Pulp Treatment Outcomes and Influencing Factors in Traumatized Teeth Associated With Maxillofacial Injury

To evaluate tooth-bearing alveolar segment salvage after maxillofacial trauma and identify surgical-pathway determinants of late infective-inflammatory segment failure that can be addressed during acute facial fracture care.

A tooth-unit cohort nested within 246 patients treated from January 2021 to March 2026 for maxillofacial injury was analyzed from the perspective of facial trauma triage, tooth-bearing alveolar segment stabilization, and postoperative surveillance. Candidate determinants included delay to definitive segment stabilization, mature root apex, alveolar fracture, open tooth wound or pulp exposure, wound contamination, Injury Severity Score, and tooth displacement. The primary outcome was 12-month tooth-bearing alveolar segment salvage, defined as retained occlusal tooth units without late pulp-derived infection, inflammatory resorption, or persistent apical disease. Multivariable logistic regression used patient-clustered robust standard errors.

The analysis included 599 traumatized permanent teeth. Tooth-bearing alveolar segment salvage at 12 months was 42.1%, occlusal tooth-unit retention was 79.3%, and late infective-inflammatory segment failure occurred in 54.1%. Definitive stabilization within 24 hours was associated with higher salvage than later intervention (52.6% vs. 34.6%). The strongest adjusted determinants of failure were delayed stabilization, mature root apex, concomitant alveolar fracture, and open tooth wound or pulp exposure; model discrimination was acceptable (AUC=0.68).

In maxillofacial trauma care, late failure of tooth-bearing alveolar segments was linked to modifiable surgical-pathway factors and injury biology. Systematic segment assessment, early stabilization, contamination control, and risk-coded follow-up should be integrated into facial fracture protocols to preserve occlusal units and reduce delayed infectious or reconstructive complications.