Avulsion of Primary Upper Incisors: A Cohort Study

Objectives: The purpose of this study was to explore the management of avulsed primary upper incisors and to investigate treatments and repercussions in permanent dentition that this injury can cause.
Methods: 2800 files of patients with photographic and radiographic images, who attended the Research and Clinical Centre of Dental Trauma in Primary Teeth, University of Sao Paulo, from 1998–2018, were evaluated. Clinical information related to sex, age, cause of trauma, tooth affected, treatment choice and sequelae were collected. To evaluate the association between the occurrence of any repercussion in the successor permanent tooth and possible independent variables, multilevel logistic regression analyses were performed.
Results: 460 (16.4%) children suffered avulsion. 218 (7.8%) presented avulsion of primary upper incisors and were followed up until complete eruption of their successor, resulting in a total of 296 avulsed primary teeth. Male sex was the most affected (61.9%) and 62.8% of the patients were up to 4 years-old. The most common treatment was placement of functional space maintainers (144, 48.6%). Seven teeth replantation were performed. From 121 (40.9%) permanent upper incisors affected, the majority (67.2%) presented enamel discoloration/hypoplasia and 9.9% presented severe complications. Therefore, 38.8% of the permanent teeth required treatment. Considering repercussion in the permanent teeth, children aged 3 to 5 years-old when the avulsion occurred had lower chance of having some repercussion (Odds Ratio – OR=0.31; p=0.04), as well as children older than 5 years-old (OR=0.22, p=0.04), compared with children up to 3 years-old at the time of avulsion.
Conclusions: Avulsion of primary upper incisors occur especially in early-aged children, who present higher chances of suffering sequelae in successor permanent dentition. Thus, special attention should be given to avulsion of primary tooth, regarding not only preventive measures which should be implemented in order to prevent the avulsion, but also the needed treatment for primary and permanent dentition.