The diagnostic value of lateral extraoral radiography for intruded maxillary primary incisors

Resident: Cho

Author(s): Holan et al.

Journal: Pediatric Dentistry

Year. Volume (number). Page #’s: 2002. 24. 38-42.

Major topic: intrusion, maxillary incisors, lateral extraoral radiography

Type of Article: Scientific Article

Main Purpose: The aim of the study was to assess the contribution of lateral extraoral radiograph in determining the location of the intruded maxillary primary incisors in relationship to the permanent successors.

Overview of method of research: 37 children with 55 intruded primary incisors who presented to the emergency clinic of the Department of Pediatric Dentistry at the Hadassah School of Dental Medicine in Jerusalem during a period of 18 months were used in this study. Each of the intruded teeth were independently examined by one to three experienced pediatric dentists based on a three-step examination. Step 1 was a clinical examination only, step 2 was evaluation of a periapical radiograph, and step 3 was evaluation of a lateral extraoral radiograph. The assessment of the relationship of the intruded primary incisor to the permanent tooth bud was recorded after each step. A total of 93 three-step evaluations were made. 15 teeth were evaluated by a single examiner, 36 teeth were evaluated by two examiners, and 2 teeth were examined by three examiners.

Findings: In the majority of the cases, the evaluators were able to assess the alignment of the intruded primary incisor without the lateral extraoral radiograph. In only 5/93 cases was step 3 needed to make a final decision about the alignment of the primary incisor. The age of the patient in these cases were 18-19 months old. In another 5/93 evaluations, tooth alignment could not be determined and these patients were also 18-19 months of age.

Key points/Summary: The findings of this study show that the contribution of the lateral extraoral radiograph in determining the alignment of the root of the intruded teeth is low. Lateral extraoral radiographs should not be routinely used in cases of intrusion of primary incisors. The dentist should base the diagnosis on clinical findings and a periapical radiograph. Swelling of the upper lip, subcutaneous hematoma adjacent to the nostrils and maxillary anterior vestibule and projected labial bone plate confirmed by palpation are clinical findings indicating that the root of an intruded primary incisor is displaced labially. Radiographically, a gap between the apex of the primary incisor and crown of its permanent successor, a shortened, more opaque image of an intruded incisor compared to non-displaced tooth and lack of rotation of the permanent successor are all signs that the indicate labial displacement of the root. The lateral extraoral radiograph should only be taken in cases where its contribution to diagnosis can be confirmed, as in cases of children younger than 20 months old.

Assessment of Article: Good study. Study may have been strengthened by having the same number of evaluations for each intruded tooth.