Root Fracture and Extrusive Luxation in Primary Teeth and Their Management: A Case Report

Splinting in the management of dental trauma in the primary dentition: a systematic review

PURPOSE

The purpose of this study was to gather existing data on the efficacy of tooth splinting (TS) in patients with traumatized primary teeth, evaluating their overall prognosis and reported complications.

METHODS

Electronic searches were performed in seven databases up to Februray/2023. Clinical studies published in the last two decades and presenting the following characteristics were included: (a) reporting on children with traumatized primary teeth; (b) describing the efficacy of splinting those teeth. Studies describing imobilization of dental avulsion were excluded.

RESULTS

A total of 163 potentially relevant studies were initially found. After title/abstract screening, and full-text evaluation, three retrospective studies with moderate to high risk of bias were included. The studies described the outcomes of TS in primary teeth with luxation (intrusion, extrusion, lateral displacement), intra-alveolar root fracture, and/or alveolar fracture. High clinical success rate was observed for teeth with root fracture. Benefits of spliting teeth with lateral luxation were not identified, although it may be a reccomended approach. No study was found evaluating TS for alveolar fracture.

CONCLUSION

Based on a low level of evidence, the findings highlight a better clinical success rate of the use of TS in the management of deciduous teeth with root fractures.

Root Fractures in the Primary Teeth and Their Management: A Scoping Review

(1) Background: Traumatic dental injuries constitute a major global health problem. Primary deciduous teeth of the upper frontal group are frequently affected by trauma, especially at an early age. It is important to treat primary traumatic injuries because early tooth loss can lead to aesthetic and functional alterations. The most common injuries are extrusion, lateral luxation, and intrusion. Root fracture is a less common complication that can lead to tooth extraction if not properly diagnosed and managed. However, there are a lack of data regarding primary root fracture treatment. The literature was reviewed to study the current knowledge on the treatment of these injuries, and to propose an operative protocol based on the results obtained. (2) Methods: A literature search was performed on Web of Science, PubMed/MEDLINE, and SCOPUS. The research focused on the following features: age of the patient; localization of the root fracture and type of displacement suffered (intrusive, extrusive, or lateral); type of emergency treatment or diagnostic test performed and their compliance with IADT guidelines; follow-up duration. (2) Results: Only 8 articles fully met the inclusion criteria, with a total of 46 patients and 62 root fractures. Out of a total of 62 root fractures, regarding only upper incisors, the most common treatment was splinting (n = 39) for a period ranging from 3 weeks to 3 months (with an average of six weeks). No treatment was performed for 23 of the root fractures. The splinting performed in most of the included cases was semi-rigid, with the splint held in place using a composite resin material. An orthodontic splint using brackets and 0.5 mm stainless steel wire was used in only in one study. (4) Conclusions: We deduced that the root fracture of primary teeth is a rare traumatic dental injury that can cause numerous complications, such as eruptive problems in the permanent teeth. Correct radiological diagnosis, immediate repositioning and semi-rigid splinting could be conservative methods to prevent premature tooth loss in very young patients.