Sae-Lim V, Yuen K W
Department of Restorative Dentistry, Ministry of Health, Singapore.
Endod Dent Traumatol. 1997 Aug;13(4):164-70. doi: 10.1111/j.1600-9657.1997.tb00032.x.
The purpose of this study was to assess the post-traumatic sequelae and treatment outcome and the corresponding prognostic factors at the initial emergency visit. Over a 5-year period, the authors collected case records from 129 dental trauma patients. These patients had been referred subsequent to receiving emergency treatment after office hours at the Accident and Emergency Department of Singapore General Hospital. After the exclusion of 31 cases with concomitant fracture of maxilla and/or mandible and cases with insufficient documentation, the final study sample consisted of 98 patients (41 males, 57 females) who had sustained injuries to 264 permanent teeth. The main cause of dental trauma was falls (56%), and the main type of injuries was periodontal tissue injuries with or without concomitant injuries to hard tissue, including root fracture (73%). For the final evaluation, teeth with insufficient recall period were excluded before univariate and multivariate stepwise logistic regression analysis. It was found that for 100 teeth with luxation type of injuries, the presence of concomitant hard tissue injuries retained prognostic significance for pulpal outcome (p < 0.001) after adjusting for severity of luxation, while the severity of luxation was the only significant factor for periodontal outcome (p < 0.001). For 34 avulsed teeth, the stage of root development was the major factor associated with the pulpal outcome (p = 0.003), while extra-alveolar storage media were found to be significantly related to the periodontal outcome (p < 0.001). For 72 teeth with hard tissue injuries, first-visit interval played a significant role in the outcome (p = 0.03). Although the sample size in the root fracture group was too small for such statistical analysis, the results indicated that patient education on dental trauma was an important factor. Thorough standardized documentation was also recommended to facilitate optimal follow-up management and future research as well as medico-legal purposes.
本研究的目的是在初次急诊就诊时评估创伤后后遗症、治疗结果及相应的预后因素。在5年期间，作者收集了129例牙外伤患者的病例记录。这些患者是在新加坡总医院急诊科非工作时间接受急诊治疗后被转诊的。排除31例伴有上颌骨和/或下颌骨骨折的病例以及记录不完整的病例后，最终研究样本包括98例患者（41例男性，57例女性），他们的264颗恒牙受到了损伤。牙外伤的主要原因是跌倒（56%），主要损伤类型是牙周组织损伤，伴有或不伴有硬组织损伤，包括根折（73%）。在进行单因素和多因素逐步逻辑回归分析之前，排除召回期不足的牙齿进行最终评估。结果发现，对于100颗脱位型损伤的牙齿，在调整脱位严重程度后，伴有硬组织损伤对牙髓预后仍具有预后意义（p<0.001），而脱位严重程度是牙周预后的唯一显著因素（p<0.001）。对于34颗脱位牙，牙根发育阶段是与牙髓预后相关的主要因素（p=0.003），而牙槽外储存介质与牙周预后显著相关（p<0.001）。对于72颗硬组织损伤的牙齿，首次就诊间隔对预后有显著影响（p=0.03）。虽然根折组的样本量太小无法进行此类统计分析，但结果表明对牙外伤患者的教育是一个重要因素。还建议进行全面的标准化记录，以促进最佳的随访管理、未来研究以及医疗法律目的。
