It is estimated that globally 22.7% of children have experienced traumatic dental injuries to their primary dentition. This can result in a range of clinical and radiographic sequalae including, crown discolouration, abscess/fistula, periapical radiolucency, pulp canal obliteration, external root resorption, internal root resorption, premature tooth loss and ankylosis.
The aim of this review was to assess the prevalence of clinical and radiographic sequelae following traumatic dental injuries to primary teeth.
Methods
A protocol was registered in PROSPERO. Searches were conducted in the PubMed, Scopus, Embase, Web of Science, BBO/LILACS OpenGrey, Google Scholar, ProQuest, and CAPES Thesis and Dissertation Databank databases. Observational studies that evaluated traumatic dental injuries in primary anterior teeth with dental trauma to determine the prevalence of sequelae (O) were considered. Two reviewers independently selected studies, data was extracted and study quality assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for studies reporting prevalence data. The number of sequelae per tooth and the total number of teeth evaluated in each study were considered and pooled prevalence rates with 95% confidence intervals (CI) calculated. The certainty of evidence was assessed using the GRADE approach.
Results
- 25 cross-sectional studies were included
- 10 studies were considered to be of low methodological quality, 7 moderate quality and 8 high methodological quality.
- Follow up periods ranged from one month to 6 years.
- Most of the studies (18) were from hospital or university settings.
- Meta-analyses for 8 reported sequelae are shown in the table below.
| Sequela | No. of studies | Pooled prevalence (95% CI) |
| Crown discoloration | 18 | 39.7% (29.52 to 50.32%) |
| Pulp necrosis with infection | 15 | 24.3% (17.34 to 32.06%) |
| Periapical radiolucency | 12 | 16.2% (8.88 to 25.49%) |
| Premature tooth loss | 14 | 15.9% (9.93 to 23.15%) |
| Pulp canal obliteration | 20 | 14.8% (8.46 to 22.73%) |
| Pathological root resorption | 19 | 11.9% (7.68 to 16.98%) |
| Abscess/fistula | 9 | 7.1% (4.4 to 10.6%) |
| Ankylosis | 12 | 1.8% (0.82 to 3.17%) |
- The certainty of the evidence was graded as very low.
Conclusions
The authors concluded: –
the most prevalent clinical and radiographic sequela after traumatic dental injuries in anterior primary teeth was crown discoloration. However, caution should be exercised when extrapolating the pre- sent findings, given the fragility and the heterogeneity of the methods employed in the primary studies and the very low certainty of evidence.
Comments
The authors searched a large range of databases with no date or language restrictions. The 25 included studies were all cross-sectional in design with a majority from hospital or university settings. Consequently, there a strong possibility of selection or information bias because of methodological limitations as highlighted by the authors. Meta-analyses were performed for 8 reported sequelae although each tooth may have more than one sequela. The authors considered that for 4 of the sequelae, abscess/fistula, pathological root resorption, premature tooth loss, and pulp canal obliteration publication bias was strongly suspected. While this review summaries the available published literature the methodological quality of the included studies mean that the findings are of very low certainty which should be taken into consideration when interpreting the findings.
Links
Primary Paper
Moccelini BS, Santos PS, Barasuol JC, Magno MB, Bolan M, Maia LC, Cardoso M. Prevalence of sequelae after traumatic dental injuries to anterior primary teeth: A systematic review and meta-analysis. Dent Traumatol. 2022 Mar 11. doi: 10.1111/edt.12744. Epub ahead of print. PMID: 35276019.
Other references
Dental Elf – 7th May 2021
Dental Elf – 9th Oct 2020
Photo Credits
Photo by Jeremiah Lawrence on Unsplash
