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Prevalence and Patterns of Multiple Injuries Affecting a Single Permanent Tooth (Combination Injuries): A Systematic
Nitesh Tewari1,2, Alina Wikstrom3,4, Eva Lauridsen5
1Division of Pediatric Dentistry, Division of Orthodontics and Paediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.
Summary
Combination injuries in permanent teeth affect 14% of cases, with enamel-dentin fractures combined with subluxation being most common. Standardized reporting is needed for accurate diagnosis of traumatic dental injuries.
Area of Science:
- Dentistry
- Oral Surgery
- Public Health
Background:
- Multiple traumatic dental injuries (TDI) on a single permanent tooth are underrecognized.
- Global TDI prevalence is known, but combination injury epidemiology is unclear.
- This study assesses the prevalence and patterns of combination injuries in traumatized permanent teeth.
Purpose of the Study:
- To systematically review and meta-analyze the prevalence of combination injuries in permanent teeth.
- To identify common patterns of combined traumatic dental injuries.
- To highlight the need for standardized diagnostic approaches.
Main Methods:
- Systematic review and meta-analysis of 30 observational studies.
- Searches conducted across major databases (PubMed, EMBASE, Web of Science, Scopus).
- Random-effects meta-analyses used to pool prevalence data; GRADE framework assessed evidence certainty.
Main Results:
- Pooled prevalence of combination injuries was 14% (95% CI: 11%-19%).
- Most frequent combinations: enamel-dentin fracture with subluxation (25%) and enamel-dentin fracture with concussion (17%).
- Denmark showed the highest country-specific prevalence; evidence certainty was very low due to reporting variations.
Conclusions:
- Combination injuries represent a significant aspect of traumatic dental injuries, with a pooled prevalence of 14%.
- Enamel-dentin fracture combined with subluxation is the most prevalent pattern.
- Urgent need for standardized nomenclature and diagnostic protocols due to significant reporting variability and very low evidence certainty.
