Severe trauma in the primary dentition – diagnosis and treatment of sequelae in permanent dentition

Abstract

A 2-year 6-month male presented after an intrusive injury sustained at 15 months of age. Intra-oral radiographs showed coronal dilaceration of the germ of the permanent central incisor and the presence of a calcified tissue mass in the area of the trauma which was identified after surgical removal as the permanent upper left lateral incisor. Immediate treatment and long-term options are discussed.

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“…Many sequelaes can be found in the coronal region, such as structural alterations associated with enamel hypoplasia, crown dilaceration and white, yellow/brown discoloration [4][5][6][7][8][9][10], such was observed in the present clinical case. Developmental disturbances of permanent teeth involving the crown have been reported to occur more frequently than those involving the roots or eruption patterns [10]. This finding may be attributed to the close relationship between the primary tooth root and the permanent tooth crown and the fact that the majority of traumatic injuries occur between ages 1 and 3, during the developmental stage of the permanent crown [10].…”

“…Intrusive injury to primary dentition often results in anomalous development of the permanent teeth [4][5][6][7][8][9], with a frequency of between 18 and 69% [5][6][7][8]. Many sequelaes can be found in the coronal region, such as structural alterations associated with enamel hypoplasia, crown dilaceration and white, yellow/brown discoloration [4][5][6][7][8][9][10], such was observed in the present clinical case. Developmental disturbances of permanent teeth involving the crown have been reported to occur more frequently than those involving the roots or eruption patterns [10].…”

“…Developmental disturbances of permanent teeth involving the crown have been reported to occur more frequently than those involving the roots or eruption patterns [10]. This finding may be attributed to the close relationship between the primary tooth root and the permanent tooth crown and the fact that the majority of traumatic injuries occur between ages 1 and 3, during the developmental stage of the permanent crown [10]. In the present case, shape and color alterations were observed in the crown only and the trauma occurred when the patient was 18 months, in this time the germ of the permanent successor was in the initial stages of odontogenesis.…”

“…Probably the trauma promoted ameloblasts destruction in the active enamel epithelium [8], crown dilacerations and enamel hypoplasia. Studies evaluated the effect of luxation injuries to primary teeth on the successor permanent teeth in children assisted at emergency centers and observed that hypoplasia was the disturbance most detected through radiographic analysis [4][5][6][7][8][9][10][11]. Depending on the degree of severity of these anomalies, various protocols of treatment may be performed, including whitening, microabrasion, aesthetic conservative restorations and prosthetic rehabilitation.…”

Endodontic and Esthetic Management of a Dilacerated Maxillary Central Incisor Having Two Root Canals Using Cone Beam Computed Tomography as a Diagnostic Aid

“…The close anatomic relationship of the permanent tooth germs to the roots of primary teeth makes them highly vulnerable to the impact of trauma. Disturbances in permanent teeth subsequent to trauma are well documented and can range from yellowish brown discoloration to structural alterations like hypoplasia, dilacerations of the crown and/or root, incomplete root formation, crown/root duplication, odontome like malformation, sequestration of tooth germ, and disturbed eruption of the permanent teeth [2, 3]. The type and severity of disturbances are dependent on the direction and amount of force, stage of the developing tooth germs, and their spatial relationship to the roots of primary teeth.…”