Prognosis of luxated permanent teeth — the development of pulp necrosis

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Abstract
A population of 400 patients, comprising 637 luxated permanent teeth was studied prospectively with respect to the development of pulp necrosis after luxation injuries. The patients were treated for traumatic dental injuries over a period of 10 years. While initial treatment was provided according to established treatment guidelines by the attending oral surgeon at the emergency room, follow‐up examination and treatment was provided by one oral surgeon. It appeared that pulp necrosis occurred soon after injury, within 3 months after concussion, within the 1st yr after subluxation and extrusion, and might be diagnosed up to 2 yr after lateral‐ and intrusive luxation. While many factors, when considered one at a time, were found to have a significant or nearly significant died on the development of pulp necrosis (i.e. type of injury, age of patient, stage of root development, degree of dislocation, reduction/repositioning procedure, type of fixation, restorations in place at the lime of injury), a multivariate regression analysis revealed that when the type of injury (diagnosis) and stage of root development were taken into account, the effect of other factors was no longer significant. The risk of pulp necrosis increased with the extent of injury, i.e. concussion and subluxation represented the least risk, followed in ascending order by extrusive‐, lateral‐, and intrusive luxation. Moreover, teeth with completed root formal ion demonstrated a greater risk of pulp necrosis than teeth with incomplete root formation. No treatment effect could be demonstrated. However, as treatment was performed according to established guidelines, which might introduce bias, it would appear justified to conduct randomized clinical studies in order to determine the value of different forms of treatment (e.g. reduction and fixation of luxated teeth) to improve the prognosis with respect to the development of pulp necrosis after injury. In conclusion, the major factors influencing development of pulp necrosis after luxation injuries appear to be the extent of the initial injury to the pulp and periodontium, as reflected by the type of luxation, and the repair potential of the injured tooth, as reflected by the stage of root development.