Development of Pulp Necrosis Following Lateral Luxation Injuries in Fully Formed Roots and its Relationship to Trauma, Patient or Treatment related Factors

Abstract

Aim: The aim of this study was to investigate the frequency of pulp necrosis following lateral luxation injury and to assess the possible relation of pulp necrosis development with a set of factors including delay of treatment, presence of a second attempt of repositioning, presence of a concomitant crown fracture, presence of gingival laceration, presence of a pre-existing restoration, history of previous trauma, achievement of complete positioning and patient age. Methodology: A group of 90 patients with 156 laterally luxated teeth was retrospectively investigated with regard to the development of pulp necrosis. Data was drawn from a database of all recorded individuals who received dental management following traumatic dental injuries at the Dental Trauma Centre in King’s College Dental Hospital between 2012 and 2016. Radiographs, clinical photographs and patients’ medical notes were thoroughly assessed to extract the relevant information. Results: Pulp necrosis occurred within 6 months following lateral luxation injury. Factors that were found to be of significance in increasing the risk of pulp necrosis development included the delay of treatment for 1 day (p value 0.034), presence of a concomitant enamel-dentin fracture (p value 0.004), complete repositioning (p value 0.009) and previous repositioning (p value 0.014). Other factors such as gingival laceration, enamel fracture and delays of treatment for 2 days were found to be of borderline significance. Presence of pre-existing restoration, history of previous trauma or age were found of no significance to pulp necrosis development. Conclusion: This study revealed that the delay of treatment for one day, presence of a concomitant enamel-dentin fracture, presence of previous repositioning and incomplete repositioning were found to be associated with an increased frequency of pulp necrosis. In view of these findings, management of any dental trauma should be carried out promptly and crown fractures should be restored as soon as possible to decrease the possibility of developing post- traumatic pulp necrosis. Further prospective studies recruiting higher numbers of patients should be carried out to ascertain the effect of other variables and to test different means of management.