Abstract
ObjectivesThis study evaluated the evolution of cases of concussion and subluxation through a retrospective study of 20 years.Material and MethodsWere examined clinical and radiographic records of 1,309 patients who underwent treatment of dentoalveolar trauma in the discipline of Integrated Clinic of the School of Dentistry of Araçatuba, UNESP, of which we selected 137 whose patients had concussion and subluxation injuries, with average age of 23.3 (SD – 10.96). The variables collected were: gender, age, history of previous and actual trauma, treatments performed, the presence of necrotic pulp, and time elapsed until the same trauma. The concussion and subluxation groups were subjected to statistical analyses using the SPSS 16.0 version software (α=0.05), Chi-square, and t-tests.ResultsOf the 301 teeth involved, 49 (16.3%) suffered concussion and 252 (83.7%), subluxation, being the upper anterior teeth the most affected (75.1%) for both conditions. Subluxation and concussion traumas were more prevalent in men aged 10 to 20 years, most caused by cycling accidents (36.2%). There was a concomitant presence of crown fracture in 21% of cases of concussion and 34.7% of subluxation. Pulp necrosis was detected in 16.3% (concussion) and 27.1% (subluxation) (p=0.12), and most occurred within 6 months after the trauma (p=0.29). The pulp necrosis shows a positive correlation with motorcycle accidents (p=0.01), direct impact (p≤0.0001), crown fracture with pulp exposure (p≤0.0001), darkening of the crown (p=0.004) and spontaneous pain (p≤0.0001); and negative correlation with indirect impact (p≤0.0001).ConclusionsAlthough concussion and subluxation traumas are considered of minor degrees, they must be monitored, since the possibility of pulp necrosis exists, and its early treatment favors a good prognosis.
Highlights
Of the traumatic dental injuries of the periodontal tissues, concussion and subluxation present the less complex clinical resolution, not causing great emotional impact on patients and their families when occurring alone
The pulp necrosis shows a positive correlation with motorcycle accidents (p=0.01), direct impact (p≤0.0001), crown fracture with pulp exposure (p≤0.0001), darkening of the crown (p=0.004) and spontaneous pain (p≤0.0001); and negative correlation with indirect impact (p≤0.0001)
Conclusions: concussion and subluxation traumas are considered of minor degrees, they must be monitored, since the possibility of pulp necrosis exists, and its early treatment favors a good prognosis
Summary
Of the traumatic dental injuries of the periodontal tissues, concussion and subluxation present the less complex clinical resolution, not causing great emotional impact on patients and their families when occurring alone. 3,15 The pulp sensitivity test is usually positive and does not notice changes radiographically[7,9,16]. Subluxation already has increased mobility in the horizontal direction, and the tooth appears to be sensitive to percussion and occlusal forces, occurring or not bleeding from the gingival sulcus. General characteristics of concussion and subluxation include edema and bleeding and breaking of some fibers of the periodontal ligament; the neurovascular pulp supply may be affected leading to necrotic pulp[3]. These injuries can go unnoticed by parents, and seeking care can occur only after the sequel have been installed, mainly when associated to severe traumas
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