Association of Concomitant Luxation Injuries on Healing Outcomes Following Treatment of Crown Fractures in Permanent Teeth: A Systematic Review and Meta‐Analysis
Bhawana Kumari, Rajeev Kumar Singh, Richa Khanna, Garima JindalABSTRACT
Background
Crown fractures may occur alone or in association with luxation injuries, potentially affecting pulpal and periodontal healing. However, whether concomitant luxation is associated with treatment and healing outcomes remains unclear. This systematic review and meta‐analysis evaluated treatment and healing outcomes of permanent teeth with isolated crown fractures compared with crown fractures associated with concomitant luxation injuries.
Methods
PubMed and EMBASE (Elsevier,
Results
Seven retrospective cohort studies involving 3129 permanent teeth were included. Of these, 2494 teeth had crown fractures, occurring either in isolation or in association with concomitant luxation injuries. Six studies contributed to the quantitative syntheses, which were based on unadjusted event counts because adjusted effect estimates were not consistently reported. Among uncomplicated crown fractures, teeth without concomitant luxation were associated with a higher probability of restorative treatment success than teeth with concomitant luxation (RR = 1.48, 95% CI: 1.15–1.92; p = 0.003) and a lower risk of treatment failure (RR = 0.14, 95% CI: 0.03–0.60; p = 0.008). No statistically significant difference in treatment success was observed following indirect pulp capping (RR = 1.18, 95% CI: 0.90–1.54; p = 0.24) or pulpotomy (RR = 1.09, 95% CI: 0.90–1.31; p = 0.37). Similarly, no significant difference was observed in treatment success (RR = 1.08, 95% CI 0.92–1.27; p = 0.37) or failure (RR = 0.44, 95% CI 0.07–2.79; p = 0.38) following vital pulp therapy for complicated crown fractures. Descriptive findings suggested that root developmental status and type of concomitant luxation were associated with differences in treatment and healing outcomes. Risk of bias was judged to be moderate across the included studies. The certainty of evidence for all quantitative outcomes was very low.
Conclusions
Concomitant luxation may be associated with poorer treatment outcomes in permanent teeth with crown fractures; however, a statistically significant association was observed only among uncomplicated crown fractures managed with restorative treatment. Because the included studies were retrospective and largely based on unadjusted comparisons, residual confounding by root maturity, injury characteristics, treatment‐related factors, and other prognostic variables cannot be excluded.