Abstract：
OBJECTIVE: The purpose of the present study was to evaluate permanent teeth with post-traumatic transversal root fractures, for their initial healing modality, the effect of candidate predictors and their long-term prognosis.
METHODS: A retrospective longitudinal clinical study was conducted to evaluate records from patients bearing transversal root fractures in permanent teeth in order to radiographically assess short-term healing and non-healing events in the fracture line, their prognostic factors and their relationship with long term outcomes. The inter-fragmentary tissues were classified as healing: hard tissue (HT), connective tissue (CT) or connective tissue and bone (CT + B) and non-healing: interposition of granulation tissue (GT). A competing risk survival analysis was conducted to estimate the hazards of healing and non-healing events in the short-term and the effect of demographic, clinical, and treatment variables was assessed using the subdistribution regression model (Fine & Gray).
RESULTS: Radiographic findings showed 61.4% of healing in the short-term being strongly influenced by the presence and type of concomitant injuries to the coronal fragment. Teeth with concomitant crown fractures (sHR 24.38, 95% CI [3.16-188.3], p = 0.0022), luxations with dislocations (sHR 10.58, 95% CI [1.37-81.9], p = 0.0240) and subluxations (HR 9.66, 95% CI [1.14-81.7], p = 0.0370) were more likely to present non-healing of root fractures in the short-term. The healing rate in the long-term was of 75.9%, most of them with interposition of bone and connective tissue. Kappa statistics demonstrated an overall agreement of 67.1% between short and long-term healing patterns, in special HT and CT + Bone modalities.
CONCLUSIONS: Healing at the fracture site was the most frequent outcome, both in the short-term and in the long-term. Short-term healing modality was strongly influenced by the presence and type of concomitant injuries to the crown fragment, being the worst prognosis observed in root-fractured teeth with concomitant crown fractures, followed by concomitant luxations with dislocation.
CONCLUSIONS: Post-traumatic transversal root fractures have a positive prognosis supporting therefore, a more conservative approach for these teeth before considering more radical treatments.
METHODS: A retrospective longitudinal clinical study was conducted to evaluate records from patients bearing transversal root fractures in permanent teeth in order to radiographically assess short-term healing and non-healing events in the fracture line, their prognostic factors and their relationship with long term outcomes. The inter-fragmentary tissues were classified as healing: hard tissue (HT), connective tissue (CT) or connective tissue and bone (CT + B) and non-healing: interposition of granulation tissue (GT). A competing risk survival analysis was conducted to estimate the hazards of healing and non-healing events in the short-term and the effect of demographic, clinical, and treatment variables was assessed using the subdistribution regression model (Fine & Gray).
RESULTS: Radiographic findings showed 61.4% of healing in the short-term being strongly influenced by the presence and type of concomitant injuries to the coronal fragment. Teeth with concomitant crown fractures (sHR 24.38, 95% CI [3.16-188.3], p = 0.0022), luxations with dislocations (sHR 10.58, 95% CI [1.37-81.9], p = 0.0240) and subluxations (HR 9.66, 95% CI [1.14-81.7], p = 0.0370) were more likely to present non-healing of root fractures in the short-term. The healing rate in the long-term was of 75.9%, most of them with interposition of bone and connective tissue. Kappa statistics demonstrated an overall agreement of 67.1% between short and long-term healing patterns, in special HT and CT + Bone modalities.
CONCLUSIONS: Healing at the fracture site was the most frequent outcome, both in the short-term and in the long-term. Short-term healing modality was strongly influenced by the presence and type of concomitant injuries to the crown fragment, being the worst prognosis observed in root-fractured teeth with concomitant crown fractures, followed by concomitant luxations with dislocation.
CONCLUSIONS: Post-traumatic transversal root fractures have a positive prognosis supporting therefore, a more conservative approach for these teeth before considering more radical treatments.
摘要：
目的：本研究的目的是评估恒牙创伤后横根骨折，对于他们最初的治疗方式，候选预测因子的影响及其长期预后。
方法：进行了一项回顾性纵向临床研究，以评估恒牙横根骨折患者的记录，以影像学评估骨折线中的短期愈合和不愈合事件。其预后因素及其与长期预后的关系。碎片间组织被分类为愈合：硬组织（HT），结缔组织（CT）或结缔组织和骨（CT+B）和不愈合：肉芽组织（GT）的介入。进行了竞争风险生存分析，以估计短期内愈合和不愈合事件的危害以及人口统计学的影响，临床,和治疗变量使用亚分布回归模型(Fine&Gray)进行评估。
结果：影像学检查结果显示，短期内61.4%的愈合受到冠状碎片伴随损伤的存在和类型的强烈影响。牙齿伴冠骨折(sHR24.38,95%CI[3.16-188.3],p=0.0022),脱位（sHR10.58，95%CI[1.37-81.9]，p=0.0240）和半脱位（HR9.66，95%CI[1.14-81.7]，p=0.0370）更有可能在短期内出现根部骨折不愈合。长期愈合率为75.9%,它们中的大多数与骨和结缔组织的插入。Kappa统计数据表明，短期和长期治疗模式之间的总体一致性为67.1％，在特殊的HT和CT+骨模式中。
结论：骨折部位愈合是最常见的结果，无论是短期还是长期。短期愈合方式受到冠部碎片伴随损伤的存在和类型的强烈影响，是在根裂牙齿伴冠骨折中观察到的最差预后，随后伴随脱位。
结论：创伤后横根骨折具有积极的预后支持，在考虑更激进的治疗之前，对这些牙齿采取更保守的方法。
方法：进行了一项回顾性纵向临床研究，以评估恒牙横根骨折患者的记录，以影像学评估骨折线中的短期愈合和不愈合事件。其预后因素及其与长期预后的关系。碎片间组织被分类为愈合：硬组织（HT），结缔组织（CT）或结缔组织和骨（CT+B）和不愈合：肉芽组织（GT）的介入。进行了竞争风险生存分析，以估计短期内愈合和不愈合事件的危害以及人口统计学的影响，临床,和治疗变量使用亚分布回归模型(Fine&Gray)进行评估。
结果：影像学检查结果显示，短期内61.4%的愈合受到冠状碎片伴随损伤的存在和类型的强烈影响。牙齿伴冠骨折(sHR24.38,95%CI[3.16-188.3],p=0.0022),脱位（sHR10.58，95%CI[1.37-81.9]，p=0.0240）和半脱位（HR9.66，95%CI[1.14-81.7]，p=0.0370）更有可能在短期内出现根部骨折不愈合。长期愈合率为75.9%,它们中的大多数与骨和结缔组织的插入。Kappa统计数据表明，短期和长期治疗模式之间的总体一致性为67.1％，在特殊的HT和CT+骨模式中。
结论：骨折部位愈合是最常见的结果，无论是短期还是长期。短期愈合方式受到冠部碎片伴随损伤的存在和类型的强烈影响，是在根裂牙齿伴冠骨折中观察到的最差预后，随后伴随脱位。
结论：创伤后横根骨折具有积极的预后支持，在考虑更激进的治疗之前，对这些牙齿采取更保守的方法。
