simultaneously to dental trauma, dental hard tissue trauma involving dentin or with pulp exposure, pain report from the children during the period of clinical follow-up, brown or grey color alteration, and external root resorption with apical infection are factors which increase the risk for pulp necrosis. Moreover, the presence of pulp calcification and external root resorption with bone formation could be protective factors against the occurrence of pulp necrosis.

ASSUNTO(S)

pulp necrosis traumatismo dental primary teeth necrose pulpar dentes decíduos traumatic dental injuries

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