Diagnosis of luxation injuries: The importance of standardized clinical, radiographic and photographic techniques in clinical investigations

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Abstract
The records of 400 patients treated for luxation injuries of the permanent dentition from 1965 to 1980 at the Dental Department of University Hospital, Copenhagen, were studied with respect to the development of post‐traumatic complications. Data from the time of injury were collected on a standardized questionnaire and completed by the treating oral surgeon as lie interviewed the patient. Standardized forms for follow‐up clinical data were also used. The present investigation was aimed at comparing the quality of information collected from the time of injury on a standaradized questionnaire vs. from a non‐standardized form. The precision of radiographic techniques with or without film holders was also studied, as well as the value of photographic documentation of luxations vs. radiographs alone. Moreover, the number of radiographs needed to diagnose displacement was checked. It was found that when a standardized questionnaire was not used for collection of data, concerning the injury, an average of 53.3% of the information on the standardized questionnaire was recorded. It was also found that the variation of tooth length from one radiographic examination to the next was more than 3 times greater when film holders were not used than when they were (6.9% average error in measurement vs. 2.0%, respectively). Moreover, an occlusal radiograph was found to be the best exposure for disclosing extrusions and lateral luxations, while occlusal and periapical exposures were equally good for disclosing intrusions. A combination of an occlusal radiograph plus an eccentric (i.e. mesio‐ or distoradial) periapical radiograph could disclose almost all displacements. It was also found that photographic registration was necessary to precisely diagnose luxation type retrospectively, as radiographs were often misleading in indicating the direction and extent of displacement. It is concluded that standardized techniques (e.g. questionnaires and radiographic film holders) are necessary to provide reliable information in clinical investigations and that photographic registration adds important information about I lie‐extent and direction of displacement, a factor to be considered in retrospective studies.