449 - Permanent Maxillary Incisor Trauma in Children with Special Needs

Purpose: To assess trauma profile and clinical outcomes of the treatment provided for traumatic dental injuries (TDI) in children with special health care needs (CSHCN) at Boston Children’s Hospital.

Methods: A ten-year retrospective chart review was conducted to analyze patients at least 6 years old seen between September 2009 and 2018. Data was screened for patients with medical diagnoses of Autism Spectrum Disorder, cardiac conditions, and other special needs with a history of dental trauma involving a permanent maxillary incisor. Electronic health records and radiographs were reviewed for treatment rendered, classifications of TDI, and patient demographics.

Results: In 152 identified patients, the most common causes of trauma were fall (49%), non-fall collision (16%), and unknown cause (16%). Fifty % experienced trauma to multiple teeth and 23% experienced repeat trauma. Among 262 teeth analyzed, the trauma profile includes fracture (67%), of which 16% had pulpal involvement, subluxation (16%), lateral luxation (12%), avulsion (10%), extrusion (7%), intrusion (5%), and concussion (4%). Among the 150 cases with at least 6 month follow up, 4 (33%) of 12 intrusion cases survived; 7 (70%) of 10 re-implanted avulsed teeth survived; 93 (95%) of 98 fracture cases without intrusion survived. Of cases with >2 year follow up, 85 (94%) of 90 fracture cases without intrusion and avulsion survived.

Conclusions: Dental treatment for CSHCN often requires challenging patient management. Our study shows that many fracture cases without intrusion or avulsion can have successful long-term treatment outcomes in CSHCN. Proper management and timely reimplantation in avulsion cases in CSHCN could also lead to a favorable outcome.