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fear and anxiety remain the primary emotion a child feels when entering the dental clinic. The main cause of this feeling is the dental injection. Many techniques for dental injection involved not showing the injector prior to the injection while others preferred showing the injector. It is believed that maternal anxiety affects the child's dental behavior. Many scales and signs can be used to determine the child's anxiety such as heart beat rate and respiratory rate. 31 children were involved in this study. The children were divided into two groups: group (a) children were shown the dental injector prior to local anesthesia administration, group (b) children were not shown the dental injector prior to local anesthesia administration. The behavior of the children was recorded during the dental injection using the Frankl scale. Maternal anxiety was evaluated using the Arabic version of the MDAS index. The vital signs recorded involved the heart beat rate and the respiratory rate. In group (a) the behavior of the children during dental injection was mostly definitely positive (code 4). While in group (b) it was mostly definitely negative (code 1). Most of the mothers had a moderate level of anxiety (35%) and their children behaved in a favorable way. The heart rate of the children of both groups was higher in group (a) than in group (b) at all times although it was not statistically significant. The difference in respiratory rates at all times between both groups was also not significant. Showing the dental injector to the child prior to injection and following the "tell-show-do" technique affects the behavior of the child in a favorable way. Children behaved favorably in a positive way in accordance to their mother's level of anxiety. The presence of the mother in the dental operatory with her child may have an effect on the behavior.

Background: Trauma to the anterior teeth is a common injury in young children. Themaxillary incisors being the most affected. Although root fractures are rare, theydo occur and were previously and often considered hopeless and were extracted.The time between the injury and the initiation of treatment, level of the fractureline, and stage of root development are some criteria to be considered whenchoosing a treatment approach for a complicated tooth fracture. This case reportdescribes the management of a traumatized immature maxillary central incisorwith Elise class IV fracture with vertical oblique subgingival fracture of the root.Materials and method: Apexification was carried out using biodentine followed byremoval of the fractured segment. A fiber post was cemented in the root canalwith resin cement. The coronal portion of the tooth was restored using anteriorlight cured composite material. The tooth was examined and evaluated after 1week and after 2 months by clinical examination and radiographical evaluation ofroot development.Results: The follow up evaluation revealed clinical and radiographical success.Radiographic view showed continued development in the apex of the root andshowed normal periodontal ligament space and dense lamina dura.Conclusion: Extraction should not be the first choice of treatment for extensivelydamaged young permanent teeth in the anterior region; instead, alternativetreatment modalities must be considered. The traumatized immature tooth wassaved and restored.

Background: An injury to both the primary and permanent teeth and the supporting structures is one of the most common dental problems seen in children. Splinting is usually difficult or impossible to perform in the primary dentition (due to diminutive room size and lack of patient cooperation). Healing must, therefore, occur despite mobility at the fracture line, usually resulting in interposition of connective tissue. In some instances, infection will occur in the coronal pulp. The present study reported a case of trauma to the anterior primary teeth and alveolar bone in a four year old child. The trauma has caused fracture to the crowns and roots of the primary anterior teeth. The following case was managed in a procedure that may provide primary teeth subjected to trauma a better chance than extraction with a better prognosis. Case presentation: a 4 and a half year old child was subjected to trauma in anterior segment of maxilla. Suturing of the torn soft tissue was the first step followed by pulpotomy for the left primary lateral incisor. Fixation of the right primary central and lateral incisors was done by acid etch wire fixation. Both clinical and radiographic follow up was carried out for 6.4 years. Results: healing of the soft tissue was observed after one week and completed after two months. Fixation of the teeth continued for ten months. The fracture lines in the roots remained in position. Clinically there was no sign of any pulpal inflammation or necrosis. Radiographically, no signs of infection to the surrounding tissues could be seen, no resorption in the alveolar bone, external or internal resorption of the root did not happen also. After ten months fixation ended and the wire was removed. At that time there was normal resorption of the roots of the primary incisors in relation with the normal development of the permanent incisors. After 3 years both permanent central incisors erupted in their normal position. After 6.4 years all four permanent incisors erupted into occlusion in their normal position. Conclusion: primary teeth with root fractures and severely mobile coronal fragments can be treated by a conservative approach. The severity of the sequels is directly related to the degree of permanent tooth formation (child’s age), type of dental trauma and extent of the impact. Key words: trauma, primary incisors, fractured crown and root