Risk of Pulp Necrosis in Permanent Teeth With Lateral Luxation

Objectives: This systematic review aimed to evaluate the evidence related to the occurrence of pulp necrosis and external root resorption (ERR) in permanent anterior teeth with lateral luxation. This was envisaged to address the ambiguity related to the recommendation for pulp extirpation within 7-10 days of repositioning with mature root apex.
Methods: An a priori protocol was formulated as per the best practices of evidence-based medicine and registered in PROSPERO. A comprehensive search was performed electronically in PubMed, LILACS, Web of Science, EMBASE, Scopus, and Cochrane on 3-7-2023 without any restriction of language or year of publication. The selection of articles was done in two phases and data extraction of the included articles was performed by using self-designed data extraction sheet. Risk of bias(ROB) assessment was done, meta-analysis was performed, and GRADE approach was used to assess the quality of evidence.
Results: The qualitative synthesis was performed on 13 studies done from 1985 to 2020 in hospital settings. There was variability in the minimum and total observation periods, sample sizes, and characteristics of the sample population. The overall pooled prevalence of pulp necrosis was found to be 57%(95%CI-42,72%). It was 12%(95%CI-8-18%,I²=0%) in immature teeth, and 58%(95%CI-42,73%,I²=86%) in mature teeth. The pooled prevalence of ERR was found to be 11% (95%CI-4,27%, I²-95%) with greater risk in teeth with mature root apex (RR-1.26,95%CI-1.12,1.42,I²=0%). The ROB was moderate or high in nine studies and GRADE of evidence was very-low in 14 of 15 outcomes.
Conclusions: There are greater chances of pulp necrosis in teeth with lateral luxation, especially with mature apex, but it can still be less than 60% in most cases with the prevalence of ERR less than 20% in most cases. Hence, an absolute recommendation for endodontic intervention in mature teeth with lateral luxation must be interpreted with slight caution.