The anterior maxilla is the primary site for an avulsion. Upto 8 percent of injuries result in a situation where a tooth cannot be reimplanted or a reimplanted tooth is eventually lost. Under such circumstances a clinician has various removable and fixed prosthetic options. One option often overlooked is the option to transplant a premolar to replace the avulsed tooth. Extensive studies show that the most decisive factor for successful tooth transplantation is the stage of root development when the root is nearly 3/4 formed. It is at this point that the tooth has the greatest ability to reconnect vital nerve and blood endings. If properly transplanted during this stage, a tooth has upwards of a 90 percent long term success rate. There are many advantages to a successful transplantation over other viable options. A tooth transplant has a bone inducing capacity that can rebuild lost labial bone. The procedure can be performed at a very young age in comparision to other procedures (10 - 12). A transplanted tooth can also be moved orthodontically. Contraindications for this procedure would include improper stage of premolar root formation. This procedure is also not considered a first choice treatment if the rest of the dentition is in proper occlusion. In order to carry out the transplantation the clinician must be familiar with specific techniques to avoid trauma to the pdl and root surface.
Thursday, September 16, 2010
Management of avulsed Permanent Incisors: A decision analysis based on changing concepts
Date: 17SEP10
Region: Providence
Article title: Management of avulsed Permanent Incisors: A decision analysis based on changing concepts
Author(s):Lee, Jessica DDS et al.
Journal: Pediatric Dentistry
Page #s: 357-360
Year: 23:3, 2001
Major topic: Avulsion injuries
Minor topic(s): NA
Type of Article: Analysis of avulsion injury management
Main Purpose: Provide a decision tree describing the management of avulsed incisors.
Key points in the article discussion:
I. General:
A. Reported incidence of avulsion 1-16% of all traumatic injuries. Maxillary central incisors most common
B. Age 8-12 most common permanent incisor avulsion.
1. loosely formed PDL provides minimal resistance to avulsion force.
C. Most common cause... fights and sports.
D. Treatment is aimed at minimizing the number of complications that occur
1. ankylosis, pulpal infection, PDL damage etc...
II. Management
A. THOROUGH HISTORY
1. Time Interval, conditions of avulsion, storage material
B. If decision is made to re-implant, RINSE with saline to remove visible debris... DO NOT SCRAPE DEBRIS OFF.
C. Teeth have been shown to survive from 20-40 yrs with normal periodontium. In other words... under the correct conditions, the tooth CAN be saved.
III. "New" Tx regimens
A. Topical AB's for enhanced revascularization
B. Hank's to preserve PDL
C. >1hr dry storage ... scrape off PDL, rinse and replant
D. Systemic AB's at time of reimplantation
Management of Avulsed Permanent Incisors: A Comprehensive Update
Department of Pediatric Dentistry
Resident’s Name: Murphy Program: Lutheran Medical Center - Providence
Article title: Management of Avulsed Permanent Incisors: A Comprehensive Update
Author(s): Judy McIntyre, DMD, MS, et al
Journal: Pediatric Dentistry
Year. Volume (number). Page #’s: 2007. Vol 29, no 1.
Major topic: Treatment of avulsed permanent teeth
Overview of method of research: Systematic comprehensive review of guidelines
Findings:
Avulsions occur most often in children 8-12 years old. This in part is due to the PDL being loosely structured, and the teeth having incomplete roots. Avulsions range from 1-16% of all dental trauma. The goal of this paper was to update the 2001 flow charts, incorporating current concepts, literature, and new philosophies.
When a tooth is avulsed, there is going to be attachment damage (duh). Damage to the PDL can be done during the injury, and while the tooth is out of the socket. Care should be taken to minimize as much damage to the PDL as possible, as this will lead to fewer complications in the future.
Pulpal Infection
When a tooth is avulsed the blood supply to the tooth is severed. While pulpal necrosis is almost certain9depending on the developmental stage of the tooth, amount of extra oral time, etc.), revascularization is possible. An avulsed tooth with an open apex (>1m), this is especially true. A closed apex (<1m) has little chance of revasc. Due to this, tx of a closed apex is aimed at prevention/elimination of bacterial toxins from the pulpal chamber.
First Steps in Tx
The best prognosis for an avulsed tooth is to a traumatically and immediately re-implant the tooth, after a gentle rinse under sterile saline, if available. For closed apexes, RCT will still be necessary, while open apexes may revasc. Resorption is a very common complication, occurring in more then 68% if cases.
Emergency Visits
How to handle the situation all comes down to how long has the tooth been out of the socket, and if the apex is open or closed. The best situation is a tooth that has an open apex that has been out for <20 min, with the worst case being a closed apex out for >60 min.
When presented with the tooth of <20 min avulsed, any debris should be carefully cleaned off with ideally sterile saline. Handle the tooth by the crown only, don’t scrape off the debris as PDL cells may be damaged. Make sure there is a screen over the drain so it the tooth doesn’t go for a swim, and no effort should be made to sterilize the tooth.
For >60 min extra oral, in hand RCT should be done in hand if possible. Soaking the tooth in HBSS or alendronate (bone strengthening medication) can aid in cemental healing. Alendronate has shown to be more effective than HBSS.
Socket Tx
Ideally the socket is still intact. Clean any debris, and if a clot has formed, remove it. If the socket has collapsed it should be reshaped with bunt instrument.
Splinting
7-10 days of passive splinting with a flexible wire or fishing line held in place by flowable composite to allow for physiological movement and cleansability.
Success of Reimplanted Teeth
Success of a reimplanted tooth is not just about if the tooth lasts a lifetime. Another type of success includes the retention of the tooth until craniofacial growth and development are complete. If the tooth can simply preserve the socket until its time for an implant, it’s a win.
New Tx’s
Applying topical antibiotics (minocycline or doxycycline) for 5 minutes can help increase the success rates (revasc) of avulsed teeth with an open apex. This is not true for closed apexes.
Preserving the PDL
The sooner we can reimplant the tooth, the better. The magic window seems to be 20 min or less. With many teeth not being reimplanted, transport is an issue. HBSS is a great medium as is save-a-tooth, and milk. Milk will preserve PDL cells for up to 8 hours. Do NOT soak the tooth in tap water as this cause cell lysis.
Condemned PDL’s
While revasc. Is great, RCT can provide a great long-term outcome. However without a PDL, resorption is inevitable. The American Association of Endodontics does not recommend reimplanting a tooth if it has been extra oral for >60 min due to the risk of ankylosis. As pediatric dentists, it’s our job to consider the growth and development of the child. Therefore is we can slow down the resorption and ankylosis, we can set up the patient for success later in life.
In this process, the PDL should be removed by either light scaling or soaking in citric acid for 3 minutes, followed by a soak in a fluoride solution for 5-20 min. This can significantly reduce the rate of resorption during the first 5 years. This additional time can get the child to the point of complete growth and development. Also, soaking of a tooth in tetracycline can increase revasc, and can decrease the incidence of resorption and ankylosis.
Recent studies with Emdogain, an enamel matrix derivative of pig origin, has been used to coat the entire root surface of the tooth prior to reimplantation. This enhances PDL cell proliferation and protein production and may act as a matrix to rebuild the PDL. More research is needed on this.
Almost half of reimplanted avulsed teeth become ankylosed, which can be a desirable outcome in the still growing child. Extraction an avulsed tooth can cause loss of attachment, loss of the cortical plate, and bony deformation. A possible treatment to combat these negative outcomes is decoronation. A flap is raised, the clinical crown and root are removed with a bur below the CEJ. The root filling material is removed and the intracanal space is allowed to fill with blood, creating a new ‘socket’. From here a tooth can be bonded to adjacent teeth, or a ‘flipper’ can be made. This procedure can preserve the buccolingual volume as well as the vertical height of the alveolus.
Adjunctive Systemic Antibiotics
This may prevent infection and necrosis of the pulp. Tetracycline has been shown to be antiresorptive, antiosteoclastic, anti-infammatory, antibacterial, and can prevent resorption. However it can stain teeth permanently, and should not be given to still growing children. For growing children either Pen VK or doxycycline can be used for 7-10 days.
Key points/Summary: Nothing has really changed from the flow charts. Follow them.
Assessment of Article: Good review of current protocol and new treatments.
09/17/2010 Factors Affecting Outcomes of Traumatically Extruded Permanent Teeth in Children
Date: 09/17/2010
Article title: Factors Affecting Outcomes of Traumatically Extruded Permanent Teeth in Children
Author(s): Humphreys et al.
Journal: Pediatric Dentistry-25: 5, 2003
Major topic: Extrusion injuries
Type of Article: Clinical observation
Main Purpose:
Determine the prevalence of residual extrusion, pulpal necrosis, and resorption for extruded permanent teeth and to establish the effect of presentation and treatment factors.
Overview of method of research:
72 traumatically extruded permanent incisors were observed. Clinical and radiographic outcomes were analyzed and related to presenting and tx factors. Pulp status was tested (EPT) at 2 wks, 6 wks, and subsequently at 3 mo intervals. Radiographs were taken up to 1 yr following the trauma to examine resorption prevalence.
Findings:
Delay in repositioning had a significant effect on residual incisor extrusion, indicating that teeth repositioned at a later stage after trauma were more likely to have been less than fully repositioned. The median delay prior to the repositioning procedure was 24h. Factors associated with the prevalence of pulp necrosis were the degree of apical closure and degree of initial extrusion. The presence of a closed apex significantly affected pulp necrosis followed by the degree of initial extrusion. A delay in repositioning the tooth did not have an effect on pulp necrosis. Inflammatory resorption may be affected by pulp necrosis.
Key points in the article discussion:
Extrusion is a form of luxation injury that results when the tooth is partially displaced from the socket in an axial direction. This type of injury results in rupture of PDL and damage to apical vessels. Clinically the tooth will appear elongated and is initially mobile. Bleeding is seen in the gingival sulcus and the percussion sound is dull. Radiographic exam will reveal increased PDL space.
Extruded teeth, when gently repositioned and splinted for a short duration, appear to have a good prognosis. Due to the nature of the injury, w/ damage and ischemic changes occurring the PDL and pulp, regular clinical and radiographic f/u are important b/c the incidence of pulp necrosis is high, especially in teeth with closed apices. If pulp necrosis occurs, ENDO should be initiated to reduce the risk of inflammatory resorption. A delay in tx can make manual repositioning very difficult and excessive force should be avoided as this will increase the risk of damage to supporting structures. If it is not possible to fully reposition, allow healing to occur if no occlusal interferences, then correct orthodontically. Overall, it appears that the prognosis for this type of injury is good, with the loss of pulp vitality being the most common complication.
Summary of conclusions:
Delay in repositioning extruded teeth increases the risk of residual extrusion. In extruded teeth, the main sequela is pulp necrosis, often detected w/in 8 wks. Apical closure and degree of extrusion increase the risk of pulp necrosis. In extruded teeth, there is a lower risk of inflammatory resorption. Extruded teeth should be repositioned promptly and monitored.
Assessment of article:
Very good article, straightforward and clinically significant.
Friday, September 10, 2010
Sequlae and prognosis of intruded primary incisors: a retrospective stud
Resident: Roberts
Date: 9/10/10
Article title: Sequlae and prognosis of intruded primary incisors: a retrospective study
Author: Holan, Gideon
Journal Pediatric Dentistry
Volume 21:4
pages: 242-246
Year: 1999
Purpose :
This research was designed to assess the outcome of intruded incisors looking back through a retrospective study
Method:
196 children, 310 intruded primary incisors presented to an emergency clinic. 110 chldren or 172 teeth were reevaluated at a later date. Male to female ratio was 1.7:1 and age range was between 12 and 72 months. Follow up time ranged between 0 and 59 months.
Results:
Fifty seven percent of all teth were completely intruded. 55 of those teeth reerupted. 45% of these reerupted into an ectopic position. 52% showed pulp obliteration. 23 teeth required extraction. 68% survived more than 36 months after the accident.
Conclusion:
Survival rate: 68% for 36 months after accident
88% will completely reerupt
Ectopic eruption is very common
Habits such as pacifier sucking or thumb sucking may prevent full eruption
Systemic antibiotics did not seem to have an outcome affecting the result of the tooth
Pulp canal obliteration is the most common sequelae following an intruded prim. incisor
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
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.
Subluxation Injuries of Maxillary primary anterior teeth
Resident: Swan
Article Title: Subluxation Injuries of Maxillary primary Anterior Teeth: Epidemiology and prognosis of 207 traumatized teeth
Journal: Pediatric Dentistry
Volume (Number): 18:2 1996
Major Topic: Causes of and sequelae following subluxation injuries
Overview of method of research: The authors performed a retrospective chart audit at Montreal Children’s Hospital to identify patients who sustained a subluxation injury to the maxillary primary anterior dentition between 1982 and 1993. The information was collected on standardized trauma assessment forms by various residents and staff members practicing at the hospital. Information was gathered concerning the patient and their trauma history, along with the many possible sequelae after subluxation. Sequelae evaluated included: discomfort, discoloration, occlusal interference, presence of fistula, percussion sensitivity, sound on percussion, mobility, pulpal calcification, rate of physiological root resorption. Post-traumatic treatment and antibiotic use was evaluated as well. Data were broken into six follow up time intervals: 0-10 days, 10 days-1 month, 1-3 months, 3-6 months, 6-12 months, 1-2 years.
Findings: Central incisors were involved 66.2 % of the time. The average age of subluxation injury for boys was between 3 and 4, for girls, between 1 and 2. The most common cause of trauma was simple falls indoors (52%). 6.8% of the trauamatized teeth showed pathological root resorption. Virtually no subluxated teeth were associated with crown, root, or alveolar fracture. Treatment of these teeth ranged from no treatment (80.2%) to extraction (9.2%). At follow up intervals, patient discomfort and occlusal interference were not common complaints; discoloration and pulp calcification tended to increase over time. Mobility lessened over time.
Key Points/Summary:
- Indidence of trauma occurred at a higher average age for boys than girls
- More than 50% of patients were seen within 3 hours of injury
- Mobility of subluxated teeth ranged from 1.6-2.5 mm.
- Treatments rendered included occlusal relief, splinting, extraction, and no treatment
- Tooth discoloration and pulpal calcification increased over time
- Subluxation injuries have LOW morbidity. (Hard to track follow up for a long time).
Assessment of Article: This study basically concludes that subluxation injuries are not that big of a deal, so we can reassure parents of this. Some of the findings, like increased discoloration, are a little skewed, because as time went on, only those parents noticing observable problems came in for evaluation. Pulpal calcification, however, did increase over time as well—most studies have shown calcified teeth to have good prognoses and normal resorption.
Luxation injuries of primary anterior teeth-prognosis and related correlates
Meghan Sullivan Walsh September 9, 2010 Literature Review - St. Joseph/LMC Pediatric Dentistry
Luxation injuries of primary anterior teeth-prognosis and related correlates
Resident: Meghan Sullivan Walsh
Program: Lutheran Medical Center- Providence
Article Title: Luxation injuries of primary anterior teeth-prognosis and related correlates
Authors: Nancy Jo Soporowski, DMD; Elizabeth N. Alfred, MS; Howard L. Needleman, DMD
Journal: Pediatric Dentistry
Month, Year, Volume, Pages: March/April 1994- Volume 16, Number 2, pgs 96-100.
Major Topic: Patterns and prognosis associated with injuries to primary dentition.
Overview of Method of Research: 307 luxation injuries of primary anterior teeth sustained by 222 patients were identified and recorded from a pediatric dental practice. Data was collected from these patients and assessed for patterns involving age, gender, etiology , type of injury, occlusion and sequelae.
Findings: Age: Intrusions were found more common in younger children while older children were more likely to sustain extrusion or luxation injuries. Older children were found treated by extraction more often than younger children who were more likely to receive no treatment. Mean age of luxation injuries was 3.8 years old.
Gender: The majority of patients sustaining injuries were male with a male to female ratio of 1.7/1.
Etiology: Falls were the most prevalent injury accounting for 72% of all injuries followed by bike accidents, sports related accidents and miscellaneous. All luxation injuries were associated with intraoral trauma. Bike accidents were more likely to cause extrusions and luxations while sport related incidents were more likely to cause lateral luxations.
Type of injury: Most luxation injuries were lateral luxations at 57%. The treatment rendered was significantly associated with the severity and type of injury sustained.
Occlusion: The mean overjet of these patients was 3.0mm and a mean overbite of 45.9%. Children with an overjet were more likely to sustain an intrusion injury rather than an avulsion. There were no significant findings regarding an increase in overjet and the risk of sustaining a luxation injury. There did no appear to be any correlation to a patient with a Class II occlusion and the risk of sustaining a luxation injury.
Sequelae: Only 51% of these patients were followed for post-op. Of these patients 55% showed no sequelae, 26% became necrotic, 10% showed calcific degeneration and 8% ankylosed. The best age ranges for survival of these primary teeth were patients under the age of 2 or over the age of 5. This may be due to the approximate age of root closure at 2 years old while the average primary tooth begins root resporbtion at age 5. Repositioning of the teeth was found to increase the risk of pulpal necrosis, however it was noted that this may also be due to the severity of the trauma which calls for the need for repositioning. However, intruded teeth that were repositioned were less likely to become necrotic. There was no significant relationship between type of injury sustained and necrosis and or hypoplasia of the succedaneous tooth.
Key Points: Summary: Majority of pediatric dental emergencies in the primary dentition occur in the maxillary anteriors with males being 1.7 times more likely to sustain an injury. Lateral luxations were most common followed by intrusions and extrusions. Intrusive injuries were more likely to occur in young patients with larger overjets. Root fractures were more common in lateral luxations. More that half of the patients showed no post operative issues while 25 % became necrotic 10% showed calcific degeneration and 8% became ankylosed. Luxated teeth that were repositioned were more likely to develop pulpal necrosis while intruded teeth that were repositioned were less likely to become necrotic. Children with the best post operative results were under the age of 2 or older than 5. There was no correlation between the type of injury and the prevalence of hypoplasia.
Assessment of the Article: This was a great article and evaluation of postoperative trauma cases. Unfortunately all patients were selected from the same office with the same practitioner therefore the numbers and percentages may differ from other similar studies. I was curious as to why this particular office tended to have such a small number of permanent teeth with hypoplasia, 7.7%, when previous studies reported an almost 50% rate of hypoplasia after trauma to the primary dentition.
Thursday, September 9, 2010
Treatment of Crown Fractures With Pulp Exposure in Primary Incisors
Program: Lutheran Medical Center - Providence
Article title: Treatment of Crown Fractures With Pulp Exposure in Primary Incisors
Author(s): Kupietzky, Holan.
Journal: Pediatric Dentistry
Year. Volume (number). Page #’s: 2003. 25(3). 241-247.
Major topic: Treatment of Crown Fractures
Overview of method of research: Clinical Review/Case Study
Purpose:
1. Present indications and contraindications for each type of treatment for complicated crown fractures in primary incisors.
2. Highlight advantages of partial pulpotomy (Cvek Pulpotomy) technique in certain scenarios.
Findings:
1. Partial Pulpotomy (PP)
a. Indications:
-Small, noncarious exposure occurring <14>14 days prior or extensive pulpal inflammation.
2. Cervical Pulpotomy
a. Indications:
-After considering PP, pulpal inflammation not extending past coronal portion with good hemostasis.
b. Technique:
- Formocresol: acute inflammation is fixed into chronic inflammation, roots do not continue to develop and teeth theoretically remain asymptomatic.
- Calcium Hydroxide (CH): teeth remain vital. Authors conclude that may be acceptable for mechanical exposures, but positive correlation between degree of inflammation and CH failure.
-If using CH for pulpotomy, absolute hemostasis is critical to prevent internal root resorption.
c. Contraindications:
-Infection or inflammation beyond coronal pulp with inability to achieve hemostasis as well as any PA pathology.
3. Pulpectomy
a. Indications:
-Trauma producing chronic inflammation or necrosis of radicular pulp and goal is to maintain esthetics and function.
b. Technique:
-Zinc Oxide Eugenol: not ideal due to resistance to resorption.
-Iodoform Paste: produce good results. Resorbable and producing antibacterial effects.
- CH: another possible option
c. Contraindications:
-Nonrestorable crown due to loss of tooth structure, extensive root resorption or PA infections extending to the permanent tooth bud.
-Parental concern about esthetics due to the high frequency of color change to yellow or brown.
4. Extraction:
-Considered as a last resort . Space maintenance generally not an issue after primary canine eruption. Discuss possibility of delayed or premature eruption of succedaneums dentition as well as possible effect on function, speech and appearance.
Key points/Summary:
1. PP technique may be used in immature or mature tooth, maintains tooth vitality, and provides esthetic result.
2. Additional studies on PP needed.
Assessment of Article: Clear & concise, but still need additional resources for an all inclusive review.
Intrusion Injuries of Primary Incisors. Part III: Effects on the Permanent Successors
Date: 10SEP
Region: Providence
Article title: Intrusion Injuries of Primary Incisors. Part III: Effects on the Permanent Successors
Author(s):Diab, Mai DDS et al.
Journal: Quintessence International
Page #s: 377-384
Year: 2000:30
Major topic: Intrusion Injuries
Minor topic(s): NA
Type of Article: Analysis of Intrusion Injury Characteristics
Main Purpose: Analyze the effects of intrusion injury of primary incisors on the permanent dentision.
Key points in the article discussion:
I. General:
A. The potential for disturbances of the developing permanent dentition is high following injuries to their predecessors. (12-74% ???)
B. 18-69% (????) of permanent developmental defects due to INTRUSION injuries of primary teeth.
II. Factors Influencing the Sequelae of Intrusion Injuries.
A. Age of child:
1. Before 3yo, crown formation can be effected. (enamel hypoplasia, coronal dilaceration, odontoma etc...)
2. After 3yo, typically, root formation effected.
3. Typically, younger=more potential for permanent injury.
4. Germ can still suffer mineralization disturbances even after crown is fully formed.
B. Direction of intrusion:
1. Most risk when intrusion forces crown labially and root palatally.
C. Severity of Intrusion:
1. Increased severity = increased chance of damage
2. Alveolar fracture also increases chance.
D. Type of Treatment:
1. Several studies report that there is no correlation between severity of damage and the decision to extract versus allow to re-erupt.
2. Injury to the tooth is sustained at time of intrusion and not dependent on subsequent extraction.
3. The only exception to this rule is when subsequent infection occurs to intruded primary tooth.
III. Sequelae affecting coronal portions of the permanent successor:
A. White or yellow brown discoloration
1. Intrusion of primary teeth during mineralization of permanent crowns between 2-7yo.
2. Result of hypocalcified areas of the labial surface. (during "maturation" stage)
3. Bleeding may also hemoglobin products to enter the mineralizing portion of the enamel.
B. White of yellow-brown discoloration associated with enamel hypoplasia
1. "imperfect formation" due to injury between 2-3yo
2. displacement of the normal alignment of the ameloblast activity
3. irreversible destruction of the active enamel epithelium
4. grooves may form around the discoloration
C. Dilaceration of the crown:
1. Typically due to intrusion injury at around 2yo. (when 1/2 the crown is formed.
2. Displaced enamel epithelium becomes activated in a new/displaced position.
3. May erupt normally but will likely necrose... prophylactic crown recommended to avoid abscess.
IV. Sequelae Affecting Rot Portions of the Permanent Successors:
A. Duplication:
1. Rare malformation usually occurs from severe intrusion at around 2yo.
B. Dilaceration of the root:
1. Intrusion between 2-5yo.
2. Displaced hard tissue relative to the developing root... likely to be impacted.
3. Lateral dilaceration occurs between 2-7yo and usually tooth erupts normally.
C. Partial or complete cessation of root formation:
1. Rare sequelae due to intrusion between 4-7yo.
2. Hertwig's epithelial root sheath damaged.
V. Sequelae affecting the whole successor tooth:
A. Odontomalike malformation:
1. Severe intrusion of primary incisor between 1-3yo. (early stages of odontogenesis)
2. Require surgical extraction.
B. Sequestration of the permanent tooth germ:
1. Underdeveloped tooth germ and inadequate rot formation.
2. RARE... caused by SEVERE intrusion.
3. Also related to severe periradicular infection
4. Surgical extraction.
C. Disturbances of permanent successor eruption:
1. Early primary tooth loss (3-4yo) can cause delay in permanent successor eruption
2. Primary tooth loss later than 5yo can accelerate permanent eruption.
2. Ankylosed or delayed root resorption can also cause delayed eruption.
VI. Conclusion:
A. High probability of permanent tooth damage when primary tooth is intruded.
B. If the "wait and see" method is chosen... periodic recall is necessary to avoid periradicular infection and probably permanent tooth damage.
Assessment of article: Informative... BUT, the bottom line is, the permanent tooth is likely to be damaged. Knowing all the percentages of the type of sequelae doesn't really help me because it doesn't change treatment options. Also... despite the information presentd, I'm extracting the primary tooth if it's intruded. Not taking chances WRT subsequent infection.