Intrusion injuries of primary incisors. Part II: Sequelae affecting the intruded incisors

LUTHERAN MEDICAL CENTER
Dental Residency Program
Literature Review Form

Resident: Boboia Date: 8/21/09
Article title: Intrusion injuries of primary incisors: Part II: Sequlae affecting the intruded primary incisors
Author(s): Diab, Mai et al.
Journal: Quintessence International
Volume #; Number; Page #s): 31; 5; 335-340
Month / Year: Nov. 2000
Major topic: Sequelae and management of intruded primary incisors
Type of Article: Review
Summary of Article:
-Intrusion injuries to primary incisors are common (4.4-22%)
-Radiographic exam will often show widened PDL / alveolar bone fx.
-Must assess condition of developing tooth bud with regard to intruded incisor
-Intrusion injuries of this kind may result in: coronal discoloration, pulpal obliteration, pulpal necrosis, root resorption, and ankylosis
Coronal Discoloration:
-Happens to 35%-40% of intrusion injuries; Gray color means damage to pulpal tissue (reddish gray at first then turns gray in 1-2 weeks), reversible, if debris is not absorbed through dentin tooth will remain discolored. Disagreement regarding prognosis among dentists; some believe color change of this kind indicates irreversible pulpitis while others don’t thin it’s enough to confirm pulpal necrosis. If no treatment is provided. Should be followed.
Yellow Discoloration:
-Indicates calcification or accelerated deposition of secondary dentin resulting in pulpal obliteration; monitor teeth for overretention
Pulpal Necrosis:
-22-35% of intruded primary incisors
-Difficult to dx.; clinical signs include discoloration, spontaneous pain, increased mobility 6-8 wks after injury; radiographic changes widening of PDL space, PA radiolucency, internal / external root resorption
-2-5 year olds have lower chance of pulpal necrosis
-Intitiate tx quickly to avoid damage to developing tooth bud
-Some authors believe that pulpal therapy is an option, others believe extraction should be done to avoid damage to developing tooth from overinstrumentation and overfilling the canal.
Pathological external root resorption: Incidence is 14%, usually managed with extraction
Abcess or cellulitis formation: requires immediate extraction of intruded incisor, may require antibiotic therapy depending on severity of infection
Failure of re-eruption and ankylosis: 20-22% of intruded incisors fail to re-erupt completely or into alignment (especially with alveolar fxs.), ankylosis occurs in 2-6% of intrusion injuries to primary incisors-presents with dull sound on percussion; manage by extracting to prevent ectopic eruption
Assessment of article: Good review